作者chucheng (用功~~~)
看板studyabroad
標題[問題] 美國的醫療保險
時間Tue Oct 12 03:04:52 2010
請教一下…我想確定我的理解是正確的
舉例：
Anthem PPO Share 7500 (31歲的保費是612/月)
---------------------
Plan Type PPO
Office Visit for Primary Doctor $40 Copay
Office Visit for Specialist $40 Copay
Coinsurance 30% after deductible
Annual Deductible Individual:$3,500
Separate Prescription Drugs Deductible $750 applies to Brand-name
prescription drug
Generic Prescription Drugs $15 copay or 40% coinsurance,
whichever is greater
Brand Prescription Drugs $15 copay or 40% coinsurance,
whichever is greater after $750 annual brand
name deductible (2 member max)
Annual Out-of-Pocket Limit Individual:$7,500
Includes deductible
Lifetime Maximum Unlimited
Health Savings Account (HSA) Eligible No
Out-or-network Coverage Yes
美國的PPO Insurance
看醫生要付US$40，拿藥是15 or 30%(看那個高）
Deductible寫3500，然後又寫一個 Out-of-pocket是7500
這是指7500裡面都是一年的病人自付上限吧？
40％是指drug的部份
其它的部份是30%
也就是簡單的講，3500以內病人自己出
3500以上，40 Office Visit + 40% Drug(or$15) + 30% 其它醫療（像是檢查）
直到碰到7500為止（之後全保險公司出）
但這是以年為單位Reset....
Deductible是以次為單位還是…
（我的理解有錯嗎？）
下面是我查到的定義
Coinsurance:
The amount that you are obligated to pay for covered medical services
after you've satisfied any co-payment or deductible required by your
health insurance plan. Coinsurance is typically expressed as a percentage
of the charge or allowable charge for a service rendered by a healthcare
provider. For example, if your insurance company covers 80% of the
allowable charge for a specific service, you may be required to cover
the remaining 20% as coinsurance.
這樣612每月也太扯了一點了吧.....
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※ 編輯: chucheng 來自: 131.179.64.241 (10/12 03:16)
→ GoldLight:好扯...學校沒有學生保險嗎？ 10/12 03:41
推 clarkchang:每月612？還是每季612？差很多 10/12 05:29
→ ndr:難道是因為沒有pre-exist的條文? 10/12 05:45
→ chucheng:這個是指沒有學校保險的情況下… 10/12 07:30
→ chucheng:像是畢業後上工前，或是F2，或是F1學生Leave for Absence 10/12 07:31
→ cchris:deductible是以年為單位;office visit不算入coinsurance裡 10/12 09:11
→ cchris:這個保險不算非常差,保費一個月$600多坦白說是蠻正常的 10/12 09:12
→ cchris:因為這個保險保大也保小;大事最多付$7500,小事每次只付$40 10/12 09:13
→ cchris:如果你要省保費就要選保大不保小的;office visit不給付那種 10/12 09:13
→ cchris:另外你還要讀清楚pre-existing條款;除非佛心來了否則都會有 10/12 09:16