Thandizo la zamagulu tsopano limatchedwa TRICARE
Mbiri ya Zopindulitsa Zamankhwala Zamagulu
Zaka za m'ma 1980 zisanachitike, panali njira ziwiri zothandizira ankhondo, olowa usilikali komanso achibale awo kuti alandire chithandizo chamankhondo.
Amishonale adalandira chithandizo chamankhwala kuchipatala, ndipo anthu othawa kwawo ndi achibale adalandira thandizo laulere (malinga ndi kupezeka kwa malo) kuchipatala, kapena akhoza kugwiritsa ntchito pulogalamu yotchedwa CHAMPUS (Civil Society and Medical Program Uniformed Services) kuti alandire boma -madokotala othandizira thandizo lachipatala kuchokera kwa opereka chithandizo.
Lingaliro la chithandizo chamankhwala chamagulu kwa mabanja a ogwira ntchito-ogwira ntchito ma uniformed services chafika kumapeto kwa zaka za m'ma 1700. Mu 1884, Congress inalangiza kuti "madokotala a Army ndi opaleshoni ya opaleshoni nthawi zonse akadzapita kumabanja a akazembe ndi asilikali kwaulere."
Kusintha kwa Mapindu Panthawi ya Nkhondo Yachiwiri Yadziko Lonse
Panali kusintha pang'ono mpaka nkhondo yachiŵiri yapadziko lonse. Ambiri omwe ankamenya nkhondoyo anali anyamata omwe anali ndi akazi okalamba. Ndondomeko ya zachipatala, yomwe inali pa nthawi ya nkhondo, sankatha kuwerengetsa chiwerengero chachikulu cha kubadwa, komanso kusamalira ana aang'ono kwambiri.
Mu 1943, Congress inavomereza kuti Emergency Maternal ndi Child Care Program (EMIC). EMIC inapereka chisamaliro chakumayi komanso chisamaliro cha ana mpaka chaka chimodzi kwa akazi ndi ana a anthu ogwira ntchito m'munsimu. Ankayendetsedwa ndi "Bungwe la Ana," kupyolera m'mazipatala a boma.
Zosintha Pa Nkhondo ya ku Korea
Nkhondo ya ku Korea kachiwiri inachepetsanso kuthekera kwa kayendetsedwe ka zaumoyo. Pa Dec. 7, 1956, lamulo la Medical Care Act linasindikizidwa kukhala lamulo. Chiwonetsero cha 1966 chomwechi chinapanga chimene chinkatchedwa CHAMPUS kuyambira mu 1967. Lamuloli linapereka chisamaliro choyendetsa komanso kusamalira maganizo kwa anthu ogwira ntchito mwakhama, ogwira ntchito pa Oct. 1, 1966. Othawa kwawo, achibale awo ndi mabanja ena omwe apulumuka Othandizira anabweretsedwa pulogalamuyi pa Jan. 1, 1967. Ndalama ya CHAMPUS ya Chaka cha Ndalama 1967 inali $ 106 miliyoni. Zolemba sizikuwonetsa kuti madandaulo angati adatumizidwa mu FY 1967, koma kwathunthu mwina sanali oposa zikwi zingapo.
Kusintha Kuletsa Ndalama za Zamankhwala ndi Kukulitsa Kufikira
M'zaka za m'ma 1980, kufunafuna njira zowonjezerapo mwayi wolandira chithandizo chamankhwala apamwamba, pamene kusunga ndalama zowonongeka, kunatsogolera polojekiti ya "mawonetsero" a COMPASS m'madera osiyanasiyana a US Ambiri mwa iwo anali "CHAMPUS Reform Initiative" (CRI) ) ku California ndi Hawaii.
Kuyambira mu 1988, CRI inapereka mabanja ntchito kuti asankhe njira zomwe angagwiritsire ntchito chithandizo chamankhwala awo. Zaka zisanu zogwira ntchito bwino komanso zokhutira ndi okhutira zimakhudza akuluakulu a Dipatimenti Yotetezera kuti ayenera kupititsa patsogolo ndi kukonza malingaliro a CRI, monga pulogalamu ya uniform m'dziko lonse lapansi.
Pulogalamu yatsopano, yotchedwa TRICARE, ili tsopano.
Mu FY 1996, bajeti ya TRICARE / CHAMPUS inali yoposa $ 3.5 biliyoni, ndipo zowonjezera zoposa 20 miliyoni zinalandiridwa. Lero, pafupifupi anthu mamiliyoni asanu ndi asanu ndi asanu akuyenera kulandira thandizo la TRICARE.
Mitundu ya TRICARE
Pamene TRICARE inayambitsidwa koyamba, panali mitundu itatu yokha. Kwa zaka zingapo zapitazo, njira zowonjezera zaumoyo za TRICARE zakhazikitsidwa. Pitani ku webusaiti ya TRICARE kuti mumve zambiri pazochitika zonse za TRICARE:
- TRICARE Prime
- TRICARE Prime Remote
- TRICARE Kumayiko Oyambirira
- TRICARE oyang'anira madera akutali
- TRICARE Yowonjezera ndi Yowonjezera
- TRICARE Mayiko Otsatira
- TRICARE Kwa Moyo
- TRICARE Malo Sankhani
- TRICARE Malo Othawa Pakhomo
- TRICARE Wachinyamata Wamkulu
- US Family Health Plan
TRICARE Prime
Njira iyi ndi yofanana ndi HMO mu lingaliro. Izi zimafuna kuti munthu athe kulembetsa pulogalamuyo (anthu ogwira ntchito mwakhama amalembetsa).
Anthu omwe amalembedwa ku TRICARE Prime amapatsidwa kwa wothandizira wamkulu (PCP), omwe nthawi zambiri amapezeka kuchipatala.
Pofuna kulandira chisamaliro cha akatswiri, olembetsa ayenera kutumizidwa ndi PCP yawo. Pansi pa pulogalamuyi, palibe malipiro olembetsa kapena kugawa ndalama kwa anthu ogwira ntchito komanso mamembala omwe ali ndi ntchito yogwira ntchito.
Kwa okalamba (osakwana zaka 65) ndi mamembala a anthu ogwira ntchito pantchito (osakwana zaka 65), pali malipiro olembetsa a TRICARE Prime omwe amakula chaka chilichonse. Mmodzi akhoza kutenga mawonekedwe kuti alowe mu TRICARE Prime online.
Chinthu chatsopano chotsatira pansi pa TRICARE Prime ndi njira yolembera ya Point of Service (POS). Kawirikawiri pansi pa TRICARE Prime, muyenera kutumizidwa ndi PCP kuti mulandire ndalama zothandizira kuchipatala zomwe munalandira kuchokera kwa wina aliyense kupatulapo PCP. Koma, ngati musankha kusankha POS panthaŵi yolembetsa, mungagwiritse ntchito TRICARE Prime ndikugwiritsabe ntchito TRICARE Standard kapena zina Zowonjezera za TRICARE zomwe zafotokozedwa pansipa.
TRICARE Yowonjezera ndi Yowonjezera
Pulogalamuyi imapereka kusintha kwakukulu kuposa TRICARE Prime, koma ikhoza kubweretsa ndalama zowonjezera. Simukusowa kulembetsa pasadakhale kuti mugwiritse ntchito TRICARE Extra. Pansi pa pulogalamuyi, muwona Wopereka Wogulitsa TRICARE aliyense, perekani Khadi lanu la ID ndi kulandira chithandizo chamankhwala.
The TRICARE Authorized Providers ali ndi mgwirizano ndi asilikali kuti athetse malipiro awo. Pansi pa TRICARE Zowonjezerapo, mamembala ogwira ntchito ogwira ntchito amalipiritsa chaka chilichonse (chaka chimayamba mu October):
- Mzere E4 ndi pansipa kulipira $ 50 payekha, koma osaposa $ 100 pa banja
- Mzere E5 ndipo pamwambapa perekani $ 150 payekha, koma osaposa $ 300 pa banja
Kwa anthu ogwira ntchito pantchito komanso abambo omwe achoka pantchito (osakwanitsa zaka 65), pulogalamuyi imapereka ndalama zambiri, ngakhale ndalama zomwe zimaperekedwa pachaka zimakhala zofanana ($ 150.00 payekha kapena $ 300 pa banja.
Pansi pa TRICARE Zowonjezerapo, wothandizira zamankhwala amadzaza mafomu a Claim TRICARE kwa inu, ndipo amalandira kulipira kwa TRICARE kwa gawo lawo. Mumangowapatsa ndalama zanu zokhazokha.
TRICARE kwa Moyo
Mpaka posachedwa, pamene munthu wochoka kumudzi kapena wopuma pantchito atakwanitsa zaka 65, sadali woyenerera TRICARE. M'malo mwake, amayembekezeredwa kulandira chithandizo chamankhwala powapatsa thandizo la Medicare. Izi zinasintha mu 2001 ndi kulumikizidwa kwa TRICARE for Life (TFL). Apanso, palibe chifukwa cholembera pasadakhale (kupatula munthu ayenera kulembedwa ku Medicare Part B). Kuonjezerapo, malipiro okha pa pulojekitiyi ndi mapepala apadera a Medicare Part B. Pansi pulogalamuyi, muwona Medicare Provider ovomerezeka ndikupereka Khadi yanu ya ID. TRICARE ndiye amakhala malipiro achiwiri ndikupeza ndalama zomwe Medicare sizikuphimba.
Ngakhale kuti Medicare sichikuphimba ntchito zoperekedwa kunja kwa dziko la United States, anthu ogwira ntchito kumayiko ena angagwiritse ntchito mwayi wa TFL chifukwa TRICARE ndi amene amapereka chithandizo chamankhwala kwa iwo.
Mofanana ndi anthu okhala ku United States, oyenera kulowa usilikali kunja kwa dziko la Malawi ayenera kulembedwa ku Medicare Part B. TRICARE kwa Moyo idzapereka gawo lomwe lidzagwiritsidwe ntchito kwa anthu ogwira ntchito pantchito pansi pa 65 ndipo iwo adzakhala ndi udindo wofanana ndi ndalama za TRICARE komanso zopereka ndalama monga osapitirira zaka 65. Popeza ambiri omwe amapuma pantchito kunja kwa dziko lapansi sanalembetse ku Gawo B chifukwa Medicare sanayambe kulandira chithandizo chamankhwala cholandiridwa m'mayiko akunja, mabungwe ena omwe amachitira usilikali akukankhira chilango cha Part B chomwe chimaphatikizapo chilango cha 10% Chaka chilichonse munthuyo adzalandira gawo B koma sanalembetse. Komabe, pakalipano palibe ntchito zomwe zikusonyeza kuti kuchotsedwa kotereku kukubwera.
Mapindu a Pharmacy ndi TRICARE
Pali njira zingapo zothandizira mankhwala a mankhwala kudzera mu TRICARE:
Apolisi Apamadzi
Mukhoza kukhala ndi mankhwala odzaza (mpaka masiku 90 a mankhwala ambiri) kuchipatala cha mankhwala (MTF) kwaulere. Chonde dziwani kuti si mankhwala onse omwe alipo pa ma pharmacy a MTF. Malo alionse amafunika kuti apangitse mankhwala omwe ali pamutu waukuluwo (BCF). MTF, kudzera m'dera lawo la Pharmacy & Therapeutics Committee, ikhoza kuwonjezera mankhwala owonjezera kumadera omwe akukhala nawo pa MTF.
TRICARE Mail Order Pharmacy (TMOP)
Mungathe kuitanitsa mankhwala pa intaneti kapena kudzera pa makalata. Mukhoza kulandira kwa masiku 90 (mankhwala ambiri). Ndalama zowonjezeredwa ndi ndalama zokwana $ 0, pamene dzina lachangu ndi $ 20. Ndalama zopanda malire ndi $ 49 pokhapokha mutakhala ndi zofunikira zachipatala.
Mapulogalamu apakompyuta
Mukhoza kulandira mankhwala osokoneza bongo kwa masiku 30 kuchokera ku pharmacy mu TRICARE Pharmacy Network. Mtengo wa generic formulary ndi $ 10, ndipo mtengo wa dzina mayina formulary ndi $ 24. Palibe-formulary ndi $ 50 pokhapokha mutakhala ndi zofunikira zachipatala.
Ma-Pharmacies omwe alibe
Zomwe zimagulidwa ndi ma pharmacies omwe si a pa Intaneti amachokera kumene iwe uli, kuti ndiwe ndani komanso nthawi zina, ndondomeko yomwe mukugwiritsira ntchito. Mungafunikire kulipiritsa kutsogolo ndikuyika chiphaso chobwezera.
Ndalama zambiri zidzakhala zapamwamba, komabe, kwa omwe sapatsidwa ntchito. Mamembala ogwira ntchito yogwira ntchito adzalandira kulipira kwathunthu. Kuti mudziwe zambiri komanso ndalama zomwe zimaperekedwa kwa opindula, pitani tsamba la TRICARE mtengo wa webusaiti.
Ntchito Yogwira Ntchito / Kusamalira Mankhwala a Mitsempha
Kusamalira mano kwa ntchito yogwira ntchito, ndithudi, ndi ufulu kudzera kuchipatala cha asilikali. TRICARE, komabe, amapereka ndondomeko yowongoka ya mano kwa mamembala a ntchito yogwira ntchito ndi mamembala a Alonda / Reserves ndi mamembala awo. Mapulogalamuwa amafunika kulipira kwa mwezi uliwonse. Mapulogalamuwa amalipira ndalama zonse za chisamaliro cha mano, kuphatikizapo mtengo wa chisamaliro china cha mano. Miyezi yamakono yowonjezera pamwezi ndi (2003):
- Ntchito yogwira ntchito - Mmodzi wa m'banja, $ 8.11 pa mwezi. Awiri kapena awiri apabanja, $ 20.27 pamwezi.
- Zosungidwa Zosankhidwa - Kwa wothandizira usilikali, $ 8.11 pa mwezi. Kwa mmodzi wa m'banja, $ 20.27 pamwezi. Kwa oposa mmodzi m'banja, $ 50.67 pamwezi. Kwa wothandizira usilikali ndi banja lake, $ 58.78 pamwezi.
- Zokonzera Zokonzeka payekha (IRR) - Kwa wogwira usilikali, $ 20.27 pamwezi. Kwa mmodzi wa m'banja, $ 20.27 pamwezi. Kwa oposa mmodzi m'banja, $ 50.67 pamwezi. Kwa wothandizira usilikali ndi banja lake, $ 70.94 pamwezi.
TRICARE Dental Programs
TRICARE amapereka ndondomeko zitatu zosiyana za mano, aliyense kupyolera mwa wojambula wothandizira inshuwalansi wosiyana:
- Mapulogalamu Ogwira Ntchito Ogwira Ntchito: United Concordia
- TRICARE Dental Program: Metlife
- TRICARE Ndondomeko Ya Mankhwala Ochotsera Mimba: Delta Dental
Ndalama zowonjezera ma ARV zimadalira kumene mukukhala, ndipo chiwerengero cha mamembala a banja chimaphimbidwa.
VA Medical Care
Ndimathamangira kwa anthu nthawi zonse amene amaganiza kuti asiye usilikali aliyense kapena wachikulire angapeze chithandizo chamankhwala kwaulere ku Administration Wachiwembu. Osati zoona. Kuti mulandire chithandizo chamankhwala kuchokera ku VA, muyenera kukhala wachikulire (masiku opitirira 180 a usilikali), mukhale ndi ulemu wodalirika ndipo muli ndi matenda okhudzana ndi ntchito, kuvulala kapena kulemala, kapena muyenera kulowa muumphaŵi wambiri.
Zambiri zokhudza VA Medical Care zilipo pa Webusaiti ya VA.