Health Insurance Explained In Plain English – Part 1
Understanding health insurance and the health industry is much easier if you recognize some of the basic terminology and how it applies to you and your health insurance policy. If you have a health insurance plan and arent sure how it works or what the terminology means, take a few minutes to read the explanations below. Knowing these terms and what they mean to you can greatly aid you in dealing with your health care providers, insurance company, insurance agent, or during the health benefits shopping process.
Benefit Year
This is the 12-month period in which your benefits are calculated. Most insurance companies use a CALENDAR year, which is January 1 to December 31, but a few will use a 12 month period from when your policy goes into effect. For example, if your insurance goes into effect on June 1, the END of your benefit year is May 31. Make sure that you understand how your benefit year will be calculated.
Deductible
Deductible means the amount of money you must pay out of your pocket for medical expenses EACH YEAR before your health insurance begins paying out. Deductibles are usually reset to 0 at the beginning of each calendar or benefit year. Many insurance companies offer health plans that have benefits that are not subject to having to meet your deductible each year such as doctors office visits, immunizations, wellness or routine exams, etc. An easy way to remember what this term means and how it works is this:
When you have incurred medical expenses, all bills must be sent to the insurance company. When the insurance company looks at your bills, they then look at your policy and see how things are covered. They will then add up what the combined medical expenses have been for the year to date: determine what your deductible is and how much you have already paid towards meeting your deductible for the year, and pay out according to how your insurance policy says it will.
So in a nutshell, the insurance company is deducting your financial responsibility for medical expenses each year from the total combined medical expenses before they have any responsibility to pay outhence the term deductible.
Co-Pay
A co-pay is an amount that is paid by the patient to a provider at the time of service. It will either be a flat fee (like $15 or $20) or it can be a percentage of the service provided. The percentages or fee may vary depending on the type of service provided. A co-pay is different than coinsurance see next.
Coinsurance
Coinsurance is the percentage paid by the insurance company after you pay the deductible. Example: Your health insurance pays 70%, you pay 30%. The insurance company pays 70% coinsurance, you pay 30% coinsurance. Most health insurance policies will have a limit on the amount of coinsurance you have to pay out each year this is known as your Annual Coinsurance Maximum or Stop-loss.
Annual Coinsurance Maximum
After paying your deductible and after paying your coinsurance (classically 20% or 30% of medical expenses) to a certain dollar amount, your health insurance will pay 100% for the remaining costs in the calendar year. Example: After you pay your deductible, your health insurance pays 70% of medical expenses and you pay 30%. Once you reach the coinsurance maximum, you no longer pay 30% of the medical expenses because the insurance pays 100%.
Out of Pocket Maximum or Stop Loss
Stop Loss is the maximum amount of money you will have to pay out of your pocket in the benefit year.
Lifetime Maximum
This is the limit of the money the health insurance will pay out over your lifetime. Most major medical health insurance policies will be a $2 million lifetime maximum, while others will go as high as a $12 million lifetime maximum. In general, it is not recommended to have a policy with less than a $2 million lifetime maximum.
Office Visits
When you visit a doctor in their office they normally bill the health insurance company for an “office visit.” Most health insurance plans pay office visit expenses at the coinsurance (generally 70% or 80%) after the deductible. Some health insurance plans pay office visit expenses at the coinsurance rate but waive the deductible, which means you dont have to reach the deductible amount before they will cover their portion of the expense. Still other health insurance plans pay office visit expenses in full after a co-pay (usually $25 or $30). It should also be noted that office visits can be classified in two different categories. One category is usually called Routine Care, Wellness visits or Preventative care (see definition below). The other type of office visit is deemed as Medically Necessary (see definition below). Certain health insurance policies cover each of these types of visits differently and other plans do not cover them at all. If having these types of office visits covered by your health insurance policy is important to you, make sure you let your agent know so that they can help find the right plan for you.
Preventive Care
Preventive Care is classically defined as routine exams, immunizations, well child care, and cancer screenings. These include your yearly exams and checkups for things such as physicals, pap smears, mammograms, etc. Not all plans cover preventive care. It may not be a wise use of your money to have preventative care included in your plan if you never go to the doctor. A good health insurance agent can help you determine if this is necessary coverage for you.
Medically Necessary
These are the visits utilized for your smaller ailments such as colds, flu, ear infections or minor accidents. Not all plans cover medically necessary visits, so make sure you know if your policy includes these exams if you need them covered. You may consider purchasing accident insurance or adding a rider (explained below) to your policy to cover these types of issues.
Diagnostic Lab and X-Ray
These are tests involving laboratory or imaging services (such as x-ray, CAT scan, etc.) to diagnose a health problem. These services are usually paid at the coinsurance (typically 70% or 80%) after the deductible.
Chiropractic Care
When you visit a chiropractor for spinal manipulation or other services, these expenses are customarily paid at the coinsurance rate (70% or 80%) either after the deductible is met, or by waiving the deductible. Most health insurance plans limit the number of chiropractic visits/services to 10 or 12 per year especially if the deductible is waived. After this, additional visits are not paid by the health insurance plan, and you will be responsible for the full amount of the bill.
Inpatient or Outpatient Care
When you receive care from a hospital (inpatient or outpatient services), these expenses are customarily paid at the coinsurance rate (70% or 80%) after the deductible has been met.
Emergency Room
When you receive care from a hospital emergency room, these expenses are customarily paid at the coinsurance level (70% or 80%) after the deductible. Most health insurance plans also require you to pay an additional co-pay (commonly $75-$100) for each emergency room visit. A number of plans waive this additional co-pay if you are actually admitted to the hospital through the emergency room and the plan will pay as an inpatient service. A plan can sometimes be structured to have separate coverage for accidents as an additional rider (see definition below) to your policy.
Prescription Medications
Prescription medications can be classified as generic, brand name, or non-preferred brand name (see below for definitions). Please Note: Not all health insurance plans pay for prescription drugs, so if you already take prescription drugs or think you will need help in the future with prescription drugs, you will want to make sure that you are purchasing a plan that includes this coverage. Prescription drugs may be covered at the coinsurance rate (70-80%) after a deductible specifically for prescription drugs is met, other plans may include Prescription drugs in the total deductible for the plan.
Generic Medications
Drug manufacturers are permitted to sell a generic version of a medication after the patent expires for the brand name medication (generally 20 years after the brand name medication was registered). Generic medications are equivalent to the corresponding brand name medication, but are much less expensive than the brand name medication. Health insurance plans frequently provide better payment for generic medications as an incentive for you to ask for the generic version. About half of all prescription medications filled in the United States are filled with generic medications.
Brand Name Medications
Brand name medications are more expensive than generic medications. Most health insurance plans create a limited list of brand name medications that they will pay for and many health insurance plans also provide less coverage for brand name medications than for their generic counterparts.
Non-Preferred Brand Name Medications
Most health insurance plans create a limited list of brand name medications they will pay for. If your brand name medication is not on this list, it might be paid at a lower level under “Non-Preferred Brand Name Medications.”
Maternity
Some health insurance plans cover the cost of maternity, which includes doctor and hospital charges for prenatal care as well as labor and delivery. Maternity is expensive to add into a health insurance policy because it is considered a guaranteed expense for the insurance company. If a woman becomes pregnant, it is a safe bet that there is going to be medical expenses incurred! If there are no complications and the birth goes well, the insurance company will be out a large monetary portion of the cost of delivery and even more if there are problems with the delivery or the newborn. Insurance companies price maternity so that they can still maintain profits. In some cases it may be best to save your money and pay for the prenatal care and the delivery out of your own pocket (or on a credit card) and let the insurance cover the catastrophic events. The difference you save in the monthly cost of having maternity coverage may be well worth it to you. Remember, once you have a policy that covers maternity, you cant just remove the maternity coverage after the pregnancy is done! You will continue to pay for that maternity coverage for as long as you have that policy.
Mammography
Mammography is a specific type of imaging that uses a low-dose x-ray system for the examination of breasts to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms. Current guidelines from the American Cancer Society (ACS), and the American Medical Association (AMA) recommend a screening mammography every year for women, beginning at age 40. Various plans will have automatic coverage for mammograms but some will not. Several states (like Washington State, for example) have specific guidelines that require companies to have coverage for mammograms in their policies as an automatic benefit.
Mental Health
Outpatient mental health services include visits to a licensed counselor, therapist, or psychiatrist. Inpatient mental health services include admission to a psychiatric hospital. Many plans do not cover mental health services.
Rehabilitation Therapy
Rehabilitation therapy may include physical therapy, occupational therapy, speech therapy, message therapy, cardiac rehabilitation, and chronic pain therapy. Most health insurance plans limit rehabilitation therapy to a certain number of visits per calendar year or to a certain dollar amount that they will pay for rehabilitation for either the year or for a lifetime.
Rider
Anything that changes the way your policy acts by default is called a Rider. A rider can be anything from an exclusion of coverage for a medical condition, or additional coverage for potential conditions. (As in an accident rider mentioned earlier in this report)
Occupational Coverage/On the job coverage
The largest portion of health insurance plans do not cover occupational related medical expenses. This can be a HUGE pitfall for self employed people. Always make sure that if you need to be covered while you are working that your plan will give you on the job coverage. If you get injured or sick while you are on the job and you do not have Workmans Compensation or Labor and Industries accident coverage, you may have to pay for ALL medical expenses out of your own pocket.
Vision Coverage
Vision coverage is usually broken into two parts: vision exam, and vision hardware. Vision exam benefits include the cost of a refractive exam used to test vision acuity (20/20, 20/40, etc.). Vision hardware represents the cost of eye glasses or contact lenses. A number of health insurance plans do not cover vision exams or hardware. However, medical issues relating to the health of the eye (like Glaucoma) are almost always covered under the regular medical portion of the health insurance plan.
Doctor Directory
Each insurance company will have a list of doctors that the company has negotiated terms for payment of services with. You can go to the insurance company’s website to find a listing of contracted preferred providers.
This information may help you understand a policy that you already have, or aid you in understanding a policy that you may be thinking about purchasing. The more knowledge you have about what the industry jargon means, the more you will be able to make informed decisions about the insurance you choose to use.
Physical Health And Work Performance A Healthy Employee Enables A Healthy Work Environment
Physical health is very important in today’s work place. In today’s high end technology world it is necessary to work smart and possess great skills. There are many important jobs that require good skills and significant amount of strength to be able to perform at the high level. Physical health and work performance go hand in hand. Mental and physical health plays a very important role for an employee’s growth and productivity. It helps to improve the efficiency of the employee, leading to better performance.
Good physical health of workers helps in long-term cost benefit saving. Job performance can be predicted through physical health and physiological wellbeing. The productivity can be increased by good physical health of the workers. A company has comparatively higher percentage of educated and skilled workers, and by implementing an up-dated Industrial Safety Program, there can be a noticeable reduction in major accidents in the factory areas too.
Physical health and work performance of the employee are directly related. Healthy work environment will help in improving his productivity. It helps in giving job satisfaction to the employees. It is used to motivate the employees to work better and in safer manner i.e. work hard and play safe. It helps to reduce the expenses on medical aid. It also helps in reducing the labor turnover rate. Safety of the employees is one of the major concerns of the company.
Consequently adequate attention to the aspect of Industrial Safety and Hygiene for improving the production has been given in the last few years. As brought out earlier, it has formulated a well defined healthy environment, has constituted a safety committee and implemented measures for prevention of accidents and fire. All statutory provisions are being followed. A number of non-statutory provisions are also incorporated to improve professional environment.
In the present industrial environment most of the management of industrial organizations has realized the importance of physical health and work performance and is paying much more attention to healthy working environment than ever before. The statutory provisions made by the government, awareness of the workers and the employers about the importance and advantages of good hygiene for good and healthy working condition which has to be improved, developing healthy working conditions for the employees in the industrial organizations.
Unsafe conditions must be removed and unsafe act totally avoided. That would prevent accidents and thus ensure safety of the employees and that of the plant and machinery. There is a need for management to have a sincere and humanitarian interest in their employees. They must implement a good safety program in their factories. When top management supports good safety program on humanitarian grounds, it contributes towards increased production, lower costs and better profits. There is no doubt that companies have realized its motive of physical health and work performance being inter related by providing a safe and labour friendly environment. In fact, companies have used this as a tool or means to keep harmonious industrial relation.
Improvement in physical health aims at the promotion of the workers physical, mental and social wellbeing. It will also help to improve the physical health and work performance of the employees resulting in increased morale of the employees who are associated with the work environment.
[Top]Drug Patents Are Good For Our Health
Miles White, Chairman and CEO of Abbott Laboratories recently wrote about the importance of drug patents for the future of medicine. He began by talking about a case settled by Abbott and the South American country of Brazil. Brazil felt that the price of Abbotts AIDS medication Kaletra, the most widely used AIDS medication, was too high and patients could not afford it. They were threatening to break Abbotts patent and produce a generic version locally in order to treat more patients. The two sides reached an agreement as Abbott agreed to significantly reduce the price per patient and the government agreed to honor the patent.
White points out that while this situation ended well for both parties involved, this issue should not be forgotten. He writes, we cannot let the agreement end discussion of the ideas involved; it is essential that we consider their implications so as to avoid situations that might not be so fortunately resolved. What hangs in the balance is how the world will continue to develop the medicines it needs.
He also writes about the need for a balance to exist between innovation and access to medicine:
The negotiation raised a well-worn chorus of criticisms of the patent system, but failed to address the underlying question: how would our society continue to progress without it? The problem is that our global needs and global systems are in conflict. This threatens to harm one goal, innovation, in the name of another, access to medicine. Access is the goal the world cares about and one taken seriously by innovator companies (those that conduct research and development of new medicines) that have made significant contributions to this end across the developing world – from building healthcare infrastructure in Africa, to drastic price cuts that have benefited a wide range of countries, including Brazil. But it must be recognized that access is inseparable from innovation: without access, innovation is meaningless; without innovation, there is nothing to have access to.
White concludes by quoting President Abraham Lincoln, The patent system added the fuel of interest to the fire of genius. The patent system exists so that innovation can continue. So scientists discoveries are protected.
[Top]Seven Relationship Talk Guidelines – Questions to Ask a Partner before Doing the Deed
When things are getting hot and heavy, the last thing either partner wants to do is sit down and have a serious conversation about their intimate contact lives: past, present, and future. However, assuming the tryst isn’t a complete spur-of-the-moment deed that is sure to be one-night-stand situation, it is important to have “the relationship talk” well in advance, lest one end up with a life-long reminder of this moment of passion in the form of a partner-transmitted infection or unwanted pregnancy. For the record, even if both partners are in favor of a single night hook-up, this is no reason not to use protection – and perhaps even more reason to do so, as such wild spirits may be more likely to have a history of sensual risk-taking, which statistically increases their chance of infection of some type. It is above all important to stay healthy; after all a healthy male organ is important for a healthy reproductive life.
Are they a virgin? A potential partner may seem experienced, but it is better to ask if they are experienced than to assume they are; after all, taking someone’s v-card is a whole different ballgame. A female losing her virginity may experience pain, and even bleeding, so a man will certainly want to know if such a thing is a possibility.
How many other partners have there been? Not only is it wise to know how many partners have been there before, it is a good idea to know how many partners a person has had since their last partner-transmitted infection screen. Remember, when a couple decides to have relations, they are not just sleeping with each other; they are sleeping with every person that partner has been with, and the people their partners were with, and so on and so forth. If any number of those people had an infection, it could have been passed along from person to person.
When was their last health screen? Where they tested for immunodeficient virus? An active person who is having intimate contact with multiple partners should be screened every 6 months at a minimum – more frequently if they have reason to believe they were exposed (i.e. intimate contact with partner who was infected, protection that broke, etc.).
Have they ever tested positive for an infection? Was it treated? This doesn’t necessarily have to be a deal breaker if a partner was positive, but it is his or her responsibility to inform all new partners if they have had an infection so they can make an informed decision about whether they want to proceed or not. In the cases of something like herpes, it is also important to know when their last outbreak was and how the infection is being treated or controlled.
There is protection, right? This one is a no-brainer. It is important to establish that safe intimate contact is important prior to starting a physical relationship, so the standard is set from the beginning.
What about hormonal birth control? Men starting a relationship with a woman should ask her if she is on a type of hormonal birth control. Latex barriers, of course, the first line of defense, but it is good to know if there is a backup in place.
What intimate activities are okay? What is off limits? Finally, the fun part! It is good to know what activities the partner prefers or enjoys so the intimate experience is comfortable for both partners. Likewise, if something is a big no-no, it should be put on the table at the beginning so there isn’t an awkward moment later on in the bedroom.
Keeping the male organ healthy
In addition to using protection and consistently getting screens to keep the male organ healthy, a man can take it one step further by using a male organ health formula (health professionals recommend Man 1 Man Oil) on a daily basis that is packed with vitamins and other nutrients to keep the skin soft and smooth and reduce the risk of surface abrasions and other injuries. A quality male organ crme can also improve the sensitivity and appearance of the manhood – something that can benefit all men.
Visit www.man1health.com for more information about treating common male organ health problems, including soreness, redness and loss of male organ sensation. John Dugan is a professional writer who specializes in men’s health issues and is an ongoing contributing writer to numerous online web sites.
[Top]Tropical Herbs The Secret Of Health Forever.
Health forevers Jobelyn health product is extracted from Sorghum, also known as Sorghum Bicolor which is a tropical herb that is grown on the Health Forever plantation. This plantation involves sustainable practices and fair trade CSR policies. Improved quality, effectiveness and energy can be guaranteed by administrating Jobelyn, right from the process of planting to packaging.
Along with cultivation, packaging and development process involved to achieve our own line of dietary supplements that support an array of fitness goals, we also indulge in supplying wholesale medicinal herbal ingredients. Most importantly, we are committed to use herbs in their most complete and natural form for all our finished products and raw ingredients. This way, the body is able to exploit the complete and amplified synergistic mix that has been naturally created. In addition, due to our cautious process of manufacturing, there is an added advantage of quality control and efficiency.
About Sorghum Bicolor
Sorghum Bicolor is a grass species cultivated for its edible grain. It is commonly known as Sweet Sorghum or Guinea-corn. Basically originated in Northern Africa, it is now cultivated widely in tropical and subtropical regions. Sorghum bicolor is a grain long known for its high nutritional value, however only a special traditional extract of the leaf sheath draws out the plants incredible health benefits. The decoction of the seeds is used in the treatment of kidney and urinary complaints. As herbal remedy, it is capable of boosting blood levels which cures anemia ,get rid of inflammation and pain, repeal cell damage (antioxidant) and raise cellular immunity in those who are gripped by Acquired Immune Deficiency Syndrome (AIDS), Human Immuno-deficiency Virus (HIV) and also widely in use in lots of herbal preparations.
Along with Northern Nigeria, the cereal is touted to be a staple food in more than 30 countries. South Western Nigeria has been making use of Sorghum bicolor for generations for treating complex diseases like multiple myeloma, leukemia, heart and other blood-associated problems even for trivial diseases like headaches. The herbal preparation is made in terms of an herbal non-alcoholic beverage, kunu-zaki (in Hausa), and thick porridge or porage, tuwo dawa (in Hausa) and tasty pap, akamu (in Ibo).
Health Forevers Core Competencies
Health Forever follows the below know-how from the process of planting to packaging.
Discovering and sourcing effective plants and herbs from diverse geographical sites.
Researching herbs and their active ingredients.
Conducting pre-clinical and clinical studies on the effects of herbal preparations.
Planting, cultivating, developing and packaging preparations for use and distribution.
At Health Forever, our comprehensive cultural knowledge of tropical plants and their conventional applications is matched up with the contemporary scientific testing. Moreover, we are persistently categorizing useful plants, developing new supplement formulas and exploring the ideas to conclude the worth of our health products. Our each and every natural remedy has been considered to be well accepted and successful.
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