Monthly Archives: June 2017

Health Insurance and Health Care Reform in 2014

The most significant changes implemented by health care reform legislation will come into force on January 1st of 2014. These changes will have at least some impact on all individual and family policy holders and will also effect grandfathered policies that were effective on or before March 23, 2010. The positive changes will be for those who have been rated up or declined for health insurance in the past, for those who are currently or plan to become pregnant, and those whose income is less than 400% of the federal poverty level (I will be developing a worksheet to help you determine whether you are eligible for a subsidy). The negative changes will be for those who have an average or better than average health rating and for those on the younger end of the health insurance spectrum (20s-30s).

If You’ve Been Declined or Rated Up

If you have pre-existing conditions, you are now in the sweet spot of health care reform. Starting in October of 2013, health insurance companies will be able to begin accepting applications for policies with a January 1st, 2014 effective date. These policies will not use health status or pre-existing conditions to determine benefits, to decline or charge higher rates. Moving forward, the only factors that will contribute to your health insurance premium is the plan you choose, your age, and tobacco usage. I am not yet aware of how currently effective policies will transition, whether your rating will simply be removed from your existing policy or whether you will need to apply for a new policy to get rid of your rating. I will know more as we get closer to the open enrollment period starting in October 2013.

Maternity Coverage

If you are pregnant or are planning a pregnancy, starting on January 1st, 2014, all new health insurance policies will cover maternity automatically. It has not been made explicitly clear whether women who are currently pregnant will be covered. However, given the language of new policies regarding pre-existing conditions, I am comfortable in speculating that there will not be a waiting period for women who are currently pregnant and whose due date falls in 2014 and beyond. I will give updates as I become aware of definite regulations.

Health Insurance Subsidies

Health insurance policies sold through the NC exchange on or after October 2013, with January 1st effective dates, will be eligible for the subsidy. The subsidy amount will be based on your income and you will be eligible if your income is less than 400% of the federal poverty level. Based on income brackets, the premium you owe for your health insurance policy will be calculated as a percentage of your annual income. As previously stated, I will be creating a calculator to help you predict what percentage of your monthly income a health insurance policy will cost you. Health insurance agents will have the ability to assist you in purchasing a policy through the exchange.

Young and/or Favorable Health Rating 

If you are young and/or have a favorable health insurance rating, in almost all cases, you can expect rate increases in 2014. This rate increase is due to required pre-existing coverage and to rate variance shrinking from young to old subscribers. The purpose of coverage penalties for currently uninsured individuals is an attempt to bring in healthy policy holders and temper this increase. There will be high deductible plans available to those who want to satisfy the health insurance mandate while minimizing monthly premium expenses.

There is a danger however, that individuals with low health care expenses will be driven to companies that have high complaint ratios, but offer coverage that fulfills the mandate, because those with poor health are likely to gravitate towards the health insurance companies that most reliably pay claims. If a scenario like this occurs, the reliable health insurance company’s premiums will be driven very high, which may even cause them to go bankrupt if they are unable to attract healthy subscribers. The tragedy of this type of scenario would be that the bargain basement health insurance company would come out on top for the very fact that they don’t do a good job of paying claims.

Grandfathered Versus Non-Grandfathered

If your health insurance policy was effective on or before March 23, 2010, and you have not made changes to your benefit level since then, you have a grandfathered plan. Grandfathered plans are not subject to many of the health care reform requirements, so if you are one of those who expects to see rate increases due to coming changes, it makes sense for you to stick with your current plan for now. If you are in your 20s or 30s, and/or have a very good health rating with your current plan then you probably fall in this category. However, in several years, up to 40% taxes will be applied to grandfathered plans that will cause them to lose their appeal. When these taxes are applied, then in almost all cases it will make sense to roll into a non-grandfathered plan.

When to Enroll (Open Enrollment)

Starting in October of 2013, you will be eligible to begin applying for a policy that falls under the new health care regulations. The initial open enrollment period will last for 6 months. After this time, there will be an annual open enrollment period at the end of each year (October 15th-December 7th) in which you may switch your benefit level or apply for a policy with a new company. Outside of open enrollment periods, you may change your policy during special enrollment periods created by certain life events such as moving your residence, losing group coverage, getting married, or having a baby.

How to Enroll

The enrollment process for policies sold outside the exchange likely remain much the same as they are today with two major exceptions. Medical underwriting will no longer be a part of applications and enrollment periods will be restricted as described above. Policies sold inside the exchange will have the same type of applications as outside except there will be required proof of income if you are eligible for a subsidized policy. It is not yet clear what specific documentation or tax form will be required to substantiate claims of income.

Current Policies

If you currently have a health insurance policy that you are happy with and plan to keep your policy beyond the open enrollment period, your policy will likely transition on January 1st of 2014 and be automatically modified to accommodate the new regulations coming into force. As previously stated, I am not aware of how ratings on current policies will be handled. They might stay on, in which case you would need to apply for a new policy without a rating to shed your old health rating. The more likely scenario is that non-grandfathered policies will automatically shed their health rating and transition into the new rating pool for that specific policy.

Understanding Health Insurance in Virginia

Health insurance remains one of the most talked about topics when it comes to products that are indispensable for residents of Virginia. With continued increase in healthcare costs, the importance of health insurance plans keeps increasing.

It goes without saying that residents of Virginia without insurance coverage are at a greater risk of experiencing financial insecurity during illness or injury. No doubt health insurance plans involve costs but affordable health policies are easily available and with the implementation of healthcare reforms, lots of options will be available to the Virginians.

Traditional indemnity insurance plans in Virginia

Traditionally, indemnity health insurance plans in Virginia offer reimbursement against the claims made by an insured person. The level of coverage provided by these plans could vary from basic to comprehensive depending upon the needs of the insured person. Accordingly, the costs of the health plans vary-premiums, deductibles, copays and coinsurance, etc.

Managed health care plans in Virginia

Unlike indemnity health plans, managed care health insurance plans involve a group of medical providers that offer comprehensive medical services. They are called preferred or participating providers.

There are basically three managed care options:

• Health Maintenance Organization or HMO

HMOs allow the insured person to select a primary care physician from the plan’s list of medical service providers. If it is necessary, the primary care physician will refer the insured person to a specialist.

• Preferred Provider Organization or PPO

PPOs allow the members to avail large medical care network. At a slightly higher cost, a PPO generally allows its members to receive care outside its network of providers

• Point of Service feature or POS

POS medical plans are special types of HMOs that allow the members to select a non-network provider at a slightly higher cost.

Impact of the Affordable Care Act of health insurance in Virginia

• Around 109,000 small businesses in Virginia will be helped with tax credit.

• Medicare beneficiaries will be mailed a check automatically to defray the costs of their prescription drugs.

• Early retirees would be provided options for reinsurance.

• $113 million federal dollars will be made available to Virginia starting July 1 to provide coverage for people with pre-existing conditions.

• With the new Act, Virginia enjoys the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status, for the very first time.

• 4.7 million people in Virginia with private insurance won’t have to worry about lifetime limits on the coverage.

• 344,000 individuals will not have to worry about to get dropped from insurance policies when they get sick.

• Children would be able to stay in their family health insurance policy till the age of 26 years.

What to look for while buying affordable health plans in Virginia

• Virginians should note what is the maximum coverage level offered in the health insurance plan. This should be the prime deciding factor.

• The second point should be the costs involved in a health plan. This could include premiums, deductibles, copays and coinsurance. Consumers can adjust these costs as per their budget.

• Virginians should make sure, if needed, that the health insurance plan offers prescription drug coverage, doctor visits and hospitalization benefits. There is no need to buy a health plan if it does not offer such coverage benefits given that consumers need them.

• A High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) is a very good option to make sure that consumers get affordable health plans. Virginians should check about this.

• Virginians, who need to see a specialist, should make sure that the health insurance plan does not require them to get referrals.

• An affordable health insurance plan should have an easy reimbursement procedure. Virginians should make sure that they do not buy from such companies whose reimbursement process is too much complicated. Such plans could actually waste a lot of money and time.

Health Care Review

The concept of Health is somewhat difficult to understand. When we say a person is healthy, it means to the lay man that the person is normally doing his activities and does not outwardly show any signs of any disease in him. However, for the medical man it denotes the conformity to certain standards like physical measurements, biochemical norms and rates, physiological standards, etc. Even these standards vary with race, rest, exercise, food, habits, starvation, climate, altitude, latitude, etc. It has been extremely difficult for scientists concerned with human biology to lay definite criteria for health and define the term Health in a specific manner.

From the history of medicine we know that there have been various systems of medicine or healing arts evolved in different parts of the world during different civilizations. But in no system has there been a clear-cut definition of health.

In the oxford dictionary health means the state of being free from sickness, injury or disease, bodily conditions; something indicating good bodily condition. A few decades ago this meaning was conveyed in the definition of health but recently the World Health Organization have considered it necessary to give a direction towards the achievement of a robust and happy and active bodily and mental condition capable of continuous productive ability and, therefore, have defined health as follows:

“Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity.” (WHO—1948) it will be seen that even after having this definition it will be difficult to conceptualise and standardise positive health with specific clear-cut attributes and criteria for measurement. A person may be enjoying mental equanimity and enthusiasm for doing anything. He may also be physically able to do any amount of work, but he may be having some minor dysfunction or deficiency or even a mild infection causing a very minor disturbance which however does not upset his normal activities.

For example, Hyper pigmentation on the skin or lack of pigmentation on the skin; angular stomatitis due to B complex deficiency; a ring-worm patch on the skin, etc. In these conditions strictly speaking the person cannot be called ‘health’ but for outward purpose he will appear healthy and he will also be fully active. Similarly, under the mental component there are ever so many stresses and strains that an individual is exposed to and depending on his own mental make-up he is either able to overcome the strain or suffers from worry and depression. If in spite of his worry he is able to function normally others may take him to be healthy, whereas the worry may normally be making him mentally unsound.

Social well-being is very much related to the mental adjustment of the individual to others around him in the family or in the community. Sometimes it may so happen that a person may find it had to adjust with his group and may, therefore, be under a mental strain. But he may be doing his work normally from which others would judge him to be healthy. It is only if he reaches a break-point and behaves either in a withdrawn manner or becomes aggressive that his mental condition will become manifest to be seen and experienced by others.

We have, therefore, to understand that the term health is not an abstract thing but a relative concept. In it we see a continuum of freedom from sickness to better health and positive health. When we say positive health we refer to a condition in which the body has sufficient reserve nutrition and resistant factors to prevent the invasion of the body by any micro-organism or by the deprivation of any nutritional factors causing a deficiency pathology and, therefore, completely free from disease.

Disease is a little less difficult to define than Health. It denotes the condition of the human body in which something has gone wrong and has upset the Norman functions of the body including the mind. As in health there is also a continuum from a predisposition or premonition of illness which may or may not be experienced or noticed even by the individual concerned, to a definite condition of illness manifested by signs or symptoms and impairment of body functions.

This continuum may further extend from mild sickness to severe sickness and death or recovery from sickness back to a debilitated condition and later to a normal condition.

As has been pointed out in the previous paragraphs the normally of health of person may shift towards positive health depending on the improvement of health by wholesome food, wholesome water proper living conditions, proper work atmosphere, good personal hygiene, etc., or the deterioration of health due to faulty or inadequate food, infection through food, water or air, skin or due to external injuries, accident etc.

For maintenance of good health the following things are essential:

1. Adequate quantities of proper nutrition
2. Adequate quantities of safe drinking water
3. Proper shelter with adequate ventilation and lighting
4. Proper clothing
5. Proper work, exercise and rest and recreation
6. Proper social conditions for a harmonious existence and work
7. Proper security from fear of any kind
8. Proper sexual behavior
9. Personal hygiene
10. Provision and utilization of health services.

Disease can be due to say one or more of the following causes:

1. Genetic traits
2. Congenital deformity or malformation
3. Cancer
4. Malnutrition
5. Poisons

The above are the direct causes.

The science of epidemiology employs various methods and approaches to explore, investigate, identify and establish the cause of disease as against maintenance of health in the individual, in the community and in a geographical area. Modern epidemiology has revealed a multiple causation theory for most of the diseases. The direct or immediate causes may be congenital, traumatic, infection or cancerous growth, etc. But besides these direct causes, many indirect and predisposing causes have been described,

For example, tuberculosis is caused by the tubercule bacilli, called myco bacterium tuberculosis, this is the direct cause. The other causes which predispose a person to the infection by tubercule bacillus may be overcrowding, poor nutrition, bad ventilation, heavy work, fatigue, etc. It may be appreciated that these causes are socio-economic causes. The economic factors arising out of poor means of livelihood, inadequate food, etc., are also inter-related with human and social factors like bad ways of living, customs, habits, beliefs, superstitions, etc. Taking another example, malnutrition may be due to either lack of availability of nutritious food in adequate quantities or the wrong practices of preparation of food in which nutrients may be wasted. The economic factors may be the cause for non-accessibility and the social factors may be the cause of wastage of nutrition even after the food stuffs are available or on the contrary over eating and addiction to alcohol, etc., causing metabolic disorder. In the rural countryside we have a lot of locally available food resources but the habits may be such that the people do not know what can be eaten and how, for deriving nutrition.

The human and social factors are very predominant determinants in any society or community. In affluent countries many of the metabolic diseases like obesity, heart diseases, diseases due to air pollution, etc., are on the increase due to social customs. In the poor countries the large number of communicable diseases and nutritional deficiencies are due to poor sanitation, poor hygiene and low and faulty intake of food. These are again in turn due to economic and social factors.

Study of human behavior is extremely important in public health and in any community oriented programme. The mere opening and establishment of hospitals or clinics or treatment centers by any government or voluntary agencies does not immediately ensure that all the people will use the facilities whenever they fall sick. For a person to seek treatment for a particular illness from a doctor or an institution the following stages of human behavior are expected to take place.

Social psychology has a very prominent place as a diagnostic tool in the beginning of the programme and also as a tool of evaluation where the programme is under progress or at its termination. For example, in the control of Cholera or any gastro enteric infection, it will be futile to introduce any sanitation programme unless the people know the causative factor and the mode of transmission of infection. There may be need to improve the water supply, provide proper excreta disposal, food hygiene and personal hygiene. All these things involve a scientific awareness of the reasoning behind each measure or practice and a change of behavior accordingly.

Health and Your Inner Teacher

When you travel the halls of your memory, who do you remember as your most influential teachers? How did these teachers influence your life and change it for the better? Great teachers spark more than math, literature, or science in your life. They spark something else as well, something deeper and long-lasting that stays with you. As an individual living your life, you have another teacher you may not have touched on in your memory. That teacher is you! When you’re trying to get healthy and support your body and mind better, your inner teacher is key toward achieving what you want.

Health involves learning. You learn about your body and which lifestyle habits foster balanced health, versus which habits derail health. But you also learn something else. You learn about yourself as a person, how you face challenges, and which obstacles are blocking your road to health. The journey toward health involves more than regimens for diet, exercise, and sleep. The journey is unique to who you are and where you’re at in life too.

Bringing out your inner teacher to learn about your health isn’t always easy. Everyone wants to believe they are perfectly healthy, and sometimes facing the reality that your health needs more support can be challenging. It means admitting that you’re not perfect and that you still have more to learn. It takes knowing that supplements, medications, or doctor’s visits alone can’t keep you healthy. You as a person are an essential part of your health, and acknowledging this fact takes honesty and courage.

When you call forth your inner teacher in an open and honest way, you can explore your physical and mental-emotional health through a unique lens. You can ask yourself if there are societal and personal expectations that are burdening you and blocking your health. You can explore whether some part of your past unfairly has a hold on your health and who you are today. You can explore your relationships with yourself and other people to see whether they are supporting or hindering health. You can also notice how you manage stress and emotions and whether your current approach could use some adjustment for better health.

Good teachers both challenge you out of your comfort zone and patiently support you through the discomfort that can result. Getting healthier can feel strange and uncomfortable at times. The body and mind are used to doing what they always do—in other words, homeostasis or equilibrium. They will maintain states of health, but they also maintain states of unbalanced health. To get healthy, your inner teacher has to push you beyond comfortably unhealthy habits. On the other hand, your inner teacher also has to patiently help you through these potentially awkward transition periods and regularly remind you: “I can do this!”

What steps have you taken lately to bring out your inner teacher on the road to better health? If you feel that it’s been a while since you’ve listened to your inner teacher, that’s okay. He or she is always there and you can turn to that side of yourself when your health feels neglected or stuck. Remember to give your inner teacher the same respect that you would any other great teacher in your life.

As you head into the autumn season, a period of time that is infused with transition in the air around you, encourage your inner teacher by asking yourself the following questions:

1) What are current strengths in my health?

2) What are some weaker points of my health that require more attention and learning?

3) Without focusing too much on the past or the future, what steps can I take today toward better health?

4) What are my obstacles to health in the present moment?

5) How can I create space in my life for my inner teacher to express itself and help me with health?

As you ask yourself these questions, you’ll find that your body and mind naturally know which direction to go in—if you listen to them. By paying attention to your inner teacher, you’ll learn new things about your health and how better to support it. And you’ll enter your own hall of fame of great teachers.