Izinhlangano Eziyisisekelo ze-Health Maintenance Organization (HMO)

Indlela Yokunakekelwa Okunakekelwayo Isekela Ngayo Izinzuzo Zempilo Ezingenakuthembekile

Njengomthengi wezempilo, akungabazeki ukuthi wezwa igama elithi HMO ngaphambili. Eqinisweni, lokhu kuyithandwa kakhulu kuzo zonke izinhlobo zezinhlelo zokunakekelwa kwezempilo emakethe. Ivelaphi i-HMO? Nansi umlando ngalolu hlobo lomhlomulo wesisebenzi. Ngo-1973, i-The Health Maintenance Organisation Act yashintsha uMthetho oPhezulu wezeMpilo kaHulumeni wangaphambilini ka-1944, futhi yaguqula ngendlela efanele izinzuzo zezempilo ezizophathwa eMelika nasemhlabeni jikelele.

Iyini Inhlangano Yokugcinwa Kwezempilo?

I-HMO akuyona leyo eyinkimbinkimbi ngempela. Ngaphansi kwekhodi yamanje yase-US, i-HMO ichazwa njengenhlangano yomphakathi noma eyimfihlo ehlangabezana nezidingo ezilandelayo:

1. inikeza izinsizakalo zezempilo eziyisisekelo kanye nezengeziwe
2. ihlelekile futhi iqhutshwa ngendlela evunyelwe nguhulumeni

Ngakho-ke, i-HMO yinhlangano enenhloso kuphela yokunikeza ukufinyelela okulinganayo ezinsizakalo zokunakekelwa kwezempilo ngokushintshaniswa kwamalungu avumelana nemigomo ethile. Ezimweni eziningi, lesi yisivumelwano sokuhlala ngaphakathi kwenethiwekhi ehlinzekwe ngabahlinzeki abaye baxoxisana ngaphambili ngezinsizakalo eziphansi, ngenkathi begcina izinga lokunakekelwa. Laba bahlinzeki kumele bahlangabezane namazinga aphakeme ukuze bajoyine inethiwekhi futhi kumele balondoloze izilinganiso ezinhle zokunakekelwa, ngakho-ke kunqoba abawathengi. Ezimweni eziningi, i-HMO isekela ukunakekelwa kokunakekelwa kokunakekelwa kwempilo, yilokho abahlinzeki bokunakekelwa kwezempilo abakhuthazayo.

Lokhu kusebenza kahle ngezinhlelo zezempilo ezinkampani kanye nokunakekelwa kokunakekelwa kwezempilo ngezikhathi ezithile kubantu abathile.

Wonke ama-HMO ahlolisiswa kakhulu yizinhlangano zikahulumeni eziningana, kuhlanganise noMnyango WezeMpilo ngamunye osebenza kuwo. Ama-HMO afika emlilweni ngasekupheleni kwawo-1990 lapho kutholakala amalungu ehlelo ayengatholi impendulo ngesikhathi esifanele nokukhathalela abafanelwe.

Kusukela ngaleso sikhathi, ukuphathwa kwe-HMO kuye kwabonga ukubonga kwedatha ye-elekthronikhi eyenza ukuphathwa kwedatha nezinqubo zokubhalisa.

I-HMO izuzisa kanjani?

Ama-HMO asengenye yezinketho ezithandwa kakhulu zokuphathwa kwezempilo abaqashi abakunikelayo, ngezizathu eziningana.

• Kulula ukuphatha ngenxa yama-premiums rates e-Flat for types of member members.
• Izimangalo azikhathazi kakhulu ngamalungu epulani ngoba azi ukuthi isabelo sabo sini, kufaka phakathi ihhovisi elikhokhela.
• Ama-HMO ngokuvamile azinhlelo zokunakekelwa kwempilo ezishibhile zabaqashi namalungu ngaphezu kokuphila kwamacebo.
• Izinga labodokotela kanye nezikhungo zokunakekelwa kwempilo zihlolisiswa ngokucophelela ukuze kube nezindinganiso eziphakeme kakhulu, ngakho-ke amalungu amalungiselelo ayazi ukuthi bathola ukunakekelwa okungcono kakhulu.
• Izimangalo zemali ezibiza kakhulu zilawulwa yi-HMO yokugunyazwa inqubo ngaphambi kokuba zenzeke, futhi lokhu kuvikela abathengi ekukhwabaneni.

Yimaphi Amathrendi Emakethe Yokunakekelwa Kwezempilo mayelana nokusetshenziswa kwe-HMO?

Ngokusho kochwepheshe bezokunakekelwa kwezempilo, ukuhamba phambili emisebenzini yokunakekelwa kwempilo yokukhokhelwa kwempilo yenkambiso yempilo kuye kwanyakalala eminyakeni engamashumi amabili edlule. Umnyango wezemiSebenzi wase-US uxwayisa ukuthi izinhlelo zokukhokhelwa kwemali zazingamaphesenti angama-96 ezinhlelo zokunakekelwa kwezempilo ezinikezwa abaqashi abaphakathi nabakhulu ngonyaka ka-1984 kanye neminyaka engama-20 kamuva baphawula ngamaphesenti angaba ngu-15 yomshwalense wezempilo ohlinzekwa ngumqashi.

Izinqubomgomo zokunakekelwa kwezempilo eziphathekayo ziyaqhubeka nokufaka esikhundleni sezinhlelo zezempilo zangaphambili zezimali zokunakekelwa kwemali.

Izinkampani eziningi zinikeza okungenani izinhlelo ezintathu zemihlomulo yezisebenzi, omunye noma ngaphezulu njengengxenye yenethiwekhi ye-HMO. Lena indlela ebiza imali yokuphatha umshuwalense wezempilo nokugcina izinga lokunakekelwa. Ama-HMO aqhubeka abe umgqugquzeli oqinile wokunakekela emakethe yomshuwalense wezempilo namuhla.