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.

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Healthy Food Choices For The Elderly

When people age, their needs for nutrition change. It is important for elderly to eat healthy foods that are full of nutrients. Some medications, as well as illness, can affect the appetite of older people. To maintain health and independence longer, elderly people should make sure that when they do eat, that the food is good for them and will help maintain health. Healthy food choices can be made at home, in restaurants, and at the grocery store.

The types of foods that should be included in an elderly persons diet should include foods that promote the following:

Circulation (soy products, fruits, seeds)
Strong bones (cheese, milk, salmon, legumes, beet greens)
Resistance to illness (apples, citrus, broccoli)
Mental alertness (high protein foods, complete carbohydrates, omega-3 fats)

Foods that are high in antioxidants are also recommended for elderly people.

Healthy food choices for elderly in restaurants may include eating low fat meats, salads, vegetables, and grilled foods. For the elderly that has trouble maintaining weight, fresh whole grain breads can be chosen at restaurants. Going to restaurants that serve fresh, healthy, and homemade dishes will

Italian food is made with tomatoes, which are high in antioxidants. Cooked tomatoes, like what is found Italian tomato sauce for pasta contains the antioxidant, Lycopene, which gives tomatoes their deep red color. Tomatoes are also high in vitamin C.

Cheese is high in calcium, which helps build strong bones. Lasagna and other Italian dishes with cheese are good choices for elderly because they are at risk for fractures and broken bones.

Many studies have proved that for some, a glass of wine with a meal is very healthy, especially red wines.

When mental alertness in the elderly seems to be diminishing, before concluding that they need additional care or are suffering from Alzheimers, check the persons diet. The diet may cause low blood sugar. Drops in blood sugar can cause mental confusion. Changes in hormones for women can also cause mental confusion. When healthy food choices are being made and there still seems to be diminished mental alertness, ask the pharmacist about the medications being prescribed and if they may be the cause. If yes, make an appointment with the doctor to discuss alternatives and any new medications that might be available.

Going to a relaxing restaurant that offers healthy food choices, like Mama Jennies in Miami, Florida, can keep healthy eating from becoming boring.

Ultimate All Natural Supplements with regard to Health and Well being

In view from the busy, stressful existence they are living, more and more people turn to natural supplements health merchandise to help them accomplish and maintain their good health. Just eating the proper foods, exercising as well as sleeping well is not enough for the immune system to stay in terrific condition. Our bodies will need all of the essential vitamins, minerals, amino acids and nutrition in order to “work” adequately on a daily basis. So it is obligatory that people provide the organism with the correct dosage regarding holistic health supplies and natural supplements.

Natural health components are a cluster of health products such as vitamins, mineral Health supplements, herbal remedies, plant : based health goods, traditional medicines, holistic medicines, fatty acids, probiotics and also homeopathic cosmetics web hosting care such as antiperspirants, medicated wash, body lotions, anti-ageing creams or mouthwashes.

Thanks to the utilization of homeopathic health merchandise it has never been simpler to take control of your bodys wellness. You have the chance to set up your own health strategy perfectly designed to maintain your health at a good optimal level and keep you away from people unpleasant doctors visits and also pharmaceutical drugs we all dislike. Still if you are facing a serious illness or a potential debilitating health problem it is recommended that you simply consult a physician with knowledge in the field of wellness merchandise and health Supplements to help you create a program perfectly suited to your bodys needs and requirements.

For your ones still thinking about if they really wish health Dietary supplements, the answer then is “Yes, you do “. Just think about the overloaded lifestyle were residing in these modern nights, the constantly increasing consumption of fast food components, the pollution and its effects on our health, the stress we have to face every single day. Because of all these factors our health is put at risk every single minute. Just because you now feel and look great doesnt imply you should not try and avoid a future illness, fireside problem or earlier aging. Health Supplements will help you do just that. You dont have to wait until health issues, weakness, and nutritional deficiency strike. A proper health merchandise as well as holistic Dietary supplements regimen can retain the body illness – free of charge and allow you to reside a peaceful healthy life even in the particular hectic times we have been living in.

In order to begin to see the results of taking natural health materials and Supplements you have to pay additional attention to what you are purchasing and putting in your own organism. Do not dash and grab the lowest priced materials you find. Due to the increasing number of Internet surfers, now you can buy the merchandise on the web. Take your time, do your research and choose your health items and organic Health supplements wisely. Remember a sound body is a happy body!

Health Positive Aspects Of Practicing Jiu Jitsu

Health is very important in all our existence’s and we ought to take care of our well-being. Some even say that health is prosperity. This statement is usually correct since when you did not have wellbeing you may be healthy adequate to take pleasure in your variety, so in order to be rich you must be nutritious. Enable’s make your investigation for finding the best sport to be part of so you can get the optimum benefit in the bodily health, effectively that sport could well be Jiu Jitsu.

Jiu Jitsu is just not only the fastest rising martial artwork but it is also confirmed to be by far the most productive martial artwork inside planet. So just by studying Jiu Jitsu you definitely have an edge through absolutely everyone else. Nonetheless, the health and fitness advantages of coaching in Brazilian Jiu Jitsu are just incredible. It’s claimed you may reduce anywhere from 700 – 1,500 calories in one teaching session of Bjj. To shed that same total in jogging for the treadmill you’ll ought to run for numerous a lot of hrs to achieve a similar result from Bjj. If you coach in such a sport your cardiovascular is beating really swiftly along with the more rapidly your heart beats indicates the more extra fat burning your get the job done out is. And also however chances are you’ll not come to feel it in the course of teaching, your muscles are functioning like crazy all through your coaching sessions. Consider me in case you train five moments per week and eat appropriate you may have a six pack having a lil little bit of sit ups and you will see that your body is pretty toned.

Another excellent health profit if Jiu Jitsu is the fact that it keeps you active being a pastime. When you might be active and use a wholesome cardiovascular that also signifies that your sexual acts existence would reach more heights. Ask several wifes of Bjj practitioners and they’ll tell you how it has helped them. In fact, many individuals now take this martial art as a way of lifestyle for them. Many individuals also use this as being a coping mechanism. What I imply by that is certainly, when people today get stressed some people drink, smoke, or do different factors but Jiu Jitsu is the best of coping mechanisms. If you’re stressed out this will get a whole lot of stress away from your every day everyday living. Bjj decreases stress dramatically.

The Relationship Between Health And Fitness

Being active makes a person healthy and strong. It is not just for people who have a weight problem but for everyone who likes to stay fit.

There is a lot a person can do such jog or walk every morning, play basketball or any other sport with friends but if a person wants to have muscles and look lean, then one can sign up and workout in a gym.

People workout for 3 reasons;

The first is that the person is overweight and the only way to lose those extra pounds will be to reduce ones calorie intake and at the same time workout in the gym.

The second is that the person is underweight and the only way to add extra pounds is to have more calories in ones diet and workout.

The third is just for fun and to keep that person in shape.

The best exercise plan should have cardiovascular and weight training exercises. This helps burn calories and increase the muscle to fat ratio that will increase ones metabolism and gain or lose weight.

Just like taking any medicine, one should first consult the doctor before undergoing any form of exercise.

Here are some benefits of exercising;

1.It is the easiest way to maintain and improve ones health from a variety of diseases and premature death.

2.Studies have shown that it makes a person feels happier and increases ones self esteem preventing one from falling into depression or anxiety.

3.An active lifestyle makes a person live longer than a person who doesn’t.

Working out for someone who has not done it before should be done gradually. Endurance will not be built in a day and doing it repeatedly will surely be beneficial to the person.

It is advisable to workout regularly with a reasonable diet.

A person can consult with a dietitian or a health professional to really help plan a good diet program. It starts by evaluating the lifestyle and the health of the patient before any program can be made.

Afterwards, this is thoroughly discussed and recommended to the person which usually consists of an eating plan and an exercise program that does not require the use of supplements or one to purchase any expensive fitness equipment.

A good diet should have food from all the food groups.

This is made up by 2 things. The first is carbohydrates. The food that a person consumes should have vitamins, minerals and fiber. A lot of this can come from oats, rice, potatoes and cereals. The best still come from vegetables and fruits since these have phytochemicals, enzymes and micronutrients that are essential for a healthy diet.

The second is fat which can come from mono and poly saturated food sources rather than animal fats. Since fat contains more than double the number of calories in food, this should be taken in small quantities to gain or lose weight.

Another way to stay healthy is to give up some vices. Most people smoke and drink. Smoking has been proven to cause lung cancer and other diseases as well complications for women giving birth. Excessive drinking has also shown to do the same.

For people who don’t smoke, it is best to stay away from people who do since studies have shown that nonsmokers are also at risk of developing cancer due to secondary smoke inhalation.