Ukunakekelwa kwezempi manje sekubizwa ngokuthi i-TRICARE
Umlando Wezinzuzo Zokunakekelwa Kwezempi ZaseMpi
Ngaphambi kweminyaka yama-1980, kwakukhona izindlela ezimbili ezenziwa abasebenzi basezempi, abahlala emakhaya kanye namalungu omndeni ukuthola usizo lwezempi.
Amalungu aseMpiya athola ukwelashwa ezindaweni zokwelapha ezempi, futhi abahlala emakhaya kanye namalungu omndeni bathola ukwelashwa mahhala (kuye ngokuthi kwenzeke kanjani isikhala) ezindaweni zokwelapha ezempi, noma bangasebenzisa uhlelo olubizwa ngokuthi yi-CHAMPUS (Impilo Yomphakathi Nezokwelapha Uniformed Services) ukuthola uhulumeni - ukunakekelwa kokunakekelwa kwezempilo okuvela kubanikeli bombuso.
Umqondo wokunakekelwa kwezempi kwezempi emindenini yamalungu asebenzayo-asebenzayo ensizakalo yunifomu ibuyele ekupheleni kwe-1700s. Ngo-1884, iCongress yaqondisa ukuthi "izisebenzi zezokwelapha ze-Army kanye nabahlinzeki bokuhlinza izinkontileka bazokwazi ukuya emindenini yamaphoyisa kanye namasosha mahhala."
Izinguquko Ezizuzweni Phakathi neMpi Yezwe II
Kwakukhona ushintsho oluncane kakhulu kuze kufike iMpi Yezwe II. Abaningi abakuleli mpi babeyizinsizwa ezaba namakhosikazi okuzala. Uhlelo lokunakekelwa kwezempi lwezempi, olwalusesikhathini sokulwa nempi, alukwazanga ukubhekana nenani elikhulu lokuzalwa, noma ukunakekelwa kwezingane ezincane kakhulu.
Ngo-1943, iCongress yagunyaza uhlelo lwe-Emergency Maternal and Child Care Program (EMIC). I-EMIC inikezwe ukunakekelwa kokubeletha nokunakekelwa kwezinsana kuze kube nomnyaka oneminyaka eyodwa kubafazi namantombazane enkonzo ezisezingeni eliphezulu. Yayiqondiswa "i-Children's Bureau," ngeminyango yempilo kahulumeni.
Izinguquko Ngenkathi Ingxabano yaseKorea
Ingxabano yaseKorea iphinde ihlukumeze amandla omsebenzi wokunakekelwa kwempilo yezempi. Ngo-Dec. 7, 1956, uMthetho Wokunakekelwa Kwezokwelashwa OseDemendents usayinwe ngomthetho. Izichibiyelo zika-1966 zalesi senzo zakha lokho okuzobizwa ngokuthi i-CHAMPUS kusukela ngo-1967. Umthetho wagunyaza ukunakekelwa kokuthungatha nokugula kwengane yomndeni osebenzayo, ukusebenza ngo-Oktoba 1, 1966. Abahlala emndenini, amalungu omndeni namalungu omndeni athile asele abaxhasi balethwe ohlelweni ngoJan. 1, 1967. Isabelomali se-CHAMPUS soMnyaka wezimali ka-1967 kwakuyizigidi ezingu-106 zamaRandi. Amarekhodi awabonisi ukuthi zingaki izimangalo ezifakiwe ngo-FY 1967, kodwa inani cishe lingekho ngaphezu kwezinkulungwane ezimbalwa.
Izinguquko Zokulawula Izindleko Zezokwelapha nokuthuthukisa Ukufinyelela
Ngama-1980, ukufuna izindlela zokuthuthukisa ukutholakala kokunakekelwa kwezokwelapha okuphezulu, ngenkathi kugcinwa izindleko, kwaholela emisebenzini eminingi ye-CHAMPUS "ekuboniseni" ezingxenyeni ezihlukahlukene ze-US Okuphambili phakathi kwazo kwakuyi "CHAMPUS Reform Initiative" (i-CRI ) eCalifornia naseHawaii.
Kusukela ngo-1988, i-CRI yanikeza imindeni yesevisi ithuba lokuzikhethela ukuthi bangasebenzisa kanjani izinsizakalo zabo zokunakekelwa kwempilo yezempi. Iminyaka emihlanu yokusebenza ngokuphumelelayo namazinga aphezulu okwaneliseka ngesiguli aqinisekisa izikhulu zoMnyango wezokuVikela ukuthi kufanele zandise futhi zithuthukise imibono ye-CRI, njengehlelo olufanayo ezweni lonke.
Uhlelo olusha, olubizwa nge-TRICARE, seluvele lukhona ngokugcwele.
Ngo-FY 1996, isabelomali se-TRICARE / CHAMPUS sasingaphezu kuka-$ 3.5 billion, futhi izimangalo ezingaphezu kwezigidi ezingu-20 zamukelwe. Namuhla, abantu abayizigidi ezingu-5.5 bafanelekele izinzuzo ze-TRICARE.
Izinhlobo ze-TRICARE
Lapho i-TRICARE isungulwa kuqala, kwakukhona izinhlobo ezintathu kuphela. Phakathi neminyaka embalwa eyedlule, izinketho eziningi ze-TRICARE zezempilo zenziwe. Vakashela iwebhusayithi ye-TRICARE ukuze uthole imininingwane ephelele kuzo zonke izinhlelo ze-TRICARE:
- I-TRICARE inhloko
- I-TRICARE Prime Remote
- I-TRICARE I-Overseas Prime
- I-TRICARE I-Overseas Remote Remote
- I-TRICARE Ejwayelekile neyengeziwe
- I-TRICARE I-Standard Overseas
- TRICARE Ukuphila
- I-TRICARE Reserve Khetha
- I-TRICARE Isitoreji Esihlala Endaweni
- TRICARE osemncane
- I-US Family Health Plan
I-TRICARE inhloko
Lolu khetho lufana ne-HMO kumqondo. Kudinga ukuba umuntu abhalise ngokuqondile ohlelweni (amalungu asebenzayo abhalisiwe ngokuzenzakalelayo).
Abantu ababhalisile ku-TRICARE Prime banikezwe kumhlinzeki wokunakekela oyinhloko (PCP), ngokuvamile okuyisikhungo sezokwelapha zasendaweni (isibhedlela esisekelwe).
Ukuze uthole ukunakekelwa kochwepheshe, ababhalisile kufanele babhekiswe yi-PCP yabo. Ngaphansi kwalolu hlelo, akukho mali yokubhalisa noma ukwabelana ngezindleko zamalungu omsebenzi osebenzayo namalungu omndeni womsebenzi osebenzayo.
Kubantu abahlala emakhaya (abangaphansi kweminyaka engama-65) namalungu omndeni abaqashile (ngaphansi kweminyaka engama-65), kukhona imali yokubhalisa ye-TRICARE Prime eyandisa ngonyaka. Umuntu angathola amafomu ukuthi afake ku-TRICARE Prime inthanethi.
Inketho entsha entsha ngaphansi kwe-TRICARE Prime yinketho yokubhalisa i-Point of Service (POS). Ngokujwayelekile ngaphansi kwe-TRICARE Prime, kumele uhanjiswe yi-PCP ukuze uthole noma yikuphi ukubuyisela ukwelashwa okutholakele kunoma ubani ngaphandle kwe-PCP. Kodwa, uma ukhetha inketho ye-POS ngesikhathi sokubhalisa, ungasebenzisa i-TRICARE Prime futhi usasebenzisa i-TRICARE Standard noma izinketho ze-TRICARE ezingezansi ezichazwe ngezansi.
I-TRICARE Ejwayelekile neyengeziwe
Lolu hlelo lunikeza ukuguquguquka okungaphezulu kune-TRICARE Prime, kodwa kungabangela izindleko zokungezelela. Awudingi ukubhalisa kusengaphambili ukusebenzisa i-TRICARE eyengeziwe. Ngaphansi kwalolu hlelo, ubona noma yini uMhlinzeki we-TRICARE ogunyaziwe, faka ikhadi lakho le-ID futhi uthole ukunakekelwa kwezokwelapha.
I-TRICARE Abahlinzeki Abagunyaziwe banesivumelwano nezempi ukukhawulela izindleko ezilinganisweni zemali. Ngaphansi kwe-TRICARE Eyengeziwe, amalungu omndeni womsebenzi osebenzayo akhokhela imali edlule ngonyaka (unyaka uqala njalo ngo-Okthoba):
- Isigaba E4 futhi ngezansi ukhokhela u-$ 50 ngabanye, kodwa angabi ngaphezu kuka-$ 100 ngomndeni ngamunye
- I-Rank E5 futhi ngenhla ikhokhela u-$ 150 ngabanye, kodwa angabi ngaphezu kuka-$ 300 ngomndeni
Kubantu abahlala emakhaya kanye namalungu omndeni asele umhlalaphansi (abangaphansi kweminyaka engama-65), lolu hlelo lubiza kancane, nakuba imali ekhishwe ngonyaka ifana ($ 150.00 ngabanye noma i-$ 300 ngomndeni. Vakashela ikhasi lewebhu le-TRICARE kanye nezindleko ezingaphezulu zemininingwane yonke yezindleko.
Ngaphansi kwe-TRICARE Eyengeziwe, umhlinzeki wezokwelapha ugcwalisa amafomu okufaka isicelo se-TRICARE kuwe, futhi bathola ukukhokha ngqo kusuka ku-TRICARE ngesabelo sabo. Uvele uzikhokhele ingxenye yakho yezindleko.
I-TRICARE yokuPhila
Kuze kube maduzane, lapho ilungu lomndeni elihlala emhlalaphansi noma elishiya umhlalaphansi lifinyelele eminyakeni engama-65, ayengasakwazi ukuthola i-TRICARE. Kunalokho, kulindeleke ukuthi bathole ukunakekelwa kwezokwelapha ngaphansi kwezihlinzeko zeMedare. Lokhu kwashintsha ngo-2001 ngokusungulwa kwe-TRICARE for Life (TFL). Futhi, asikho isidingo sokubhalisa kusengaphambili (ngaphandle kokuthi umuntu kufanele abhalise ku-Medicare Part B). Ukwengeza, izinkokhelo kuphela zalolu hlelo yizinkokhelo zenyanga zonke ze-Medicare Part B. Ngaphansi kwalolu hlelo, ubona umhlinzeki ogunyaziwe we-Medicare futhi ubonise ikhadi lakho le-ID. I-TRICARE iba ngumkhokheli wesibili futhi iqoqe noma yiziphi izindleko uM Medicare azikufihli.
Ngisho noma i-Medicare ayihambisani nezinsizakalo ezinikezwe ngaphandle kwezwekazi lase-United States, abahlala emakhaya bangaphandle bangasasebenzisa i-TFL ngoba i-TRICARE iba umthombo oyinhloko wezinzuzo zezempilo kubo.
Njengalabo abahlala e-United States, ukuba bafaneleke ukuhlala emakhaya ngaphandle kwamanye amazwe kumele babhalise ku-Medicare Part B. TRICARE ye-Life izohlinzeka ngezinga elifanayo lokuhlinzekwa abahola umhlalaphansi abangaphansi kweminyaka engama-65 futhi bayoba nemithwalo yemali efana ne-TRICARE kanye nama-deductibles njengoba abangaphansi kuka-65 abaqashile. Njengoba inani elikhulu labahlala emakhaya behlala ngaphandle kwezilwandle abazange babhalise kuNgxenye B ngoba uMedare akazange agubungele ukunakekelwa kwezokwelapha ezamukelwe emazweni angaphandle, ezinye zezinhlangano ezihlobene nezempi ziphikisana nokukhishwa kwesigwebo se-Part B okufaka isijeziso se-10% unyaka ngamunye umuntu wayefanelekile kwiNgxenye B kepha akazange abhalise. Kodwa-ke, okwamanje akukho lutho emisebenzini ebonisa ukuthi ukukhishwa okunjalo kuyeza.
Izinzuzo ze-Pharmacy nge-TRICARE
Kunezindlela eziningana zokugcwalisa imithi yokwelashwa nge-TRICARE:
Pharmacy Pharmacies
Ungase ube nemigomo egcwaliswe (kuze kube yimini engu-90 yemithi yemithi eminingi) endaweni yezokwelapha (MTF) mahhala. Sicela wazi ukuthi akuyona yonke imithi etholakalayo kuma-pharmacy we-MTF. Isikhungo ngasinye siyadingeka ukuba sitholakale imithi ehlongozwe ngokuyisisekelo ngokomthetho (BCF). I-MTF, ngokusebenzisa iKomidi leKhaya le-Pharmacy & Therapeutics, ingangezelela imithi eyengeziwe emphakathini ngokusemthethweni ngokusekelwe ekunakekelweni kwaleyo MTF.
I-TRICARE I-Mail Order Pharmacy (TMOP)
Ungalawula imithi online noma ngeposi. Ungathola kuze kube yizinsuku eziyi-90 (ngemithi eminingi). Izindleko ze-generic formulary ziyi-$ 0, kanti igama legama lomkhiqizo lingu-$ 20. Izindleko ezingezona i-formulary yi-$ 49 ngaphandle kokuthi unesidingo sezokwelapha.
Ama-Pharmacy enethiwekhi
Ungathola kuze kube yizinsuku ezingama-30 zokunikezwa kwemithi kadokotela kusuka ekhemisi ngaphakathi kwe-TRICARE Pharmacy Network. Izindleko ze-generic formulary yi-$ 10, futhi izindleko zamagama wegama lomkhiqizo ngu-$ 24. I-non-formulary yi-$ 50 ngaphandle kokuthi unesidingo sezokwelapha.
Ama-Pharmacy angenayo inethiwekhi
Izindleko zama-pharmacy angewona wenethiwekhi zisekelwe lapho ukhona, ukuthi ungubani futhi kwezinye izimo, yiziphi izinhlelo ozisebenzisayo. Kungadingeka ukhokhe phambili bese ufaka isimangalo sokubuyiselwa.
Izindleko ngokuvamile zizobe ziphakeme, nokho, kubasebenzi abangasebenzi abangasebenzi. Amalungu okusebenza komsebenzi osebenzayo azothola ukubuyisela okugcwele. Ukuze uthole imininingwane ephelele kanye nezindleko zabazuzi, vakashela ikhasi le-TRICARE lendleko yekhasi lewebhu.
Ukunakekelwa Kwezinsizakalo Zamazinyo Esebenzayo
Ukunakekelwa kwamazinyo ngomsebenzi osebenzayo, Yebo, ukhululekile eMtholampilo Wamazinyo Wezempi. Nokho, i-TRICARE ihlinzeka ngamalungiselelo amazinyo okuzikhethela amalungu omndeni womsebenzi osebenzayo kanye namalungu e-Guard / Reserves namalungu omndeni wawo. Lezi zinhlelo zidinga premium yenyanga. Lezi zinhlelo zikhokha izindleko eziphelele zokunakekelwa kwamanye amazinyo, kanye nezindleko zokwabelana kwamanye amazinyo. Izinkokhelo zamakhompiyutha zamanje zenyanga (2003):
- Umsebenzi osebenzayo - Ilungu lomndeni elilodwa, $ 8.11 ngenyanga. Amalungu amabili noma ngaphezulu omndeni, $ 20.27 ngenyanga.
- Izindawo ezikhethiwe - Ukuze ilungu lempi, $ 8.11 ngenyanga. Ilungu elilodwa lomndeni, i-$ 20.27 ngenyanga. Kulilunga elingaphezu kweyodwa lomndeni, $ 50.67 ngenyanga. Ngelungu lezempi kanye nomndeni wakhe, $ 58.78 ngenyanga.
- I-Individual Ready Reserves (i-IRR) - Ngelungu lezempi, i-$ 20.27 ngenyanga. Ilungu elilodwa lomndeni, i-$ 20.27 ngenyanga. Kulilunga elingaphezu kweyodwa lomndeni, $ 50.67 ngenyanga. Ukuze ilungu lezempi kanye nomndeni wakhe, u-$ 70.94 ngenyanga.
Izinhlelo ze-TRICARE zamazinyo
I-TRICARE inikeza izinhlelo ezintathu zamazinyo ezihlukene, ngamunye nge-contractor ehlukile yama-inshuwalense yamazinyo:
- Uhlelo Olusebenzayo Lwezinyosi: U-United Concordia
- Uhlelo lwe-TRICARE yamazinyo: i-Metlife
- I-TRICARE I-Retiree Dental Program: I-Delta Dental
Ama-premium we-Retiree Dental Program incike lapho uhlala khona, futhi inani lamalungu omndeni limbozwe.
Ukunakekelwa kwe-VA
Ngigijimela abantu ngaso sonke isikhathi abacabanga ukuthi noma yikuphi ukuhola umkhosi noma noma ubani onamandla angathola ukunakekelwa kwezempilo mahhala ku-Veterans Administration. Akulona iqiniso. Ukuze uthole ukunakekelwa kwezokwelapha kusuka ku-VA, kumele ube yi-Veteran (izinsuku ezingaphezu kwezingu-180 zemisebenzi yezempi), ube nokukhishwa okuhloniphekile futhi ube nokugula okuhlobene nesevisi, ukulimala noma ukukhubazeka, noma kufanele uwele ebangeni elithile lobuphofu.
Ukwaziswa okwengeziwe mayelana ne-VA Medical Care kuyatholakala kwi-Web Site ye-VA.