Aad ayaan ugu faraxsanahay inaan ku dhawaaqno war cusub oo ku saabsan Qorshaha Caafimaadka Bulshada ee Washington (CHPW) Qorshe Baahiyaha Gaarka ah ee Dual Special Needs Plan (D-SNP). Ballanqaadkayaga joogtada ah ee ah in aan xubnahayaga siino daryeel gaar ah, dhaqangal Janaayo 1, 2024, waxaanu abuuraynaa laba Qorshe oo Baahiyaha Gaarka ah ee u Qalma laba kala duwan, Dual Complete iyo Labada Xul, si loo daboolo baahiyaha gaarka ah ee ka faa'iideystayaasha.
Dual Complete waxaa loogu talagalay shaqsiyaadka si buuxda u-qalma, oo ay ku jiraan kuwa hoos yimaada QMB+, SLMB+, CNP, iyo LCP-MNP. Waxay bixisaa faa'iidooyin iyo adeegyo fara badan, oo loogu talagalay in lagu bixiyo daryeel dhammaystiran oo shakhsi ahaaneed.
Labada Xul waxaa loogu talagalay shakhsiyaadka u-qalma qayb ahaan, oo ay ku jiraan kuwa hoos yimaada QMB, SLMB, QI, iyo QDWI. Waxay bixisaa faa'iidooyin iyo adeegyo la mid ah, marka laga reebo qaar ka mid ah sida (gaadiidka caafimaadka ee aan degdega ahayn, gunnada raashinka, iyo gunnada ka-hortagga-counter-ka).
Si kastaba ha ahaatee, iyada oo aan loo eegin qorshaha xubnahayagu ku diiwaangashan yihiin, Labada Qorshe ee Dhamaystiran iyo Labada Xulba waxay bixiyaan isku-dubarid daryeel oo isku mid ah, hubinta inay helaan taageerada iyo feejignaanta ay u baahan yihiin si ay u ilaashadaan caafimaadkooda iyo fayoobidooda.
Doorkaaga ku aaddan hirgelinta isbeddelladan.
Sida xubnaha muhiimka ah ee kooxda daryeelka xubinta, fahamkaaga iyo xidhiidhka isbeddeladan ayaa muhiim u ah xaqiijinta kala-guurka fudud ee xubnahayaga. Fadlan sii wad inaad ku dhaqanto aqoonta iyo xirfadaha aad ka heshay DSNP Model of training training, adoo xooga saaraya faa'iidooyinka iyo isuduwidda daryeelka ee ku sii jira labada qorshe.
Haddii aad qabto wax su'aalo ah ama aad u baahan tahay caddayn dheeraad ah oo ku saabsan isbeddeladan, fadlan la xidhiidh meesha aad kala xidhiidhayso gudaha CHPW. Waxaan sidoo kale cusbooneysiinay Sannadlaha Qaabka D-SNP ee tababbarka daryeelka ee 2023 si loo muujiyo isbedeladan.
| Qorshaha/ Faa'iidada CHPW MA | Laba Dhamaystiran* (HMO D-SNP) | Labada Xul* (HMO D-SNP) |
| Lacagta Billaha ah | $ 0 ** | $0 - $40.60 (qadarka saxda ah waxay kuxirantahay heerka Caawinta Dheeraadka ah) |
| Ka-baxsan-jeebka Ugu badnaan | $8,850 | $8,850 |
| Qaybta A | Isbitaalka bukaan-jiifka | $0 | $ 0 ama 20% |
| Kormeerka Isbitaalka Bukaan-socodka | $0 | $ 0 ama 20% |
| Qaybta B | Laga jari karo | $0 | Iyadoo aan la helin kaalmo-dhaqaaleedka kharashka-qeybsiga Medicaid oo dhammaystiran, laga jari karo $226 ayaa khuseysa. Lacagtani waxay isbedeshaa sanad walba |
| Daryeelka Koowaad/Telehealth (booqasho kasta) | $0 | $ 0 ama 20% |
| Caafimaadka Maskaxda (booqasho kasta) | $0 | $ 0 ama 20% |
| Daryeelka Khaaska ah/Telehealth (booqasho kasta) | $0 | $ 0 ama 20% |
| Daryeelka degdega ah (booqasho kasta) | $0 | $0 ama 20%; xadka $55 |
| Daryeelka Degdegga ah (booqasho kasta) | $0 | $0 ama 20%; xadka $100 |
| Ambalaaska ( adeeg kasta) | $0 | $ 0 ama 20% |
| Sahayda Sonkorowga | $0 | $ 0 ama 20% |
| Imtixaannada aragga iyo qalabka † | $0 lacag-bixineed - 1 imtixaan isha oo joogto ah sannadkii, $500 oo qorshe caymis ah ayaa xaddidaya sannad kasta dharka indhaha | $0 lacag-bixineed - 1 imtixaan isha oo joogto ah sannadkii, $500 oo qorshe caymis ah ayaa xaddidaya sannad kasta dharka indhaha |
| Adeegyada Ilkaha ‡ | $5,000 oo loogu talagalay ka hortagga iyo adeegyada dhammaystiran | $500 oo loogu talagalay ka hortagga iyo adeegyada dhammaystiran |
| Caafimaadka & Caafimaadka | Isku darka booqashooyinka 25 sannadkii ee acupuncture, naturopathy, xanuunka loo yaqaan 'chiropractic', iyo duugista | Isku darka booqashooyinka 25 sannadkii ee acupuncture, naturopathy, xanuunka loo yaqaan 'chiropractic', iyo duugista |
| Barnaamijka Jimicsiga | Qalabka jimicsiga, xubinimada jimicsiga | Qalabka jimicsiga, xubinimada jimicsiga |
| Cuntooyinka Marka aad u Baahan Tahay | 28 cunto marka isbitaalka laga saaro ama laga helay COVID-19 | 28 cunto marka isbitaalka laga saaro ama laga helay COVID-19 |
| Ka-hor-ka-counter (OTC) & Dukaamada | $100 bishiiba si aad ugu isticmaasho raashinka daboolan iyo alaabta OTC | Lama daboolin |
| Aaladaha Maqalka, Imtixaanada iyo Qalabyada | $2,250 sanadkii; $0 lacag bixinta imtixaanka & ku haboonaanta | $2,250 sanadkii; $0 lacag bixinta imtixaanka & ku haboonaanta |
| Gaadiidka | 40 safar hal-jid ah (xadka 50-mayl) sannadkii | Lama daboolin |
| Qoyska Dalbadiisa | 60 saacadood sannadkii oo taageero iyo gargaar shakhsiyeed ah | 60 saacadood sannadkii oo taageero iyo gargaar shakhsiyeed ah |
| Qaybta D | Laga jari karo | $0 | $0 - $545 (qadarka saxda ah waxay kuxirantahay heerka Caawinta Dheeraadka ah) |
| Qaybta D Dawada | Daawooyinka Guud: $0 | Daawooyinka Sumada: $0 | Daawooyinka Guud: $0 | Daawooyinka Sumada: $0 |
Faa'iidooyinka la muujiyay waa isku-xidhka oo ay maamusho VSP. Waxaad haysataa tiro door ah oo loogu talagalay muraayadaha iyo muraayadaha aasaasiga ah ee qadarkan faa'iidada ah.
‡ Faa'iidooyinka ilkaha waxaa maamula Delta Dental of Washington. Waa inaad aragto dhakhtarka ilkaha ee Delta Dental network si aad u hesho caymis. Si aad u hesho liiska ugu badan ee Delta Dental PPO Plus Premier network dentists, booqo deltadentalwa.com.
* Qorshayaal Dhameystiran iyo Dual Select waxay siiyan taageero dheeri ah shaqsiyaadka u qalma labada faa'iidooyinka Medicare Parts A iyo B iyo Apple Health (Medicaid). Dhammaan kharash wadaagga qorshayaashan, oo ay ku jiraan khidmadaha, caafimaadka, iyo kharashyada dawada, waxay ku salaysan tahay heerkaaga u-qalmitaanka Medicaid. Haddii aad ka diiwaangashan tahay Gobolka ama qorshe kale ee dheefaha Medicaid, Qorshaha Caafimaadka Bulshada ee Washington (CHPW) ayaa kaa caawin doona inaad xalliso arrimaha biilasha. Sida uu dhigayo Qorshaha Dual Complete, haddii aad leedahay laba xaaladood oo buuxa dhakhtarkaagu kuma dallici karo qaybsiga kharashka hoos yimaada dheefaha Medicaid. Dhakhtarkaagu waa inuu aqbalaa lacag bixinta qorshahayaga sidii lacag-bixin buuxda ama biil isha saxda ah ee Medicaid.
** Lacagta qorshahaaga billaha ah ee $40.60 ayaa la bixinayaa ilaa inta aad u qalanto 100% Kaalmada Dakhliga Hoose ("Caawimo Dheeraad ah").
