Icho Chiremba yeHurumende Inoda Kuziva
Kunzwisisa zvidzidzo zvehutano hwehutano hunoita kuti vashandi vemahofisi ezvokurapa vataure zvakanaka nevarwere maererano nehutano hwavo hwehutano inshuwarano uye kurukurai nezvemagariro ehutano nezvevashandi nevanomiririra vekambani.
Kuva neruzivo rwekutanga rwemhando imwe neimwe ye inshuwarisi ichaderedza zvinetso zvekutumira zvirevo uye kubhadhara mari. Kune miviri miviri mikuru yehutano hwehutano inshuwarheni:
- Indemnity Insurance
- Kutarisirwa Kuchengetedza Zvirongwa
Indemnity Insurance
Indemnity inshuwarano zvirongwa zvinokweretesa kuhofisi yezvokurapa inobva pamari-ye-service model. Mune mari-ye-kushanda, hofisi yezvokurapa inobhadharwa mari yakatarwa yega yega yega kana chikwata chebasa rakashandurwa. Kushanyira ehofisi, mabhii ekuongorora, x-ray, kana mamwe mabasa anobhadharwa maererano nemutengo wemari. Iyi nzira yekubhadhara inobvumira hofisi yezvokurapa kugamuchira kubhadharwa kwakakwana kwechikamu chega chega chekutarisira.
Varwere vane hurongwa hwekubhadhara huripo hwemabasa kunze kwehomwe uye vanotsvaka kubhadharwa kwebasa rakapfigirwa kubva kune yavo inoronga hurongwa hwekupa. Ihofisi yezvokurapa inongova iyo inobatanidzwa kumabasa anoda kusati apiwa mvumo .
Mukuwedzera, zvirongwa zvekubhadhara:
- Nhengo hadzisi dzehutano hwechiremba
- Hapana kutumirwa kunotarisirwa kune vanyori vanoshanyira
- Mitsara inoshandiswa inobva pane zvinodiwa, tsika netsika (UCR) mubhadharo pamabasa akavharwa.
Kutarisirwa Kuchengetedza Zvirongwa
Kutarisira zvirongwa zvekuchengetedza zvinoda kutarisira mari yekutarisira utano kune nhengo dzayo kuburikidza nekuronga uye kuronga kutarisirwa nehutano hwechiremba, nyanzvi, uye zvipatara. Kune marudzi mana ezvirongwa zvekutarisira zvakachengetedzwa:
- Health Maintenance Organizations (HMOs)
- Zvipo Zvokupa Zvokuda (PPOs)
- Exclusive Provider Organizations (EPOs)
- Point-of-Service (POS) Zvirongwa
Misiyano yakakura pakati pemhando idzi dzezvirongwa zvekutarisira dzakarongwa dzakanyorwa pasi apa.
1. Utano hwehutano hwehutano (HMOs)
Chimiro icho chinonyanya kunyanya neHMO zvirongwa ndeye nzira yekubhadhara kwayo. Pose mubhadharo wekutenda, kana kubhadhara chikwereti, zvakagadziriswa, mwedzi miviri zvipo zvakagamuchirwa nehofisi yezvipatara kune murwere. Iyi mari inoramba ichifanana zvisinei nokuti vangani vanoshanyira murwere ane kana mari yezvakawanikwa mari uye kunyange kana vasingagamuchiri kutarisirwa zvachose. Mamwe maitiro eHMO ndeaya:
- Kushoma kune in-network providers kunze kwekukurumidza
- Zviratidzo zvinotarisirwa kuona chiremba
- Pamberi pemvumo inotarisirwa kune mamwe mabasa
- Nhengo hadzina deductible uye zvishoma copays
2. Zvipo Zvokupa Zvokuda (PPOs)
PPOs zvakafanana nezvirongwa zvekubhadhara mari nenzira dzakawanda. Zvose zviviri zvePPOs uye zvirongwa zvekubhadhara zvinorayirwa nemari yekubhadhara-ye-yese nzira. Mune mari-ye-kushanda, hofisi yezvokurapa inobhadharwa mari yakatarwa yega yega yega kana chikwata chebasa rakashandurwa. Kushanyira ehofisi, mabhii ekuongorora, x-ray, kana mamwe mabasa anobhadharwa maererano nemutengo wemari. Iyi nzira yekubhadhara inobvumira hofisi yezvokurapa kugamuchira kubhadharwa kwakakwana kwechikamu chega chega chekutarisira. Mamwe maitiro ePPO ndeaya:
- In-and-out-network providers vanobvumira, varwere vanobhadhara zvishoma apo in-network providers vanoshandiswa
- Hapana kutumira kunodiwa kuti uone nyanzvi
- Pamberi pemvumo inotarisirwa kune mamwe mabasa
- Nhengo dzinogona kunge dziine basa rekudzikinura, zvinyorwa, uye coinsurance
3. Exclusive Provider Organizations (EPOs)
EPOs zvakafanana asi zvinodzvinyirira kupfuura PPOs.
- Kushoma kune in-network providers kunze kwekukurumidza
- Hapana kutumira kunodiwa kuti uone nyanzvi
- Pamberi pemvumo inotarisirwa kune mamwe mabasa
- Nhengo dzinogona kunge dziine basa rekudzikinura, zvinyorwa, uye coinsurance
4. Point-of-Service (POS) Zvirongwa
POS zvirongwa ndiwo musara pakati pePPO zvirongwa uye zvirongwa zveHMO. POS zvirongwa zvinopa kunze-kwe-network services, zvisinei, zvimwe zvadzo zvingave zvishoma, zvishoma kana zvisingabviri.
- In-and-out-network providers vanobvumira, varwere vanobhadhara zvishoma apo in-network providers vanoshandiswa
- Zviratidzo zvinotarisirwa kuona chiremba
- Pamberi pemvumo inotarisirwa kune mamwe mabasa
- Nhengo dzinogona kunge dziine basa rekudzikinura, zvinyorwa, uye coinsurance