Health Insurance Policy

A Health insurance policy is a contract between an insurance company and an individual. The contract can be renewable annually or monthly. The type and amount of health care costs that will be covered by the health plan are specified in advance, in the member contract or Evidence of Coverage booklet. The individual policy-holder's payment obligations may take several forms[7]: Premium: The amount the policy-holder pays to the health plan each month to purchase health coverage. Deductible: The amount that the policy-holder must pay out-of-pocket before the health plan pays its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of their health care is covered by the health plan. It may take several doctor's visits or prescription refills before the policy-holder reaches the deductible and the health plan starts to pay for care. Copayment: The amount that the policy-holder must pay out of pocket before the health plan pays for a particular visit or service. For example, a policy-holder might pay a $45 copayment for a doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service is obtained. Coinsurance: Instead of paying a fixed amount up front (a copayment), the policy-holder must pay a percentage of the total cost. For example, the member might have to pay 20% of the cost of a surgery, while the health plan pays the other 80%. Because there is no upper limit on coinsurance, the policy-holder can end up owing very little, or a significant amount, depending on the actual costs of the services they obtain. Exclusions: Not all services are covered. The policy-holder is generally expected to pay the full cost of non-covered services out of their own pocket. Coverage limits: Some health plans only pay for health care up to a certain dollar amount. The policy-holder may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some plans have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs. Out-of-pocket maximums: Similar to coverage limits, except that in this case, the member's payment obligation ends when they reach the out-of-pocket maximum, and the health plan pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year. Prescription drug plans are a form of insurance offered through many employer benefit plans in the US, where the patient pays a copayment and the prescription drug insurance pays the rest. Some health care providers will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay, as the insurance company pays according to "reasonable" or "customary" charges, which may be less than the provider's usual fee. Health insurance companies also often have a network of providers who agree to accept the reasonable and customary fee and waive the remainder. It will generally cost the patient less to use an in-network provider. Health plan vs. health insurance Historically, HMOs tended to use the term "health plan", while commercial insurance companies used the term "health insurance". A health plan can also refer to a subscription-based medical care arrangement offered through health maintenance organization,HMO, PPO, or POS plan. These plans are similar to pre-paid dental, pre-paid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a fixed number of services (for instance, $300 in preventive care, a certain number of days of hospice care or care in a skilled nursing facility, a fixed number of home health visits, a fixed number of spinal manipulation charges, etc.) The services offered are usually at the discretion of a utilization review nurse who is often contracted through the managed care entity providing the subscription health plan. This determination may be made either prior to or after hospital admission (concurrent utilization review). Inherent problems with insurance Insurance systems must typically deal with two inherent challenges: adverse selection, which affects any voluntary system, and ex-post moral hazard, which affects any insurance system in which a third party bears major responsibility for payment, whether that is an employer or the government. Some national systems with compulsory insurance utilize systems such as risk equalization and community rating to overcome these inherent problems. ' '

Alcohol: The Number One Drug in America

Alcohol, the most widely consumed drug in our society, when consumed moderation is not only harmless but also good for the body. Many experts claim that moderate drinking, about one to two drinks a day, is beneficial to health. However, other scientists continue to question the validity of these reports.
No reliable casual relationship exists between moderate drinking and the lower risk of death. Only that an association may exist. People who drink in moderation often eat a good diet and get exercise. Drinking in moderation may be a result of a healthy lifestyle, not something that makes a person healthy.
Supporters of moderate alcohol consumption still have to provide the necessary precautionary advice about the dangers of alcohol: injury even when used in small amounts; breast cancer and when consumed in larger amounts may result in liver disease, cancers, heart disease and strokes.
Yet over one hundred studies claim moderate alcohol use has a positive effect on mortality.

Alcohol Industry

The funds for these repots come from the alcoholic industry and support the academic centers in order to pay for research, train students and promote the findings. After a published analysis criticized the vast majority of the studies that scholars reviewed as flawed, Dr. Curtis Ellison, of Boston University published a rebuttal saying that scientists had reached a consensus that moderate alcohol use has beneficial effects on health. Industry grants partially funded the work of Dr. Ellison work. Marjana Martini, a senior vice president for the International Center for Alcohol Policies, a nonprofit group supported by the industry, helped with his rebuttal report. Tens of thousands of copies of the report, paid for by the industry, appeared as inserts in two medical journals: The American Journal of Medicine and The American Journal of Cardiology.
Drinking in moderation is no doubt healthier than excessive alcohol use. However, there may be more to the claim that moderate drinking is necessary for good health. For the industry that underwrite the claims, a lot more.
Source: http://www.nytimes.com/2009/06/16/health/16alco.html

Top 10 Sleep Myths

Shut Down

Myth 1: Sleep is a time when the body and brain shut down for rest and relaxation.
No evidence shows that any major organ (including the brain) or regulatory system in the body shuts down during sleep. Some physiological processes actually become more active while sleeping. For example, some hormones secretions rise and activity of the pathways in the brain needed for learning and memory increases.

One Hour Less

Myth 2: Getting just one hour less sleep per night than needed does not have any effect on daytime functioning.
This lack of sleep may not make a person noticeably sleepy during the day. However, even slightly less sleep can affect the ability to think properly and respond quickly. Sleep deprivation can compromise cardiovascular health and energy balance as well as the ability to fight infections, particularly if lack of sleep continues. If a person consistently does not get enough sleep, eventually a sleep debt builds up that will cause excessively tiredness during the day.

The Body Adjust Quickly

Myth 3: The body adjusts quickly to different sleep schedules.
The internal biological clock signals the body to be more alert during the daytime and drowsier at night. Thus, even if a person works the night shift, the body will naturally feel sleepy when nighttime comes. Most people can reset their biological clock, but only by appropriately timed cues and even then, by one to two hours per day at best. Consequently, it can take more than a week to adjust to a dramatically altered sleep/wake cycle, such as people encounter when traveling across several time zones or switching from working the day shift to the night shift.

Do It Less When Older

Myth 4: People need less sleep with age.
Older people do not need less sleep, but often get less sleep or find sleep less refreshing. As people age, the body spends less time in the deep, restful stages of sleep and wakes more easily. Older people are also more likely to have insomnia or other medical conditions that disrupt sleep.

Extra Sleep Cures Fatigue

Myth 5: Extra sleep at night can cure problems of excessive daytime fatigue.
Not only is the quantity of sleep important but also the quality of sleep. Some people sleep eight or nine hours a night but do not feel rested in the morning because the quality of sleep is poor. A number of sleep disorders and other medical condi­tions affect the quality of sleep. Sleeping more will not alleviate the daytime sleepiness these disorders or conditions cause. However, many of these disorders or conditions disappear with changes in behavior or with medical ther­apies.

Make Up Sleep on the Weekend

Myth 6: People can make up for lost sleep during the week by sleeping more on the weekends.
Although this sleeping pattern will help relieve part of a sleep debt, it will not completely make up for the lack of sleep. This pattern also will not make up for impaired performance during the week because of not sleeping enough. Furthermore, sleep­ing later on the weekends can affect the internal clock of the body so that it is much harder to go to sleep at the right time on Sunday nights and get up early on Monday mornings.

Naps

Myth 7: Naps are a waste of time.
Although naps are not substitutes for good sleep, naps can be restorative and help counter some of the impaired performance that results from not getting enough sleep at night. Naps can actually help the body and brain learn how to do certain tasks quicker. Avoid taking naps later than 3 PM, as late naps can interfere with the ability to fall asleep at night. In addition, limit naps to no longer than one hour because longer naps will make it harder to wake up and get back in the swing of things.

Snoring Is Not a Problem

Myth 8: Snoring is a normal part of sleep.
Snoring during sleep is common, particularly as a person gets older. Evidence suggests that snoring on a regular basis can make a person sleepy during the day and more susceptible to diabetes and heart disease. In addition, some studies link frequent snor­ing to problem behavior and poorer school achievement in children. Loud, frequent snoring can also be a sign of sleep apnea, a serious sleep disorder.

Not Enough Sleep Results in Sleepiness

Myth 9: Children who do not get enough sleep at night will show signs of sleepiness during the day.
Unlike adults, children who do not get enough sleep at night typically become more active than normal during the day. They often show difficulty paying attention and behaving properly. Consequently, doctors may misdiagnose children as having attention-deficit hyperactivity.

Worry Causes Insomnia

Myth 10: The main cause of insomnia is worry.
Although worry or stress can cause a short bout of insomnia, a number of factors can cause persistent inability to fall asleep or stay asleep at night. Certain medications and sleep disorders can keep a person up at night. Other common causes of insomnia are depression, anxiety disorders and asthma, arthritis or other medical conditions with symptoms that become more troublesome at night. Some people who have chronic insomnia also appear to be more revved up than normal, making it is harder to fall asleep.