Dental Benefit Coverage Hmong
Cov Kev Pab Them Nqi Kho Hniav
California Dental Association
Qhov chaw tso siab tau los qhia txog kev kho hniav
“Kev Kho Hniav Nws Txawv”
Yuav kom nkag siab zoo txog cov kev xaiv uas muaj rau cov tswv hauj lwm uas muab kev pab them nqi kho hniav rau lawv cov neeg ua hauj lwm mas, nws yog ib qho tseem ceeb uas yuav tau los nkag siab txog qhov txawv ntawm kev kho hniav thiab kev kho mob.Cov kev txawv no yog qhov uas siv los tsim cov kev pab them nqi kho hniav, thiab tsim ib qho uas txawv ntawm cov kev pab them nqi kho hniav thiab kho mob.
Tsis zoo li cov kab mob ntawm cev, cov kab mob ntawm hniav nws tsis yog ib qho kev pheej hmoo uas yuav muaj kev tiv thaiv tau.
- Muaj ib qho uas yuav luag txhua tus neeg hauv ntiaj teb no muaj ntawm cov kab mob hniav – txhua tus muaj qhov no, thiab li ntawv, txhua tus yuav xav thiab yuav siv kev kho hniav.
- Ib yam uas txawv deb ntawm kev mob mus ntev thiab kev mob, tus neeg mob muaj kev tswj txog seb thaum twg, los sis seb, puas yuav kho.Qhov kev kho thiab seb kho npaum li cas yog los ntawm tom qab kho tas.
- Txawm tias qhov kev kho hniav nws sib txawv rau cov neeg los, kev kho hniav ntawm cov neeg ua hauj lwm mas yeej paub tau ua ntej lawm. Li no, cov kev pab them nqi kho hniav thiaj li yog ib qho uas yus them yus thiab yus siv yus.
- Tsis zoo li cov kab mob ntawm cev, cov kab mob hniav nws tsis yog ib qho mob loj los sis ib qho uas yuav ua tau kom tuag taus; li no, qhov nyiaj uas siv rau kev kho hniav tsis yog ib qho uas phem heev.
Tsis zoo li ntau hom kab mob, kab mob hniav nws yuav tsis zoo yog tsis muaj kev pab los cuam tshuam; nws yog ib qho mob ntev, mob zuj zus, thiab ua kom puas tsuaj, uas ua kom mob loj ntev mus.
mas yuav tiv thaiv tau, yam uas raug nqi tsawg. Li no, cov kev pab them nqi kho hniav yuav tsum tau muaj ib qho kev qhia txog kev tiv thaiv.
Kab mob hniav feem ntau yog ib qho uas maj mas muaj. Li no cov kev kho hniav yuav muab ncua tau thiab muaj ntau zuj zus yam uas tsis muaj cov tsos mob kom txog thaum uas ntev heev tso.
Qhov uas muaj kab mob hniav mas nws tshwm sim thaum ntxov thaum tseem yog menyuam yaus. Li no, cov kev pab them nqi kho hniav rau cov menyuam yaus mas nws tseem ceeb hais txog kev txaus siab rau txoj kev kaj huv ntawm qhov ncauj mus tas lub neej txoj sia.
Txoj hauj lwm kho hniav nws npaj tau txawv dua kev kho mob:
- 80% ntawm cov neeg kho hniav nws yog cov neeg ua hauj lwm pab dav dav (general practitioners) thiab feem ntau yog cov neeg muab kev pab kho hniav ua ntej
- Qhov feem pua uas loj tshaj plaws ntawm kev kho hniav mas nws yog ua los ntawm ib tug kws kho hniav ntawm ib qho chaw
- Yuav luag tag nrho cov kev kho hniav ntawv yog ua los ntawm qhov uas tsis tau pw tim tsev kho mob
- Muaj tsawg pawg neeg ua hauj lwm pab hauv kev kho hniav [thiab tej zaum tsawg tus tus neeg pab rau ib tug kws kho hniav twg]
- Tsis muaj ib qho chaw uas nyob nruab nrab uas yuav mus tau, zoo li tsev kho mob, uas cov kws kho hniav yuav sib txuas lus tau tas li
- Cov kws kho hniav yog tswv, muaj cov twj thiab khiav lawv lus “tsev kho mob”, piv txwv li, yam uas tsis tau kev pab nyiaj los ntawm pej xeem
Cov twj tshiab uas "zoo heev" hauv kev kho hniav feem ntau nws tsis kim, ntxiv rau qhov kho tau zoo thiab qhov uas muaj peev xwm los kho, thiab tsis tau muaj qhov uas nce kom kim heev ntawm cov nqi kho hniav.
Kev sib tw yeej muaj hauv kev kho hniav, vim feem ntau cov kev kho hniav tsis yog kho tej yam uas mob luv luv, vim li no cov neeg mob muaj sij hawm mus nrhiav seb qhov twg yog qhov uas yuav kho tau zoo tshaj.
Tus nqi nruab nrab txhua xyoo uas ib tug neeg twg siv rau kev kho hnaiv hauv Teb Chaws Mis Kas mas nws me heev, txawm tias tsim nyog yuav tau kho hniav.
Kev kho hniav yog li ntawm 5% ntawm cov nqi kho mob txhua xyoo hauv Teb Chaws Mis Kas.
kev kho hniav mas nws nyob tus yees; qhov uas nce nqi hauv kev kho hniav hauv Teb Chaws Mis Kas no mas nws tsuas yog hauj sim.
Sua lus:
Muaj ntau qhov kev txawv ntawm kev kho hniav thiab kev kho mob. Cov kev txawv no yuav tsum tau muab los xav thaum uas tsim ib qho kev pab them nqi kho hniav. Ib qho kev pab them nqi kho hniav yuav tsum tsis txhob tsim yam tias nws yog ib qho kev pab them nqi kho mob, thiab yuav tsum tsis txhob them rau cov nqi kho mob. Tsis xam qhovkev sib txawv ntawm kev kho hniav thiab kev kho mob yuav ua rau muaj qhov yuam kev uas raug nqi ntau hauv kev pab them nqi kho hniav rau ib pawg twg.
Cov Kev Pab Them Nqi Kho Hniav
Ua ntau txoj kev, qhov kev pab them nqi kho hniav nws zoo tib yam li cov kev pab them nqi uas siv rau kev kho mob.
Cov Kev Pab Them Nqi Rau Cov Lag Luam
Cov kev pab them nqi rau cov lag luam nws poob ua ob pawg:kev pab cuam koom ua ke, thiab tus-nqi-rau-qhov-kev-pab. Cov kev pab them nqi rau kev pab cuam koom ua ke yog:
Preferred Provider Organization
Cov kev pab Preferred Provider Organization (PPO) yog cov kev pab them nqi uas cov neeg mob nws xaiv ib tug kws kho hniav los ntawm ib pawg neeg uas sib koom ua ke (network) los sis ib co neeg muab kev pab uas tau pom zoo, los ntawm kev cog lus, los txo lawv cov nqi. Hauv cov PPOs uas cia cov neeg mob tau cov kev pab kho hniav los ntawm cov kws kho hniav uas tsis koom, cov neeg mob raug nplua uas yuav tau them ib qho kev them nyiaj ntawm yus ntiag tug (deductible) thiab tus nqi koom them (co-payments) siab zog. Cov PPOs yuav muab kev pab them nqi tag nrho los sis yus them yus los tau. Lawv feem ntau tsis tshua kim piv rau cov kev pab them nqi uas muaj kev tiv thaiv (indemnity) thiab tau kev tswj nyob hauv cov cai uas yog rau kev tuav pov hwm hauv lub tuam txhab ntawm lub xeev uas lub tuam txhab nyob thiab khiav hauj lwm.
| Hom Kev Pab Them Nqi |
Cov Kev Pab |
Cov Kev Txwv |
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Pawg Kev Pab Them Nqi PPO/DPO Plan |
PPO cov kev pab them nqi nws tsis kim npaum li cov kev pab them nqi uas muaj kev tiv thaiv. Cov tswv hauj lwm yuav kho tau cov kev pab thiab cov kev pab uas muaj kev pab them nqi. Zoo tib yam li cov kev pab them nqi uas muaj kev tiv thaiv, tiam sis, qhov kev pab them nqi muaj kev cog lus nrog cov kws kho hniav los muab cov kev pab uas them tus nqi tsawg. PPO cov kev pab them nqi muaj kev txwv rau qhov tus nqi koom them uas tus kws kho hniav yuav kom them tau, li no nws txo tus nqi ntawm qhov tus neeg ua hauj lwm uas nws them nws. Cov kev pab them nqi no nws muaj kev tswj los ntawm xeev cov cai. Cov kev pab them nqi los ntawm kev pab them nqi uas yog ib tug tswv uas muaj feem nraim (private employer-sponsored) uas muaj kev tiv thaiv hauv ERISA. |
Tsuas pub rau tej co kws kho hniav uas koom xwb. Tus neeg ua hauj lwm tej zaum yuav tau hloov cov kws kho hniav. Qhov no tej zaum yuav ua rau cov neeg mob tsis tshua xav mus nrhiav kev pab. Txo cov kev pab yog hais tias tus neeg mob mus cuag ib tug kws kho hniav uas tsis nyob hauv qhov kev koom tes. Exclusive Provider Organization (EPO) tsis them rau cov nqi thaum uas ib tug neeg mob mus ntsib ib tug kws kho hniav uas tsis nyob hauv qhov kev koom tes. Muaj qhov uas tsuas pub them txog pes tsawg hauv ib xyoos twg raws li daim ntawv teem caij nyoog (calendar). |
Dental Health Maintenance Organization (DHMO)/Capitation Plan
Dental Health Maintenance Organizations los sis cov kev pab them nqi uas muaj tib tug nqi zoo tib yam rau txhua tus neeg (capitation plans) them cov kws kho hniav muaj kev cog lus rau tib tug nqi (feem ntau raws hli) rau ib tse neeg los sis ib tug neeg uas koom twg, tsis hais seb siv hom kev pab dab tsi. Li no, cov kws kho hniav uas koom ntawv pom zoo muab tej yam kev kho rau tus neeg mob uas tsis kom nws them nqi (rau tej cov kev kho hniav tej zaum yuav tsum tau kom them tus nqi koom them). Raws li txoj kev xav, DHMO muab phaj tshab rau cov kws kho hniav uas ua kom nws cov neeg mob nyob yam muaj kev kaj huv ntawm cev, li no ua rau cov nqi tsawg.
| Hom Kev Pab Them Nqi |
Cov Kev Pab |
Cov Kev Txwv |
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Pawg HMO/DHMO |
Hom kev pab them nqi kho hniav uas pheej yig tshaj plaws. Paub tias yuav tau them tus nqi koom them li cas los sis tsis muaj tus nqi koom them. Feem ntau muab kev pab tiv thaiv uas tsis kom tus neeg mob them nqi. Muab phaj tshab (incentives) rau kev pab tiv thaiv. Kev paub thaum ntxov thiab kev pab tiv thaiv ua rau kom tus nqi tsawg. HMO cov kev pab them nqi mas nws yog tswj los ntawm Department of Managed Health Care. Cov kev pab them nqi yog tswj los ntawm txoj cai los ua kom muaj ib qho kev soj ntsuam sab hauv kom paub tias yeej muab kev pab zoo tiag. |
Tus neeg ua hauj lwm yuav tsum tau xaiv ib tug Primary Care Provider (PCP) los ntawm ib daim ntawv uas muaj cov kws kho hniav uas koom cov npe. Tus neeg ua hauj lwm tej zaum yuav tau hloov cov kws kho hniav. Qhov no tej zaum yuav ua rau cov neeg mob tsis tshua xav mus nrhiav kev pab. Yuav tsis them rau cov kev pab yog hais tias tus neeg mob tsis nrhiav kev pab los ntawm tus PCP Cov kev pab uas tsis yog li niaj zaus muaj los sis cov kev pab loj mas muaj qhov kom tus neeg mob them tus nqi koom them uas ntau, los sis tej zaum yuav tsis muaj kev pab them los ntawm qhov kev pab them nqi. Tus kws kho hniav pheej txoj hmoov tias tsam yuav tsis them nqi. Cov kws kho hniav tau txais ib tus nqi “uas muaj tib tug nqi zoo tib yam rau txhua tus neeg” (rau ib tse neeg twg) rau txhua tus neeg mob uas xa mus kho mob, tsis hais seb muab kev pab dab tsi. Qhov kev kho ntawv tej zaum yuav tsis tshua xav kom ua thiab qhov kev pab kho mob kom zoo ntawv yuav sib nyom nqi tau. Kev kho tej zaum yuav tsuas pub rau qhov seb kho tau pes tsawg tus neeg mob rau ib lub hlis twg, li no muaj kev txwv rau tus neeg mob txoj kev mus nrhiav kev pab. Tus neeg mob raug tshem tawm ntawm tus nqi kho mob tiag tiag; tej zaum yuav tsis nkag siab txog qhov muaj nqis ntawm txoj kev pab uas muab rau nws. Muaj qhov uas tsuas pub them txog pes tsawg hauv ib xyoos twg raws li daim ntawv teem caij nyoog (calendar). |
Cov kev pab them nqi kho mob uas yus them tus-nqi-rau-qhov-kev-pab uas yus tau muaj:
Cov kev pab them nqi uas muaj kev tiv thaiv
Ib qho cov kev pab them nqi uas muaj kev tiv thaiv yog ib qho kev pab them nqi uas muaj kev pab them tag nrho los sis yus them yus tus kheej uas tau muab ib tug nqi kho mob rau cov kws kho hniav rau tej hom kev pab, tsis hais seb tus nqi tiag tiag yuav raug li cas los ntawm tus neeg muab kev pab. Cov kev them nqi tej zaum yuav them rau cov neeg koom uas yog ua cov nqi them rov qab, los sis xa ncaj qha rau cov kws kho hniav.
| Hom Kev Pab Them Nqi |
Cov Kev Pab |
Cov Kev Txwv |
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Pawg Uas Muaj Kev Pab Them Tag Nrho Qhov Kev Pab Them Nqi Uas Muaj Kev Tiv Thaiv |
Tus neeg ua hauj lwm yuav mus ntsib tus kws kho hniav twg los tau. Them tib tug nqi them txhua hli (premium) mus li 6-12 lub hlis. Tus-Nqi-Rau-Qhov-Kev-Pab; cov kev pab them raws UCR daim ntawv. Cov kev pab tiv thaiv mas feem ntau yog them 100%, cov kev pab yooj yim yog them 80% thiab cov kev pab loj yog them 50%. Cov kev pab them nqi rau kev kho cov hniav uas nkhaus uas yooj yim tej zaum yuav muaj rau hauv. Cov kev pab them nqi no yog tswj los ntawm xeev cov cai. Cov kev pab them nqi los ntawm kev pab them nqi uas yog ib tug tswv uas muaj feem nraim (private employer-sponsored) uas muaj kev tiv thaiv hauv ERISA. |
Hom kev pab them nqi kho hniav uas kim tshaj plaws. Txwv cov nqi uas ntau tshaj ntawv tsis pub tshaj $1,000-$2,000 hauv ib xyoos raws li daim ntawv teem caij nyoog twg. Tsis suav cov kev pab them nqi rau kev kho kom cov hniav zoo nkauj, kev cog hniav, kev pab rau TMJ. Kev them nyiaj ntawm yus ntiag tug txhua xyoo yog $50-$150 Tus neeg mob yuav tau them qhov seem ntawm UCR tus nqi mus rau tus nqi tiag tiag uas muaj ntawv. Tej zaum yuav tau tos. |
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Pawg Yus Them Yus Ntiag Tug Rau Qhov Kev Pab Them Nqi Uas Muaj Kev Tiv Thaiv |
Tus neeg ua hauj lwm yuav mus ntsib tus kws kho hniav twg los tau. Tus-Nqi-Rau-Qhov-Kev-Pab; cov kev pab them raws UCR daim ntawv. Pheej yig dua ib qho kev pab them tag nrho qhov kev pab them nqi uas muaj kev pab tiv thaiv. Cov nqi feem ntau them ncaj qha rau tus kws kho hniav. Cov kev pab them nqi los ntawm kev pab them nqi uas yog ib tug tswv uas muaj feem nraim (private employer-sponsored) uas muaj kev tiv thaiv hauv ERISA. |
Tus tswv hauj lwm tsis muaj thiv meem los them cov nqi; cov nyiaj them raws hli yog them mus rau hauv ib qho chaw tuav nyiaj (trust fund). Tus tswv hauj lwm cov nqi nws tsis yog zoo tib yam, cov nqi sib txawv nyob ntawm seb siv hom kev pab twg. Tus tswv hauj lwm yuav tau xaiv thiab them rau Tus Neeg Sab Nrauv (Third Party Administrator). Xyuas qhov uas qhia ntawm TPA. Cov kev pab them nqi uas yus them yus tsis raug tswj los ntawm xeev txoj cai. |
Them Ncaj Qha Rov Qab (Direct Reimbursement)
Them Ncaj Qha Rov Qab (DR) yog ib qho kev pab kho hniav uas yuav them nyiaj rov qab rau tus neeg mob raws li cov nyiaj uas siv rau kev kho hniav, tsis yog raws hom kev pab uas tau txais. Nws cia tus neeg mob xaiv tus kws kho hniav uas nws xav tau. Tsis siv qhov uas them ib tug nqi rau kev tuav pov hwm txhua hli cov tswv hauj lwm them ib qho feem pua ntawm tus nqi ntawm qhov kev pab uas tau txaiv ntawv. Ntxiv thiab, cov tswv hauj lwm raug tshem tawm ntawm qhov uas tej zaum yuav muaj thiv meem los cuam tshuam txog cov kev txiav txim ntawm kev kho nyob ntawm saib xaiv qhov kev pab them nqi twg los sis qhov kev pab twg.
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Hom Kev Pab Them Nqi |
Cov Kev Pab |
Cov Kev Txwv |
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Them Ncaj Qha Rov Qab |
Cov neeg ua hauj lwm lawv yuav xaiv tau lawv tus kws kho hniav. Tsis muaj kev cuam tshuam los ntawm qhov kev tuav pov hwm nrog rau kev sib raug zoo ntawm tus neeg mob-tus neeg muab kev pab. Tus tswv hauj lwm yog tus uas qhia seb yuav pab txog li cas. Cov neeg ua hauj lwm tswj tau qhov uas lawv siv lawv cov nyiaj rau cov kev pab. Cov neeg ua hauj lwm muaj feem ncaj qha rau hauv kev them nqi. Cov nqi khiav hauj lwm tsawg. Ib co tswv hauj lwm lawv khiav cov hauj lwm lawv tus kheej los sis xaiv ib qho TPA. Yuav luag tag nrho cov nyiaj mus ncaj qha rau cov kev pab kho hniav. Cov kev pab them nqi los ntawm kev pab them nqi uas yog ib tug tswv uas muaj feem nraim (private employer-sponsored) uas muaj kev tiv thaiv hauv ERISA. |
Tsis paub seb yuav mus zoo li cas uas tsis zoo li qhov kev pab uas them nyiaj txhua hli; cov nqi sib txawv ib hlis rau ib hlis nyob ntawm kev siv xwb. Qhov kev pab them nqi tsis yog tswj los ntawm xeev cov cai. Tej zaum cov neeg ua hauj lwm yuav tau them ncaj qha rau tus kws kho hniav rau cov kev pab thiab tom qab tus tswv hauj lwm mam li them nws rov qab. Qhov uas tsis zoo raws siab xav no yuav zam tau yog hais tias tus tswv hauj lwm npaj kom them ncaj qha rau tus kws kho hniav. |
Lwm cov kev pab them nqi kho mob:
Cov Kev Pab Them Nqi Kho Hniav Uas Muaj Ib Qho Kev Txo Nqi (Discount Dental Plans)
Cov kev pab them nqi kho hniav uas muaj ib qho kev txo nqi tsis yog cov kev tuav pov hwm: lawv tsis muab cov kev pab kho hniav, tsis muaj ib daim ntawv uas qhia txog cov kev pab, tsis them cov neeg muab kev pab rau lawv cov kev pab uas lawv muab, thiab tsis muaj thiv meem dab tsi hais txog kev pab zoo. Cov kev pab them nqi kho hniav uas muaj ib qho kev txo nqi muaj ib pawg kws kho hniav uas pom zoo yuav muab cov kev pab ntawm ib tug nqi uas tsawg. Tus neeg mob them rau tag nrho cov kev kho mob hauv lawv hnab tshos los, li no lawv yuav tau lav 100% ntawm qhov kev pheej hmoo. Hauv kev pab them nqi kho hniav uas muaj ib qho kev txo nqi tsis tau kev tswj los ntawm xeev txoj cai.
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Hom Kev Pab Them Nqi |
Cov Kev Pab |
Cov Kev Txwv |
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Cov Kev Pab Them Nqi Kho Hniav Uas Muaj Ib Qho Kev Txo Nqi |
Cia cov neeeg ua hauj lwm yuav ib qho kev pab kho hniav uas txo nqi, muaj ntsis zoo li “lub koom haum uas muab kev txo nqi rau tus neeg koom” Tsis muaj kev cuam tshuam los ntawm qhov kev tuav pov hwm nrog rau kev sib raug zoo ntawm tus neeg mob-tus neeg muab kev pab. Yeej paub hais tias tus nqi koom yog li cas; tsis muaj kev hloov Cov neeg ua hauj lwm muaj kev tswj tag nrho hais txog seb yuav tau kev pab dab tsi los sis xav yuav qhov kev pab dab tsi Tsis muaj cov nqi khiav hauj lwm rau cov tswv hauj lwm |
Cov kev pab them nqi tsis muaj kev tswj (tsis xam tias yog ib qho “kev tuav pov hwm”) Tsis muaj kev lees tias cov nqi uas kom them ntawv yuav yog tus nqi uas txo, los sis lawv yuav txo rau txhua txoj kev pab Cov kev pab them nqi tsis them cov kws kho hniav; kev them ntawv yog los ntawm tus neeg koom hauv qhov kev pab them nqi (txawm tias nws yog ib qho kev txo nqi) Ib lub koom haum uas tsis muaj kev tswj, tsis muaj ib qho kev paub hais tias seb cov neeg muab kev pab hauv pawg neeg sib koom (network) ntawv puas muab cov kev pab kho mob uas zoo |
Ntsiab txhais
Kev Pab Them Nqi Rau Ib Pawg: Tus tswv hauj lwm yuav rau ib pawg neeg thiab tswj qhov kev tuav pov hwm rau nws cov neeg ua hauj lwm. Cov nyiaj uas them txhua hli yog them los ntawm tus tswv hauj lwm thiab tej zaum yuav kom tus neeg ua hauj lwm them ib feem los sis them tag nrho rau qhov kev pab them nqi ntawm cov kev rho tawm ntawm cov nyiaj ua hauj lwm ua ntej rho se. Tus tswv hauj lwm yuav kho tau qhov kev pab them nqi nrog rau lub tuam txhab tuav pov hwm hais txog cov kev pab, tus neeg ua hauj lwm cov nyiaj yus them yus ntiag tug/tus nqi koom them, cov kev kho mob uas muaj kev pab them nqi kho mob, thiab qhov uas tsuas pub them txog pes tsawg hauv ib xyoos twg.
Cov kev pab them nqi los ntawm kev pab them nqi uas yog ib tug tswv uas muaj feem nraim (private employer-sponsored) yog tswj los ntawm Employee Retirement Income Security Act of 1974 (ERISA), nyob rau hauv Pension and Welfare Benefits Administration, U.S. Department of Labor. ERISA yog tus ua cov qauv rau kev khiav cov kev pab them nqi no, yuav tsum tau qhia txog cov nyiaj txiag thiab lwm cov lus qhia rau cov neeg koom hauv qhov kev pab them nqi, thiab ua cov qauv rau qhov uas yuav tsum tau muaj rau kev khiav cov nqi.
Pawg uas muaj kev pab them tag nrho qhov kev pab them nqi uas muaj kev tiv thaiv thiab Preferred Provider Organizations (PPO) plans mas yog tswj los ntawm xeev txoj cai. Cov neeg yuav nrhiav tau kev pab los daws ib qho kev them nqi nrog rau California Department of Insurance. Pawg uas yus them yus tus kheej tsis yog tswj los ntawm xeev txoj cai.
Health Maintenance Organizations (HMO) plans thiab ib co PPO yog tswj los ntawm California Department of Managed Health Care. Thaum uas tus neeg yuav ntawv tau siv qhov kev pab them nqi kho mob qhov hais txog kev tsis txaus siab sab hauv uas lawv pab tsis tau lawm, tus neeg yuav ntawv yuav nrhiav tau kev pab los ntawm DMHC.
Kev Them Nqi Ntawm Ib Tug Neeg (Individual Plan): Ib tug neeg yuav tau kev tuav pov hwm uas muaj los ntawm tus tswv hauj lwm nrog qhov uas rho qhov nyiaj tom qab txiav seb tas los sis yuav kev tuav pov hwm los ntawm ib tug neeg uas muag los sis ncaj qha los ntawm lub tuam txhab muag kev tuav pov hwm. Cov kev them nqi ntawm ib tug neeg tsis muaj kev pab tiv thaiv los ntawm ERISA. Feem ntau cov kev them nqi kho hniav ntawm ib tug neeg uas muaj yog Health Maintenance Organizations.
Tsoom Fwv Cov Kev Pab
Ib sab ntawm cov kev pab rau lag luam, muaj ob qho kev pab uas siv pej xeem cov nyiaj los pab them nqi kho hniav hauv California :
Denti-Cal: Thaum uas tsoom fwv tsis hais kom muab kev pab them nqi kho hniav rau cov laus hauv lawv cov kev pab, xeev muaj ib txoj kev xaiv kom muaj cov kev kho hniav rau cov laus hauv lawv qhov kev pab los ntawm Medicaid; California tau siv qhov kev xaiv ntawv. Thaum uas txoj kev tau cov kev pab kho hniav rau cov menyuam uas muaj 21 xyoos mas yuav tsum muaj nyob hauv tsoom fwv txoj cai, California tseem kom muaj rau cov laus nyob hauv qhov kev pab thiab. Medi-Cal them rau ib qho kev pab kho hniav tagn rho, uas muaj txoj kev xyuas thiab cov kev pab tiv thiav xws li kev soj ntsuam thiab prophylaxis (ntxuav), kev kho xws li ntsaws hniav, thiab kev phais hauv qhov ncauj. Ib co kev pab, xws li kho yas hau hniav, cov lo hniav yas thiab kho cag hlwb hniav mas yuav tsum tau kev tso cai ua ntej, thiab ib co kev pab xws li cov yas los lo hniav, kev siv fluoride thiab tej co kev kho cov hniav kom zoo nkauj tsuas yog yuav them rau cov menyuam uas muaj 21 xyoos rov hauv xwb. Pib lub Ib Hlis Ntuj Tim 1, 2006, cov kev pab ntawm seem rau cov neeg laus ntawm qhov kev pab Denti-Cal tsuas yog pub txog $1800 hauv ib xyoos twg raws li daim ntawv teem caij nyoog (calendar), tsis suav tej co kev pab xws li kev pab thaum muaj xwm ceev, cov hniav yas, cov kev phais ntawm sab ntsej muag saum toj ntawm lub puab tsaig sauv (maxillofacial), cov kev pab hauv cov tsev kho mob mus ntev thiab ib co kev pab uas tsoom fwv tso cai rau kom muaj.
Healthy Families: Qhov kev pab Healthy Families Program yog xeev thiab tsoom fwv ib qho kev pab them nqi kho mob rau cov menyuam uas nyob hauv cov tsev neeg uas tau nyiaj ntau tshaj qhov uas yuav tsim nyog tau qhov yuav tsis tau them Medi-Cal thiab qis tshaj 250% ntawm tsoom fwv cov qauv hais txog nyiaj tau ($40,200 rau ib tse neeg uas muaj peb leeg). Qhov kev pab no tseem muaj kev pab them rau cov nqi kho hniav. Lub Xeev California tau thov kom muab kev pom zoo, thiab tsoom fwv pom zoo, tias kom Healthy Families pab rau cov niam txiv ntawm cov menyuam uas muaj kev pab them hauv qhov kev pab thiab. Tiam sis, vim qhov kev pab them nqi kho mob rau cov kev pab uas dav dav sab nrauv no thiab qhov uas xeev cov nyiaj pheej yuav luag tsis txaus li, seem no ntawm qhov kev pab yeej tsis tau muab los siv li.
Lub Peb Hlis Ntuj 2006
800.CDA.SMILE
cda.org