Tuesday, June 20, 2006

Individual Health Insurance Company - Why Should I Look for One?

Even though many people choose whether or not to take a job, as well as keep a job, based on benefits such as a great health insurance package, not all employers offer health insurance packages. And, they are not required to. If you work for an employer such as a small-business owner, chances are you are not going to be able to get health insurance through your job. Unless you are married and can be added on to your spouse’s health insurance, you will most likely need to look into purchasing an individual health insurance.

Other people who will be interested in finding individual health insurance include those who are unemployed for various reasons, including the return to school, and those who are self-employed. The good news for self-employed individual health insurance policy holders is that the insurance premium is tax-deductible.

With the seemingly steady rise of already expensive medical costs, health insurance is something everyone needs. Health insurance offers a sense of financial security as well as peace of mind. The number of people in America who are currently without some type of health insurance is always astounding. Having health insurance helps protect you and your family from financial disasters in the all too often event of a major injury or illness. Even if the medical situation is not quite as severe, it is still better to have health insurance to help with the medical costs than not have it.

Remember, most all of us have other bills of some sort that must be paid. It will be difficult to manage payment of them all once those medical bills start rolling in and you do not have health insurance to help with the costs. It is true that an individual health insurance company is most likely going to have much higher rates and much more limited coverage, but if purchasing individual health insurance is your last option, it is one you should definitely take.

Visit EZ Quote Guide to find affordable health insurance. We also offer cheap car insurance quotes online.

To learn more about purchasing individual health insurance online visit our site today.

Monday, October 03, 2005

Is Drug Screening Too Costly To Do Or Do Without? One Company Has The Answer!

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Is Drug Screening Too Costly To Do Or Do Without? One Company Has The Answer!
by Laura Betterly


The director of telemarketing operations at a financial services company looks out across his 3600 square foot call center on a typical Monday morning. "Look at all those empty chairs", he laments. "It is sickly Monday and my partiers are taking their usual unscheduled day long break". The problem of the "three day weekend" or absenteeism in general doesn't just affect the manager in this setting. What about the other 80% of the work force who showed up? They are now burdened with additional duties while filling the vacancies that have temporarily developed.

With the challenge of recruiting qualified workers becoming more difficult all over the nation, the last thing American businesses can afford is to have major portions of its existing work force abusing drugs - on or off the job. The truth is that most employees do not engage in illicit drug use and most do not want to work side-by-side with drug abusers. A majority of employees are parents who are concerned about the effects of drug abuse on their children, now and in the future. Given this profile of the typical American workers, it is clear that substance-abuse prevention can and should be viewed as a common concern of both employers and employees.

We interviewed one company that has recognized the true damage that drugs in the workplace causes and why it is still prevalent. Labwire, Inc. (http://www.labwire.com), a Houston, Texas based developer of online security solutions, began addressing what many medium and large size companies have consistently failed to address--the true cost effectiveness of their testing programs. "What stops companies from being effective about drug prevention in the workplace is the apparent cost to do so", states Dexter Morris, President of the company. "What most companies don't understand is the wasted cost of NOT using the latest in technology management in handling such issues," he added.

Drug use in the workplace costs this country billions of dollars every year in lost productivity, increased health problems and workplace accidents, to say nothing of the problems it causes us at the federal and state level with associated family problems. Contrary to the typical portrayal of drug abusers, many apparently functional drug and alcohol abusers manage to hold down full or part-time jobs, masking their destructive problem from their employers. In fact, over seventy four percent of all current illegal drug and heavy alcohol * users hold down some type of job. *(Those drinking five or more drinks per occasion on five or more days in the 30 days preceding the survey). According to the U.S. Department of Labor, more than 8 million Americans use some type of illegal substance.

The overall cost of illicit drug abuse is estimated to have been $160.7 billion in 2000, and 69 percent of these costs are from productivity losses due to drug-related illnesses and deaths. Reducing substance abuse positively impacts America's economic landscape.

Medium businesses bear the greatest burden of substance abusers. Traditionally, larger employers participate in drug-free workplace practices. As a result, medium to large employers who do not have drug free workplace policies in place are - in essence - adversely selected against in terms of the employees that are left to hire. Another thing to note is that substance abusers will steer away from drug-free workplace companies. They will work for those businesses that don't have a policy or a program and where there is no drug testing involved. Let's face it, no abuser wants to be detected.

"The fact that medium and large size companies are at greatest risk is why we developed our web-based employee screening process. Any company can deploy this system inside of 30 days", says Morris confidently. "In fact, we can train up to 100 human resource people on how to use our system in only 60 minutes online".

Morris went on to say that just the cost of workers compensation claims can bury a company. Drug-using employees are 3.6 times more likely to be involved in workplace accidents and five times more likely to file a workers' compensation claim. Between thirty eight and fifty percent of all workers' compensation claims are related to substance abuse per the National Council on Compensation Insurance.. Substance abusers are three times more likely to use medical benefits than other employees.

According to Edward Poole, president and COO of OHS Health and Safety Services Inc., in Costa Mesa, Calif., several government and private industry studies concluded that each drug user in the workplace "can cost an employer an average of $11,000-$13,000 annually." Despite studies and surveys that indicate a significant number of substance abusers hold jobs and work while under the influence, Poole points out that many employers have an "it can't happen here" attitude about substance abuse in the workplace. "Once they get in there and implement a policy and start testing employees, they're usually very surprised by the results," he says.

Poole tells the story of one client who operated a small, local delivery service. When a representative from OHS Health and Safety Services visited the business owner, he stated repeatedly that there was no reason to conduct drug testing in that workplace. After all, the company had only 63 employees. After a couple of years of rebuffing them, the delivery service owner called OHS to start up an immediate screening program. Apparently the company had a change of heart after observing unusual behavior in their workforce. OHS showed up unannounced one day after performing roughly 45 days of drug free workplace education, and did what's called a "sweep." They were going to test every employee in the workplace.

Nine people immediately walked off the job. Says Poole, "One or two probably had deeply rooted beliefs in the right to privacy and all that crap, but it is probably safe to say that most of those nine employees would have tested positive." Out of the 54 who took the drug test, 19 tested positive for marijuana and several tested positive for cocaine as well. "The employer was shocked," says Poole, "Most employers have no clue how many employees are working under the influence."

Once a company decides to confront its potential workplace issue regarding illicit drug use the problem of finding the appropriate security company crops up. "There are a lot of companies professing to have the expertise to address drug screening issues", Morris cautions. "Just find out what their track record is and talk to some of their clients".

Many companies are heading the warnings about drug abuse in the workplace. According to data on companies that test employees, drug testing increased from twenty one and a half percent to almost eighty five percent in one six year period - a two hundred and fifty percent increase. Recent evidence suggests that drug testing has now leveled off and in fact has decreased slightly, but primarily among medium businesses. National studies indicate that sixty six percent of the country's largest firms engage in some type of drug testing. Among Fortune 500 companies, during the late 1980s and early 1990s, drug testing likewise increased in use. For example, in 1985 about eighteen percent of Fortune 500 companies tested their employees. The number increased to a high point of forty percent by 1991. Among Fortune 1000 firms, forty eight percent of employees are subject to drug testing.

"These are good trends overall", says Morris when asked about the increase in drug screening across the US. The weakness in screening program administrations (drug testing and background screens) by medium and large size businesses is the increasing focus of Labwire's business model. "We know what the solution is for tens of thousands of companies, and we are it", concludes Morris. With companies like Labwire, who are building affordable applications, coming onto the scene, maybe your call center manager will have better attendance on future Monday mornings.

Laura Betterly Press Direct International


About the Author
Press Direct International is a global information web site providing indispensable information tailored for professionals in the financial services, media and corporate markets. Our information is trusted and drives decision making across the globe. We have a reputation for speed, accuracy and freedom from bias. For more info visit http://www.pressdirectinternational.org












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Healthcare system

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Healthcare system

A healthcare system is the organization by which health care is provided.

Although some view healthcare from an economic perspective as being no different from other products or services, others believe it has many characteristics that encourage government intervention or regulation:

The provision of critical healthcare treatment is often regarded as a basic human right, regardless of whether the individual has the means to pay—at the same moment some forms of healthcare treatment cost more than a typical family's life savings.
Healthcare professionals are bound by law and their oaths of service to provide lifesaving treatment.
Healthcare professionals are monopolists in various respects: surgery, gynecology, prescribing, etc.
Consumers often lack the information or understanding to be able to choose rationally between competing healthcare providers when they need treatment, particularly in the event of the need of urgent or emergency treatment.

Healthcare systems models
Purely private enterprise healthcare systems are comparatively rare. Where they exist, it is usually for a comparatively well-off subpopulation in a poorer country with a poorer standard of healthcare–for instance, private clinics for a small, wealthy expatriate population in an otherwise poor country. But there are countries with a majority-private healthcare system with residual public service (see Medicare, Medicaid).
The other major models are public insurance systems:
Social security healthcare model, where workers and their families are insuranced by the State.
Publicly funded healthcare model, where the residents of the country are insured by the State.
Sickness insurance model, where the whole population or most of the population is a member of a sickness insurance company, which many regard as the ideal U.S. model, but which due to increasing costs is now less true than it was previously in the U.S.
In almost every country with a government health care system a parallel private system is allowed to operate, this is sometimes referred to as two-tier health care. The scale, extent, and funding of these private systems is very variable, however. In Canada the lack of private care is notable, and pride is widespread in their one-tier system of only government-provided healthcare, largely coordinated at the provincial level.





See also
Accident compensation
Canadian and American health care systems compared
DRG
Emergency services (see also Lifeline)
Healthcare delivery
Healthcare professionals
Healthcare reform
HMO
Health insurance
International aid organizations (e.g. World Health Organization)
National Health Service (British system)
Publicly funded medicine
Social security
Workplace insurance
Retrieved from "http://en.wikipedia.org/wiki/Healthcare_system"
From Wikipedia, the free encyclopedia.








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HIPAA

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HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996.

According to the Centers for Medicare and Medicaid Services' website, Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs.

Title II of HIPAA, the Administrative Simplification provisions, required the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.

The AS provisions also address the security and privacy of health data. The standards are meant to improve the efficiency and effectiveness of the nation's health care system by encouraging the widespread use of electronic data interchange in health care.

Contents [hide]
1 Administrative simplification provisions
1.1 Privacy provision
1.2 HIPAA Administrative Simplification (HIPAA/AS)
1.3 Security provision
2 Legislative information
3 See also
4 External links




Administrative simplification provisions

Privacy provision
The HIPAA Privacy provision took effect on April 14, 2003.

Key privacy provisions include:

Patients must be able to access their record and request correction of errors
Patients must be informed of how their personal information will be used.
Patient information cannot be used for marketing purposes without the explicit consent of the involved patients.
Patients can ask their health insurers and providers to take reasonable steps to ensure that their communications with the patient are confidential. For instance, a patient can ask to be called at his or her work number, instead of home or cell phone number.
Patients can file formal privacy-related complaints to the Department of Health and Human Services (HHS) Office for Civil Rights.
Health insurers or providers must document their privacy procedures, but they have discretion on what to include in their privacy procedure.
Health insurers or providers must designate a privacy officer and train their employees.
Providers may use patient information without patient consent for the purposes of providing treatment, obtaining payment for services and performing the non-treatment operational tasks of the provider's business.

HIPAA Administrative Simplification (HIPAA/AS)
The HIPAA/AS provision was scheduled to take effect October 16, 2003; however, due to widespread confusion and difficulty in implementing the rule, CMS granted a one-year extension to all parties. As of October 16, 2004, full implementation was not achieved and CMS began an open-ended "contingency period." Penalties for non-compliance were not levied; however, all parties are expected to make a "good-faith effort" to come into compliance.

CMS has announced that the contingency period will end July 1, 2005. After July 1, most medical providers will have to file electronic claims in order to be paid. There are exceptions for doctors that meet certain criteria.

Key EDI transactions are:

837: Medical claims with subtypes for Professional, Institutional, and Dental varieties.
835: Electronic remittances
270/271: Eligibility inquiry and response
276/277: Claim status inquiry and response
278: Health Services Review request and reply
Implementation Guides are available for free from the Washington Publishing Company.


Security provision
The HIPAA Security provisions took effect April 20, 2005. The Security provision complements the Privacy provision. HIPAA defines three segments of security safeguards for compliance: administrative, physical, and technical. Key provisions are:

Administrative Safeguards - policies and procedures designed to clearly show how the entity will comply with the act
Covered entities (entities that must comply with HIPAA requirements) must adopt a written set of privacy procedures and designate a privacy officer to be responsible for developing and implementing all required policies and procedures.
The policies and procedures must reference management oversight and organizational buy-in to compliance with the documented security controls.
Procedures should clearly identify employees or classes of employees who will have access to protected health information (PHI). Access to PHI in all forms must be restricted to only those employees who have a need for it to complete their job function.
The procedures must address access authorization, establishment, modification, and termination.
Entities must show that an appropriate ongoing training program regarding the handling PHI is provided to employees performing health plan administrative functions.
Covered entities that out-source some of their business processes to a third party must ensure that their vendors also have a framework in place to comply with HIPAA requirements. Companies typically gain this assurance through clauses in the contracts stating that the vendor will meet the same data protection requirements that apply to the covered entity. Care must be taken to determine if the vendor further out-sources any data handling functions to other vendors and monitor whether appropriate contracts and controls are in place.
A contingency plan should be in place for responding to emergencies. Covered entities are responsible for backing up their data and having disaster recovery procedures in place. The plan should document data priority and failure analysis, testing activities, and change control procedures.
Internal audits play a key role in HIPAA compliance by reviewing operations with the goal of identifying potential security violations. Policies and procedures should specifically document the scope, frequency, and procedures of audits. Audits should be both routine and event-based.
Procedures should document instructions for addressing and responding to security breaches that are identified either during the audit or the normal course of operations.
Physical Safeguards - controlling physical access to protect against inappropriate access to protected data
Responsibility for security must be assigned to a specific person or department. This responsibility includes the management and oversight of data protection and personnel conduct with respect to data protection. Frequently, a Chief Security Officer position is established to fulfill this requirement. This position typically reports to executive level management.
Controls must govern the introduction and removal of hardware and software from the network. (When equipment is retired it must be disposed of properly to ensure that PHI is not compromised.)
Access to equipment containing health information should be carefully controlled and monitored.
Access to hardware and software must be limited to properly authorized individuals.
Required access controls consist of facility security plans, maintenance records, and visitor sign-in and escorts.
Policies are required to address proper workstation use. Workstations should be removed from high traffic areas and monitor screens should not be in direct view of the public.
If the covered entities utilize contractors or agents, they too must be fully trained on their physical access responsibilities.
Technical Safeguards - controlling access to computer systems and enabling covered entities to protect communications containing PHI transmitted electronically over open networks from being intercepted by anyone other than the intended recipient
Information systems housing PHI must be protected from intrusion. When information flows over open networks, some form of encryption must be utilized. If closed systems/networks are utilized, existing access controls are considered sufficient and encryption is optional.
Each covered entity is responsible for ensuring that the data within its systems has not been changed or erased in an unauthorized manner.
Data corroboration, including the use of check sum, double-keying, message authentication, and digital signature may be used to ensure data integrity.
Covered entities must also authenticate entities it communicates with. Authentication consists of corroborating that an entity is who it claims to be. Examples of corroboration include: password systems, two or three-way handshakes, telephone callback, and token systems.
Covered entities must make documentation of their HIPAA practices available to the government to determine compliance.
In addition to policies and procedures and access records, information technology documentation should also include a written record of all configuration settings on the components of the network because these components are complex, configurable, and always changing.
Documented risk analysis and risk management programs are required. Covered entities must carefully consider the risks of their operations as they implement systems to comply with the act. (The requirement of risk analysis and risk management implies that the act’s security requirements are a minimum standard and places responsibility on covered entities to take all reasonable precautions necessary to prevent PHI from being used for non-health purposes.)




Legislative information
House: 104 H.R. 3103, H. Rept. 104-469, Pt. 1, H. Rept. 104-736
Senate: 104 S. 1028, 104 S. 1698, S. Rept. 104-156
Law: Pub. L. 104-191, 110 Stat. 1936
HHS Privacy Rule: 45 CFR 160, 45 CFR 164

See also
Information Technology Audit
From Wikipedia, the free encyclopedia.








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Who’s Enrolled in the State Children’s Health Insurance Program (SCHIP)? An Overview of Findings From the Child Health Insurance Research Initiative (

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Who’s Enrolled in the State Children’s Health Insurance Program (SCHIP)? An Overview of Findings From the Child Health Insurance Research Initiative (CHIRI)

Cindy Brach, MPP*, Eugene M. Lewit, PhD, Karen VanLandeghem, MPH, Janet Bronstein, PhD||, Andrew W. Dick, PhD¶, Kim S. Kimminau, PhD#, Barbara LaClair, MPH#, Elizabeth Shenkman, PhD**, Laura P. Shone, MSW, Nancy Swigonski, MD and Peter G. Szilagyi, MD, MPH¶,

* Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Rockville, Maryland
The David and Lucile Packard Foundation, Los Altos, California
Independent Consultant with the Agency for Healthcare Research and Quality, Arlington Heights, Illinois
|| University of Alabama, Birmingham, Alabama
¶ Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
# Kansas Health Institute, Topeka, Kansas
** Institute for Child Health Policy, University of Florida, Gainesville, Florida
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
Departments of Pediatrics and Medicine, Indiana University School of Medicine, Indianapolis, Indiana



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ABSTRACT

Background. The State Children’s Health Insurance Program (SCHIP) was enacted in 1997 to provide health insurance coverage to uninsured low-income children from families who earned too much to be eligible for Medicaid.

Objectives. To develop a "baseline" portrait of SCHIP enrollees in 5 states (Alabama, Florida, Kansas, Indiana, and New York) by examining: 1) SCHIP enrollees’ demographic characteristics and health care experiences before enrolling in SCHIP, particularly children with special health care needs (CSHCN), racial and ethnic minority children, and adolescents; 2) the quality of the care adolescents received before enrollment; and 3) the changes in enrollee characteristics as programs evolve and mature.

Methods. Each of 5 projects from the Child Health Insurance Research Initiative (CHIRI) surveyed new SCHIP enrollees as identified by state enrollment data. CHIRI investigators developed the CHIRI common core (a set of survey items from validated instruments), which were largely incorporated into each survey. Bivariate and multivariate analyses were conducted to ascertain whether there were racial and ethnic disparities in access to health care and differences between CSHCN and those without. Current Population Survey data for New York State were used to identify secular trends in enrollee characteristics.

Results. Most SCHIP enrollees (65% in Florida to 79% in New York) resided in families with incomes 150% of the federal poverty level. Almost half of SCHIP enrollees lived in single-parent households. A majority of SCHIP parents had not had education beyond high school, and in 2 states (Alabama and New York) 25% had not completed high school. The vast majority of children lived in households with a working adult, and in a substantial proportion of households both parents worked. Children tended to be either insured for the entire 12 months or uninsured the entire 12 months before enrolling in SCHIP. Private insurance was the predominant form of insurance before enrollment in SCHIP in most states, but 23.3% to 51.2% of insured children had Medicaid as their most recent insurance.

Health Care Use and Unmet Needs Before SCHIP. The vast majority of all SCHIP enrollees had a usual source of care (USC) during the year before SCHIP. The proportion of children who changed their USC after enrolling in SCHIP ranged from 29% to 41.3%. A large proportion of SCHIP enrollees used health services during the year before SCHIP, with some variability across states in the use of health care. Nevertheless, 32% to almost 50% of children reported unmet needs.

CSHCN. The prevalence of CSHCN in SCHIP (between 17% and 25%) in the study states was higher than the prevalence of CSHCN reported in the general population in those states. In many respects, CSHCN were similar to children without special health care needs, but CSHCN had poorer health status, were more likely to have had unmet needs, and were more likely to use the emergency department, mental health care, specialty care, and acute care in the year before enrolling in SCHIP than children without special health care needs.

Race and Ethnicity. A substantial proportion of SCHIP enrollees were black non-Hispanic or Hispanic children (Alabama: 34% and <1%; Florida: 6% and 26%; Kansas: 12% and 15%; and New York: 31% and 45%, respectively). Minority children were poorer, in poorer health, and less likely to have had a USC or private insurance before enrolling in SCHIP. The prevalence and magnitude of the disparities varied among the states.

Quality of Care for Adolescents. Seventy-three percent of adolescent SCHIP enrollees engaged in one or more risk behaviors (ie, feeling sad or blue; alcohol, tobacco, and drug use; having sexual intercourse; and not wearing seat belts). Although almost 70% of adolescents reported having had a preventive care visit the previous year, a majority of them did not receive counseling in each of 4 counseling areas. Controlling for other factors, having a private, confidential visit with the physician was associated with an increased likelihood (2–3 times more likely) that the adolescent received counseling for 3 of 4 counseling areas.

Trends Over Time. New York SCHIP enrollees in 2001, compared with 1994 enrollees in New York’s SCHIP-precursor child health insurance program, were more likely to be black or Hispanic, older, from New York City, and from families with lower education, income, and employment levels. A greater proportion of 2001 enrollees was uninsured for some time in the year before enrollment, was insured by Medicaid, and lacked a USC. Secular trends in the low-income population in the state did not seem to be responsible for these differences. Program modifications during this time period that may be related to the shift in enrollee characteristics include changes to benefits, outreach and marketing efforts, changes in the premium structure, and the advent of a single application form for multiple public programs.

Conclusions. SCHIP enrollees are a diverse group, and there was considerable variation among the 5 study states. Overall, SCHIP enrollees had substantial and wide-ranging health care needs despite high levels of prior contact with the health care system. A sizable minority of SCHIP enrollees has special health care needs. There is racial and ethnic diversity in the composition of enrollees as well, with racial and ethnic disparities present. The quality of care adolescents received before enrollment in SCHIP was suboptimal, with many reporting unmet health care needs and not receiving recommended counseling. The characteristics of SCHIP enrollees can be expected to change as SCHIP programs evolve and mature.

Policy Implications. 1) Benefits should be structured to meet the needs of SCHIP enrollees, which are comparable to Medicaid enrollees’ needs in many respects. 2) Provider networks will have to be broad if continuity of care is to be achieved. 3) Multiple outreach strategies should be used, including using providers to distribute information about SCHIP. 4) The quality of care delivered to vulnerable populations (eg, minority children, CSHCN, and adolescents) should be monitored. 5) States and health plans should actively promote quality health care with the goal of improving the care received by SCHIP enrollees before enrollment. 6) States will have to craft policies that fit their local context. 7) Collecting baseline information on SCHIP enrollees on a continuous basis is important, because enrollee characteristics and needs can change, and many vulnerable children are enrolling in SCHIP.



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Key Words: access • children • children with special health care needs • disparities • enrollment • ethnicity • insurance • Medicaid • minorities • quality • race • State Children’s Health Insurance Program


Abbreviations: CHIRI, Child Health Insurance Research Initiative • SCHIP, State Children’s Health Insurance Program • CSHCN, children with special health care needs • USC, usual source of care • FPL, federal poverty level

This supplement to Pediatrics presents findings from the Child Health Insurance Research Initiative (CHIRI) that shed light on the question, "Who is enrolled in the State Children’s Health Insurance Program (SCHIP)?" SCHIP1 was enacted in 1997 in response to a seemingly intractable problem: the lack of health insurance among children. Although a large public insurance program for low-income children, Medicaid, has been in effect since 1965, 14% of all children under 19 were uninsured in 1995.2 Evidence had continued to accumulate that children without insurance had reduced access to health care and poorer health status.3–11 However, low-income children from families who earned too much to be eligible for Medicaid and did not have access to affordable dependent coverage from employers continued to fall between the cracks.12 Congress responded to the plight of these uninsured children by sponsoring SCHIP, which made $40 billion available as federal matching funds to states over a 10-year period.

Under the SCHIP legislation, states are given considerable latitude in designing and implementing their programs.13 They can expand Medicaid, create a separate program, or combine the 2 approaches. States also have control over setting the eligibility criteria, the delivery system, and, for states that opted for separate or combination programs, the benefit structure of their SCHIP programs. Although SCHIP is a small program compared with Medicaid (Medicaid serves 10 times as many children as SCHIP), it generated enthusiasm for the task of providing health insurance for children.14 Many were inspired by the flexibility offered under SCHIP to invest considerable energy into designing SCHIP programs.14 The autonomy given to states has resulted in the implementation of SCHIP programs with greatly varying features.


WHO’S INTERESTED IN WHO’S ENROLLED IN SCHIP?

Policy makers have an interest in knowing whether SCHIP is in fact serving the children it was intended to serve. SCHIP was designed to serve a specific segment of children: those who were not eligible for Medicaid and yet did not have "creditable coverage," that is, alternative health insurance that meets minimum standards.15 At the time of SCHIP’s passage, policy makers balanced an interest in reducing the number of uninsured children against concern over creating an additional entitlement by further expanding Medicaid. Furthermore, SCHIP was passed during a time period in which the welfare system was reformed dramatically to encourage and reward work. As a result, beneficiaries of the SCHIP legislation were portrayed as children of working families who pay their taxes but could not afford health insurance.16–18

State health agency administrators, public officials, and health plans also need information about who enrolls in SCHIP. Ideally, the SCHIP health care delivery system would be shaped by information regarding the characteristics and needs of enrollees. Because SCHIP was new, policy makers had to design their programs based on assumptions and estimates about how the SCHIP population may resemble or be dissimilar to other low-income children: those insured by Medicaid, those privately insured, and those uninsured. Data on SCHIP enrollees’ demographics and prior health care experiences allow policy makers to reexamine their assumptions and make evidence-based decisions.

Policy makers and program administrators are also interested in the characteristics and needs of vulnerable groups of SCHIP enrollees. Children with special health care needs (CSHCN), members of racial and ethnic minority groups, and adolescents constitute distinct populations whose health is of particular concern to policy makers. Their prevalence in SCHIP, characteristics, and prior health care experiences could influence future program adjustments.

Providers are also interested in knowing about the characteristics and needs of SCHIP enrollees. As SCHIP’s front line, providers want to know about the types of children they are likely to see to deliver the most appropriate services. Providers also want to know about the care enrollees have received before SCHIP enrollment, which can serve as a benchmark for learning if their participation in SCHIP improves health care for enrolled children.


WHAT IS CHIRI?

Numerous child health services researchers and funders of research recognized that the implementation of SCHIP represented an unparalleled research opportunity.19 In response to this opportunity, CHIRI, a unique, multistate research program, was launched in the fall of 1999 by the Agency for Health Care Research and Quality, The David and Lucile Packard Foundation, and the Health Resources and Services Administration.20 CHIRI’s main purpose is to supply policy makers with information to help them improve access to and the quality of health care for low-income children.

CHIRI is a 3-year, $9.7 million effort that includes 9 separate research projects, 7 of which are state-based and 2 of which are national in scope. Although the primary focus of most CHIRI studies is SCHIP, some projects include studies of Medicaid and the Title V Maternal and Child Health Services Block Grant program (a component of which serves CSHCN). The majority of the studies concentrate on the impact of public insurance programs on enrolled children, but some CHIRI projects examine impacts of public health insurance programs on communities and the health care system.

CHIRI places an emphasis on particularly vulnerable populations: CSHCN, racial and ethnic minority children, and adolescents. Little is known about the impact of changes in health care delivery systems on CSHCN, who have been found in general to have many needs.21–24 Minority children are also of particular interest, because past research has shown that minority children can face greater barriers to care than nonminority children.25–27 Adolescents have also been identified as a third vulnerable population that is at risk of high morbidity and mortality but often goes underserved.28 Thus, 7 CHIRI projects address CSHCN, 5 projects address disparities between minority and nonminority children, and 2 projects address adolescents. Furthermore, several CHIRI studies are longitudinal and are assessing SCHIP’s impact both overall and on vulnerable populations.

Producing policy-relevant research has been a fundamental objective of CHIRI from its inception. CHIRI grantees are required to work with the state and local programs being studied to ensure that the researchers are answering questions that policy makers are asking. Researchers are also required to ensure that public officials and other stakeholders continue to be involved throughout the studies. National stakeholders have also been given an opportunity to have input into CHIRI research.

Finally, CHIRI is a collaborative initiative that is able to harness the research skills, knowledge, and perspectives of multiple research entities. Although the 9 CHIRI studies were designed and funded separately, the researchers have engaged in a cooperative process that makes CHIRI truly an initiative rather than a collection of disparate studies. The principal investigators all participate in a coordinating committee and various work groups to facilitate research collaboration among projects. This Pediatrics supplement is an example of this collaboration. CHIRI researchers have joined forces to present comparable findings across several states, highlighting commonalities and dissimilarities of SCHIP enrollees.


WHAT IS CHIRI’S NEW CONTRIBUTION?

Despite researchers’ interest in studying SCHIP, no national studies have yet been published that can answer the question, "Who’s enrolled in SCHIP?" based on identified samples of program enrollees. Several researchers have modeled what the SCHIP-eligible population looks like by using population-based household surveys.29,30 Population-based surveys, however, cannot conclusively identify children who are enrolled in SCHIP because of confusion about which insurance coverage children possess. Moreover, models of income eligibility, even sophisticated ones, cannot take into account all states’ complex eligibility rules. Even if SCHIP enrollees could be identified reliably, most national surveys would be limited by having few SCHIP enrollees in most states because of the relatively small number of SCHIP enrollees.

CHIRI analyses are based on surveys of children known to be enrolled in SCHIP and thus provide robust samples of SCHIP enrollees. Additionally, CHIRI surveys are able to capture SCHIP enrollees’ experiences with insurance and health care before they enrolled in SCHIP as well as support analyses by race and ethnicity or CSHCN status and examinations of the quality of care received by adolescents.

A handful of researchers have collected data for single-state evaluations of SCHIP programs,31–33 but these studies have not included the breadth of analyses found in the CHIRI research. Although not national in scope, the CHIRI data in this supplement encompass 5 states that collectively accounted for almost 30% of SCHIP enrollment in 2001. CHIRI includes states that are large and had SCHIP-like programs before the passage of the SCHIP legislation as well as relatively small states that implemented new programs as a result of SCHIP. This range provides more breadth than studies of single states.


METHODS

The specific methods of the CHIRI projects are described in detail in the articles and technical appendices included in this supplement.24,28,34–38 Each CHIRI project represented in this supplement conducted a survey of new enrollees of separate, free-standing SCHIP programs as identified by state enrollment data. (Indiana sampled only CSHCN new enrollees in both their free-standing and Medicaid expansion SCHIP programs, and Florida sampled only adolescents.) Table 1 summarizes the SCHIP program characteristics in the study states. Each project was responsible for the design of its own survey to meet its objectives.

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The Impact of a Children's Health Insurance Program by Age

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The Impact of a Children's Health Insurance Program by Age Christopher R. Keane, ScD*, Judith R. Lave, PhD, Edmund M. Ricci, PhD§, and Charles P. LaVallee, BA

From the * Graduate School of Public Health, University of Pittsburgh; the Departments of Health Economics and § Health Services Administration, Graduate School of Public Health, University of Pittsburgh; and the Western Pennsylvania Caring Foundation for Children, Pittsburgh, Pennsylvania.


ABSTRACT
Top
Abstract
Methods
Results
Discussion
References

Objectives. 1) To examine age variation in unmet need/delayed care, access, utilization, and restricted activities attributable to lack of health insurance in children before they receive health insurance; and 2) to examine the effect of health insurance on these indicators within each age group of children (in years).

Methods. We use cohort data on children before and after receiving health insurance. The study population consists of 750 children, 0 through 19 years of age, newly enrolling in two children's health programs. The families of the newly enrolled children were interviewed at the time of their enrollment (baseline), and again at 6 months and 1 year after enrollment. The dependent variables measured included access to regular provider, utilization, unmet need or delayed health care, and restrictions on activities attributable to health insurance status. All these indicator variables were examined by age groups (0-5, 6-10, 11-14, and 15-19 years of age). 2 tests were performed to determine whether these dependent variables varied by age at baseline. Using logistic regression, odds ratios were calculated for baseline indicators by age group of child, adjusting for variables commonly found to be associated with health insurance status and utilization. Changes in indicator variables from before to after receiving health insurance within each age group were documented and tested using the McNemar test. A comparison group of families of children enrolling newly 12 months later were interviewed to identify any potential effects of trend.

Results. All ages of children saw statistically significant improvements in access, reduced unmet/delayed care, dental utilization, and childhood activities. Before obtaining health insurance, older children, compared with younger children, were more likely to have had unmet/delayed care, to have not received health care, to have low access, and to have had activities limited by their parents. This pattern held for all types of care except dental care. Age effects were strong and independent of covariates. After being covered by health insurance, the majority of the delayed care, low utilization, low access, and limited activities in the older age groups (11-14 and 15-19 years) was eliminated. Thus, as levels of unmet need, delayed care, and limitations in activities approached zero in all age groups by 1 year after receipt of health insurance, age variation in these variables was eliminated. By contrast, age variation in utilization remained detectable yet greatly reduced.

Conclusion. Health insurance will reduce unmet need, delayed care, and restricted childhood activities in all age groups. Health care professionals and policy makers also should be aware of the especially high health care delay, unmet need, and restricted activities experienced by uninsured older children. The new state children's health insurance programs offer the potential to eliminate these problems. Realization of this potential requires that enrollment criteria, outreach strategies, and delivery systems be effectively fashioned so that all ages of children are enrolled in health insurance. Key words: children's health insurance, age, program evaluation, improvement, access.


Under the Balanced Budget Act of 1997, the Congress established the State Children's Health Insurance Program, the most significant health insurance initiative for children since the enactment of the Medicaid program in 1965. Under this act, 24 billion dollars will be allocated to states over a 5-year period to provide health insurance to children who otherwise would be uninsured. The law gives the states considerable flexibility in how to insure the children and in the extent to which services (such as vision, hearing, and dental services) are covered. To date, the Federal government has approved 45 Kidcare programs. Recognizing the importance of this initiative, a number of private foundations and government agencies are funding evaluations of the program.

Some preliminary information on the likely impact of these new insurance programs can be gained through evaluations of earlier programs designed to cover uninsured children. We have been evaluating the impact on children of such a program. In the initial report of our evaluation, we described the impact of not having health insurance on the health status, utilization of services, and limitation of activity of uninsured children.1 In a second paper, we described the general impact of such a health insurance program on newly enrolled children.2 We found there was a significant increase in access to care, decrease in unmet need and/or delay in receiving services, more appropriate use of services, and less restriction of childhood activities after receipt of insurance coverage. However, we did not examine the impact of the program on children of different ages.

There are reasons to believe that the impact of such programs may vary by the age of the child. For instance, data from the 1977, 1987, and 1997 National Medical Expenditure Panel Surveys suggest that, among uninsured children, older children were less likely to have a regular source of care than were younger children.3,4 Thus, if health insurance led to equality in the probability of having a regular source of care across all ages of children, we would expect that a higher proportion of older children would benefit from such programs. Similarly, if uninsured children of older ages are more likely to have unmet need or restricted activities that can be eliminated through health insurance, then it would be especially important to target this group for coverage. However, there have been few studies that assess the impact of being uninsured on children in different age groups or the impact of obtaining coverage by the age of the child.

In this article, we report the effect that a children's health insurance program has on children of varying ages. Three separate, but interrelated, questions are addressed: 1) Before enrollment in the health insurance program, were there any differences in indicator variables across age groups?; 2) After being enrolled in the program for 1 year, was there any improvement in indicator variables within age groups?; and 3) After being enrolled in the health insurance program for 1 year, what was the magnitude of differences in indicators across age groups?

Four categories of dependent variables are measured: 1) having an usual source of care; 2) use of specific services; 3) unmet need or delay in obtaining services; and 4) childhood activities limited by parent because of the lack of health insurance.

METHODS
Top
Abstract
Methods
Results
Discussion
References
The evaluation design has been described in detail elsewhere.1,2 In brief, we used a before-after design with a comparison group to study the effects of health insurance for uninsured children in Western Pennsylvania. The program studied is actually a blend of two programs: the Children's Health Insurance Program of Pennsylvania (called BlueCHIP in Western Pennsylvania) and the Caring Program for Children. Both Programs were administered by the Western Pennsylvania Caring Foundation for Children, an affiliate of Highmark Blue Cross Blue Shield. The two programs offered an identical comprehensive package of inpatient, outpatient (including dental and vision services), and preventive health care services to children. There was no copayment with the exception of a small copayment for outpatient drugs. Together they provided seamless coverage for uninsured children 0 through 18 years of age. The eligibility criteria varied by age of the child and family income.1,2

The Study Population

The names of 5864 uninsured children enrolling in the insurance programs between August and December 1995 were obtained from the Caring Foundation. We aggregated children to the family level and randomly selected 887 families to be recruited for telephone interviews by experienced interviewers. The families were contacted within 2 weeks after acceptance into either the BlueCHIP or the Caring Program. Of the 887 families, 783 (88.3%) agreed to participate and were interviewed. These families were contacted again after 6 months and 12 months; 659 families answered all three interviews. These 659 families had a total of 1031 children. Of the 1031 children at the end of the study year, ~15% were covered by private health insurance, 7% were covered by Medicaid, 6% were uninsured, and 73% (750 children) were enrolled continuously, ie, still covered by either the BlueCHIP or Caring Programs. (We do not know whether the children who shifted to Medicaid did so because their family income decreased or because their family spent down to Medicaid because of health care utilization of another family member. We also do not know why some children lost their health insurance. We believe children who gained private insurance did so as a result of a change in their parents' income or work status.2) The 750 children who remained continuously enrolled are the subjects of this study. Given the high response and large sample size, this sample is representative of the total population of the Western Pennsylvania enrollees of the insurance program.

In this article, we include data from the baseline and 12-month follow-up interview. In an earlier paper, we reported all 6-month aggregate follow-up data.2 We showed that, with the exception of utilization variables, most indicators improved in the first 6 months after enrollment and then improved only slightly after that. However, utilization increased in the first 6 months and then somewhat decreased in the second 6 months. Thus, in the present article, we report the 6-month follow-up data only for health service utilization data.

Variables Measured

The interviewers followed an almost identical survey instrument, with both fixed-response and open-ended questions, for both the baseline and follow-up interviews. The respondents, usually mothers, were asked questions about each child in the family. In addition to standard demographic information, several questions were included about access and use of health services, including whether the child had a usual source of medical and dental care, the number of visits the child made to different types of health care providers, and whether the child experienced unmet need or delayed care for six types of services. For all questions related to health services utilization and health status, the parents were asked to focus on the 6-month period before the interview. Parents also were asked about whether the child's health insurance status had any effect on usual childhood activities. During the baseline interview, the respondents were asked how long a child had been without health insurance.

The Comparison Group

A list of children who were enrolled in the BlueCHIP or the Caring Program between August and December 1996 (corresponding to 1 year after our 1995 cohort enrollment) was made available to the research team to serve as a comparison group. As for the cohort group, we aggregated children to the family level and randomly selected 371 families to be interviewed using the same telephone survey; 330 families (89%) who had 460 newly enrolled children agreed to participate. These children serve as a comparison group in that they enable us to assess whether changes observed in the study group were attributable to the insurance programs rather than to other underlying changes or influences in the environment. This design, a variation of a recurrent institutional cycle design, rules out a major threat to the internal validity of simple before-after evaluations, namely, the effects of a secular trend.2,5,6

Analyses

The children were first grouped into age groups that are close to those used in recent American Academy of Pediatrics recommendations on frequency of health examinations. We grouped children into the following categories: 0 through 5, 6 to 10, 11 to 14, and 15 years of age.7 Although the American Academy of Pediatrics recommends that children 0 to 2 years of age should make more visits than children 3 to 5 years of age, we had too few children <2 years of age to justify creating a separate group; therefore, we merged this category into the 0- to 5-year stratum. These categories contain adequate sample sizes for each age group. We first performed the 2 test to determine whether there were statistically significant differences in indicators across the age groups. In addition, we used logistic regressions in which the indicator variables were used as dependent variables and the independent variable was age group. Other child or family characteristics found to be associated with the indicator variables were included as covariates. These variables include months without health insurance coverage, parental working status, maternal education, the number of children in family, race, maternal education, parental employment status, urban-rural status, and health conditions of child (ear, nose, and throat infections, asthma, allergies, and overall health on a 4-point Likert scale). From the regression results, we calculated the odds ratios for our indicators by age group of child, controlling for the covariates. The odds ratios for each age group used the youngest age group as the reference category.

To determine the impact of the health insurance programs on the various indicators we: 1) examined the changes in indicators from before and after receiving health insurance within each age stratum, testing for statistical significance using the two-tailed McNemar test for within-subject changes; and 2) used a comparison group of children newly enrolling in the health insurance programs 1 year after the initial cohort to rule out the possibility that effects were attributable to a general secular trend.
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Self Employed Health Insurance - Tips For Getting Cheap Health Insurance When You're Self Employed

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Self Employed Health Insurance - Tips For Getting Cheap Health Insurance When You're Self Employed
By Carrie Reeder

If you're self-employed and facing high health insurance bills, there are a number of things you can do to make your health insurance premiums cheaper once you find a good health insurance plan. Some involve opting out of certain coverage, others mean increasing the amount you'll pay out of pocket for expenses. There are also discount health plans that you can join which will offer you cheaper fees for the services that you use. All involve taking on some of the risk for insuring yourself onto your own shoulders.

Eliminate Coverage for Routine Office Visits for Cheaper Premiums - If you're healthy, have few prescriptions and no children, a catastrophic health insurance policy can be all the coverage that you need. The premiums to cover you just in the event of an accident or unexpected illness are among the cheapest you'll find - well under $100 a month for an individual. Shop online for the best rates you can find. In many cases, you can apply online and be insured within 24 hours.

Increase Your Deductible to Save On Premiums - A deductible is the amount of money you'll pay out of pocket before your insurance company takes over payments on your bill. If your health insurance plan includes a deductible (not a co-payment), you can often make your monthly premiums cheaper by increasing the amount of your deductible. While you'll pay more out of pocket if something does happen, it’s far more affordable than going without health insurance because you can't afford to pay the monthly premium.

Pay Your Premium Annually for Big Discounts - If overall savings are your goal, you can often get the cheapest rate on your health insurance by paying for the full year at one time. Most health insurance companies will substantially discount your health insurance premium if you pay it all at once.

Open a Medical Savings Account - MSA’s are the government's way of helping to make health care more affordable for people who work for themselves or in a small business. A Medical Savings Account allows you to put a certain amount of your earnings into a tax-deferred savings account to cover the cost of medical expenses. By combining this with a cheap high deductible insurance policy, you pay fewer taxes on your MSA earnings, and use them to pay the deductible on your health insurances if it becomes necessary.

Take Your Health Insurance Deduction - When you file your taxes, be sure to take your health insurance deduction. Even if you don't itemize all expenses, you can deduct up to 70% of your health insurance costs from your income when you file your taxes.

To view our recommended sources for health insurance, or to read more articles about health insurance, visit: Recommended Health Insurance Companies Online.

Carrie Reeder is the owner of eZerk, an informational website with articles and the latest news about various topics.

Article Source: http://EzineArticles.com/










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Health Insurance And Insurance Brokers

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Health Insurance And Insurance Brokers
By Matthew Keegan

If you are in the market to purchase your own health insurance coverage you can save yourself precious time and money by shopping and comparing policies right online. Sites dedicated to giving you quotes on various types of insurance make it very easy for you to get an idea of what your coverage and costs will be. However, please be forewarned that there are some pitfalls in using an insurance broker as I discovered within the past year.

As a self employed person, I carry my own health and life insurance for my family. When making the move from New Jersey to North Carolina in 2004 I knew two things about our health insurance:

1. I would have to shop for a health insurance provider covering North Carolina.

2. Rates would be cheaper than in New Jersey, with costs being about half of what I had been paying and with slight better coverage.

Several weeks before we moved I contacted a well known internet insurance broker and received quotes. We selected one company and received the paperwork from the broker about ten days before our move. Quite frankly, I wish I had started the process a little earlier as all of our free time was dedicated toward preparing and making the move. So, I ended up packing the paperwork with my personal stuff and was only able to fill it out and submit it one week after our arrival in North Carolina.

Dealing with the online insurance broker was a simple task, but I soon discovered that they were an extra step in the application process, one that only slowed down our approval.

Once the paperwork was received by the broker, they acknowledged the same via email and mentioned that they would review our package before forwarding it to the health insurance company.

Over the next couple of weeks we received messages from the insurance broker stating the following:

1. We are in the process of reviewing your application.

2. We have sent your application off to the insurance company.

3. The insurance company has your application and will be reviewing it in about one week.

4. The insurance company expects a delay in reviewing your application due to the high volume of applications received.

5. Please do not contact the insurance company directly; we will keep you posted as to the status of your application. Yeah, right.

Originally, we were assured by the insurance broker that the health insurance company would review and approve our application within two weeks. Follow up phone calls by us to the broker along with several exchanges of emails revealed that this was not going to happen. In addition, when we contacted the health insurance company directly – at the encouragement of the broker – the health insurance company had difficulty finding our application. Within a few days the application was found sitting in another department; our contact at the health insurance company blamed the broker for sending the information to the wrong address.

As it turned out, the original insurance quote we received online was off by just over 20%. Once the health insurance company determined that certain pre existing conditions needed to be factored in our rates rose accordingly. Of course, when working with the internet broker we knew that the rate quoted wasn’t ‘absolute’ but the big jump was still a bitter pill to swallow.

Among our thoughts at that point in the process were:

1. Had we known ahead of time that our “final rate” would be so high, we would have shopped around some more.

2. Because of the delays and the passage of time, we needed to complete the application process as our coverage with the NJ health provider would need to be canceled, preferably by the end of the year.

By the middle of December, a full ten weeks after we submitted our paperwork, we received official notification that our application was approved and that we were covered. During the last couple of weeks of the lengthy application process we contacted the health insurance company directly several times to learn what the status of our application was. At no time during the process were we assured that we would receive approval; essentially we were told that coverage would begin pending approval.

In conclusion, I offer the following recommendations for shopping for health insurance:

1. Comparison shop online. Get quotes through the online brokers to get a general idea of what your costs will be. If you have pre-existing conditions, the prices quoted will not be reflected in your quote.

2. Narrow down the list of companies quoted to three and then contact them directly. Bypass the broker as they are an unnecessary additional step in what certainly is not a quick approval process.

3. If you need insurance by a particular date, apply well in advance to allow for delays, for misplaced paperwork, changes in your application, etc. Our insurance coverage was approved effective a specific date, but we were able to move it to another date to coincide with the dropping of our NJ health care provider.

In all, the experience was wearisome at times and a real eye opener. I know you see ads all the time for online insurance quotes. I am not saying to avoid the sites, but please consider what we went through before using an online broker exclusively.

Matthew Keegan is the owner of a successful web design and marketing company based in North Carolina, USA. He manages several sites including the Corporate Flight Attendant Community at http://www.corporateflyer.net and the Aviation Employment Board at http://www.aviationemploymentboard.net

Article Source: http://EzineArticles.com/










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Affordable Health Insurance - Health Insurance For The Self Employed

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Affordable Health Insurance - Health Insurance For The Self Employed
By Carrie Reeder


One of the things that is important to consider when you leave corporate America for the freedom of your own business is affordable health insurance. In fact, the reason most often cited for NOT taking the plunge into self-employment is the lack of cheap health insurance alternatives for people who are not employed by a company that can offer more affordable rates on health insurance through a group health insurance plan.

If you do decide to brave it and be your own boss, there are many places where you can cut corners. Letting yourself or your family go without health insurance isn't one of them. Here are some common options that can make health insurance affordable if you're a self-employed entrepreneur or crafter.

Coverage under a Spouse's Plan

By far the most common option is to cover the family for health insurance through a spouse's employer. As long as one member of the couple is working for a company that has a group health insurance plan, it's usually the cheapest option for insuring the entire family.

COBRA

COBRA is an option for the beginning of your self-employment. For the first several months after you leave your job, your employer is required by law to give you the option of retaining membership in their health insurance plan. You will have to cover the entire monthly premium paid by your company rather than the amount that you're used to paying as an employee when your employer was covering part of the cost. The true cost of that insurance can come as a shock to you - a family health insurance through a group can easily cost close to $1000 a month. It's still more affordable than most plans that you can purchase as an individual. It's also only temporary, so you should be looking for other health insurance options while you're still covered.

A Health Insurance Cooperative with Other Self-employed and Small Business Owners

There are national and local organizations of self-employed workers who have banded together to combine their buying power and get affordable health insurance premiums through group policies. You can find more information about groups in your area through the National Association for the Self Employed (www.nase.org) or the American Association of Home-Based Businesses (www.aahbb.org).

Group Health Insurance for the Self-Employed

In many states like Maine, health insurance companies offer affordable group policies for groups of one. You may have to shop around to find a company that does, but there are benefits other than being a cheaper policy. The most important of these is that they MUST cover everyone in the group, regardless of health conditions. This is important for someone who may have been turned down for an individual health insurance policy because of health.

No matter what, it is vital that you insure yourself and your family against the possibility of illness or accident. There are cheap alternatives to individual health insurance plans for the self-employed.

To view our recommended sources for health insurance, or to read more articles about health insurance, visit: Recommended Health Insurance Companies Online.

Carrie Reeder is the owner of eZerk, an informational website with articles and the latest news about various topics.

Article Source: http://EzineArticles.com/












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Variable Life Insurance

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Variable Life Insurance
by Donald Lusan


Variable life insurance is like attaching a life insurance policy to your stock portfolio. Your portfolio may contain stocks, bonds, money market etc. which would give you the tremendous opportunity to earn awesome profits on your investments. You will choose where your money is invested, but as a result you also bear the risk. It is therefore incumbent on you to do some research before you get started.

A variable life insurance policy has a guaranteed death benefit and accumulates a cash value which is based on an assumed minimum interest rate of about 4%. This, however, may vary from company to company. Your investment will be separate and apart from your life insurance policy. You make the decision as to how much is applied to investment and how much to pay life insurance premiums. You may invest in stocks bonds, money market or any other applicable investment with the sole purpose of getting the highest return possible on your money.

Any quotation you get for a variable life insurance policy must be accompanied by a prospectus which should be carefully scrutinized by you. These policies are regulated by the Securities And Exchange Commission and The Commissioner of Insurance of the state in which the policy is issued. The agent must have an NASD, National Association Of Securities Dealers license, in addition to his regular life insurance license, to sell these policies.

You are allowed to take a loan from your variable life insurance policy. This loan, however, reduces the face amount of the policy as well as the cash value, by the amount of the loan. The normal assumption is that when you repay the loan the cash value will revert to what it was before and the face amount also. That is not necessarily so. Bear in mind that while the loan was outstanding, the amount of the loan was not there to invest, so your profit will be less that amount that would have been earned on that money. Now, you attempt to recover your life insurance; you may be able to do so in most cases, however, if your health should change you may not be allowed to recover the life insurance portion.

For additional information on variable life insurance click: Variable Life Insurance


About the Author
For more than 40 years Donald has been known for his extensive knowledge of the life insurance business. He has studied the work of all of the greats from Ben Feldman and Frank Bettger to Joe Gandolfo. He has represented some of the largest and best life insurance companies in the United States as well as Canada. His advice is invaluable.

Donald website is life insurance hub











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Health insurance

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Health insurance

Health insurance is a type of insurance whereby the insurer pays the medical costs of the insured if the insured becomes sick due to covered causes, or due to accidents. The insurer may be a private organization or a government agency. Market-based health care systems such as that in the United States rely primarily on private health insurance.

Contents [hide]
1 Private health insurance
2 Publicly funded medicine
3 Medicare/Medicaid
4 History and evolution
5 Common complaints of private insurance
6 Common complaints of publicly funded medicine
7 Future challenges
8 See also




Private health insurance
Health insurance is one of the most controversial forms of insurance because of the perceived conflict between the need for the insurance company to remain solvent versus the need of its customers to remain healthy, which many view as a basic human right. Critics of private health insurance claim that this conflict of interest is why state and federal regulation of health insurance companies is necessary. Some say that this conflict exists in a liberal healthcare system because of the unpredictability of how patients respond to medical treatment. But proponents of regulation argue that too many health insurance companies put their desire for profits above the welfare of the consumer or patient.

The following is a hypothetical example of a situation that might confront an insurance company: Suppose that a large number of customers of a particular insurance company contracted a rare disease and the hospital charged 10 million dollars a patient to treat them. The insurance company would then be faced with a choice of paying all claims without complaint (thus losing money and possibly going out of business) or denying the claims (thus outraging patients and their families, discouraging potential customers, and becoming a target for lawsuits and legislation).

Since a health insurance policy is a legal, binding contract between the insurance company and the customer, the insurance company should pay all valid claims without question. Many insurance companies purchase re-insurance to protect themselves from a catastrophic loss due to an unforeseen event. But just like any other business, a health insurance company does not have a right to shirk its legal obligations just to make a profit or stay in existence.

Health insurance companies and consumer advocates agree that private health insurance faces unique problems. Health insurance companies use the term "adverse selection" to describe the tendency for sick people to be more likely to sign up for health insurance. Insurance companies say that asymmetry of information about a person's health and behaviour is likely to lead to adverse selection and (ex-ante) moral hazard. Health insurance companies say, that in essence, those seeking health insurance are likely to be those with existing medical problems or those who are likely to have future medical problems, and that those who take out insurance may engage in risky behaviour, such as smoking and excessive alcohol consumption, which an otherwise sane person would not do. Insurance companies say that the cost of providing health insurance to these bad risks raises the cost of insurance to the 'good' insurance risks, possibly pricing them out of the market, and could create a situation in a market where insurance was uneconomical for private insurance companies to provide.

One must also recognize that both public and private health insurance will also suffer from ex-post moral hazard. This phenomena is in essence the consequence of reduced prices for medical care. Since most insurance plans, whether public or private, reduce the out-of pocket cost of medical care, the behavior of individuals will be affected by those reduced prices. In the same way that people treat water with little care when it is very inexpensive, people will also tend to over-use medical care when the out-of pocket costs are small. Of course, medical care still needs to be financed, and so taxes or premiums will be higher than the optimal amount. This inflation of taxes or premiums to cover the choices made under subsidized prices is what is termed ex-post moral hazard, and is a different phenomena than the ex-ante moral hazard mentioned above.

Critics of private health insurance state that those who are sick should be able to get health insurance because they need it the most and that if everyone had health insurance, adverse selection would not be a problem.

With publicly funded health insurance the good and the bad risks all receive coverage without regard to their health status, which eliminates the problem of adverse selection, although it introduces a problem of moral hazard. As to the concept of moral hazard, those who favor public health insurance ask, do people play with matches in their homes if they have fire insurance or drive like maniacs if they have auto insurance, or do some people just engage in self destructive behavior for no rational reason.

Insurance companies explain the economics of insurance by saying that, in general, if many sick people buy health insurance from a private health insurance company, but few healthy people buy it, the price of the insurance rises. (Critics of private health insurance point out that few sick people are allowed to buy health insurance). Insurance companies also say that if more healthy people buy health insurance, but few sick people buy it, the price drops. In other words, the price drops if more money goes in and less is paid out.

According to the latest United States Census Bureau figures, approximately 85% of Americans have health insurance. Approximately 60% obtain health insurance through their place of employment or as individuals, and various government agencies provide health insurance to 25% of Americans.

Because of advances in medicine and medical technology, medical treatment is more expensive, and people in developed countries are living longer. The population of those countries is aging, and a larger group of senior citizens requires more medical care than a young healthier population. (A similar rise in costs is evident in Social Security in the United States.) These factors cause an increase in the price of health insurance.

Some other factors that cause an increase in health insurance prices are health related: insufficient exercise; unhealthy food choices; a shortage of doctors in impoverished or rural areas; excessive alcohol use, smoking, street drugs, obesity, among some parts of the population; and the modern sedentary lifestyle of the middle classes.

In theory, people could lower health insurance prices by doing the opposite of the above; that is, by exercising, eating healthy food, avoiding addictive substances, etc. Healthier lifestyles protect the body from disease, and with fewer diseases, the insurance companies would pay fewer doctor bills.

Under these circumstances, consumer would hope to benefit from the savings; however, critics of private health insurance claim that too much of the insurance premiums are paid out in executive salaries or retained as profits by the company.

Before buying health insurance, a person typically fills out a comprehensive medical history form that asks whether the person smokes, how much the person weighs, and has the person ever been treated for any of a long list of diseases. Applicants can get discounts if they do not smoke and live a healthy lifestyle, which might encourage some people to quit smoking or make other improvements in their lifestyle. The medical history is also used to screen out persons with pre-existing medical conditions.


Publicly funded medicine
Many countries have made the societal choice to avoid this important conflict by nationalizing the health industry so that doctors, nurses, and other medical workers become state employees, all funded by taxes; or setting up a national health insurance plan that all citizens pay into with tax or quasi-tax payments, and which pays private doctors for health care. These national health care systems also have their problems.

Some of these countries have citizen groups which protest bureaucracy and cost-cutting measures that unduly delay medical treatment. Similar issues exist with private health management insurances (HMO) in countries with privately funded medicine.

The British National Health Service has maintained a compromise with doctors in general practice by not making them state employees. Each practice decides its own working pattern and contracts to the NHS providing designated services (including the benefit of membership of state pension schemes comensurate with the work for the NHS) with many also providing private services. Some medical staff employed on an NHS contract also have work in the private sector and others work exclusively in either sector.

One result of a mixed system is that insurance for alternative private care is greatly reduced, as basic needs are met by the NHS. Many choose to have private care only where it suits (such as to avoid waiting time or improve the facilities they have access to in a hospital stay). Some proponents of such a private system claim the benefits of coexisiting with a nationalized system compared to countries where it is almost exclusively private except for the very needy (as in the United States) is that they can enjoy the benefits of private healthcare but: not have to worry about providing the costs of more basic needs; not have to pay for children; and have a system to fall back on when they have a chronic illness which would be excluded from a private policy and they would have to pay for if it were not for the NHS.


Medicare/Medicaid
In the United States, health insurance is made more complicated by federal Medicare/Medicaid programs, which have had the unintended consequence of determining the price of medical procedures. Many suspect that these prices are set independently of medical necessity or actual cost. A physician who refuses to accept a Medicare/Medicaid payment will be banned from accepting any such payments for a number of years, regardless of the reason for rejecting the payment or the amount offered. In either case, this means that private insurers have little incentive to pay more than the government does.


History and evolution
The concept of health insurance was proposed in 1694 by Hugh the Elder Chamberlen from the Peter Chamberlen family. In the late 19th century, early health insurance was actually disability insurance, in the sense that it covered only the cost of emergency care for catastrophic injuries that could (and often did) lead to a disability. This artifact of history persisted right up to the start of the 21st century in some jurisdictions (like California), where all laws regulating health insurance actually referred to disability insurance. Patients were expected to pay all other health care costs out of their own pockets, under what is known as the fee-for-service business model.

As the Industrial Revolution matured during the middle to late 20th century, traditional disability insurance evolved into modern health insurance as both employers and governments recognized the value of health care by encouraging patients to seek regular checkups from primary care physicians. It is usually much cheaper to treat diseases like cancer if they are diagnosed early.

Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures, and also most prescription drugs, but this was not always the case.


Common complaints of private insurance
Some common complaints about private health insurance include:

Insurance companies do not announce their health insurance premiums more than a year in advance. This means that, if one becomes ill, he or she may find that his premiums have greatly increased. This largely defeats the purpose of having insurance in the eyes of many.
If insurance companies try to charge different people different amounts based on their own personal health, people will feel they are unfairly treated. Some states require that insurance companies cover all who apply at the same cost, or that rates vary only by age of the insured; this rule has the effect that healthy people subsidize sick ones, and thus frequently only those in poor health buy insurance, making the premiums very expensive.
When a claim is made, particularly for a sizeable amount, it may be deemed in the best interest of the insurance company to use paperwork and bureaucracy to attempt to avoid payment of the claim or, at a minimum, greatly delay it. Some percentage of insureds will simply give up, leading to lower costs for the insurance company.
Health insurance is often only widely available at a reasonable cost through an employer-sponsored group plan. This means that unemployed individuals and self-employed individuals are at a disadvantage.
Employers can write some or all of their employee health insurance premiums off of their taxable income whereas traditionally individuals have had to pay taxes on income used to fund health insurance. This reduces the employee's bargaining power in negotiating service with the insurance provider and also increases their dependence on the employer. In the U.S., COBRA and more recent legislation has been passed in an attempt to address the latter concern, and full tax deductibility for health insurance premiums paid by the self-employed has recently been passed by Congress as well.
Experimental treatments are generally not covered. This practice is especially criticized by those who have already tried, and not benefited from, all "standard" medical treatments for their condition. It also leads to many insurers claiming or attempting to claim that procedures are still "experimental" well after they have become standard medical practice in many instances. (This phenomenon was especially seen after organ transplants, particularly kidney transplants, first became standard medical practice, due to the tremendous costs associated with this procedure and other organ transplantation.)
The Health Maintenance Organization (HMO) type of health insurance plan has been criticized for excessive cost-cutting policies. The least justifiable of these efforts, according to critics, is having accountants or other administrators essentially making medical decisions for customers by deciding which types of medical treatment will be covered and which will not.
As the health care recipient is not directly involved in payment of health care services and products, they are less likely to scrutinize or negotiate the costs of the health care received. To care providers, insured care recipients are essentially seen as customers with relatively limitless financial resources who don't look at prices. The health care company has few popular and many unpopular ways of controlling this market force. In response to this, many insurers have implemented a program of bill review in which insureds are allowed to challenge items on a bill (particularly an inpatient hospital bill) as being for goods or services not received; if this is proven to be the case, the insured is awarded with a percentage of the amount that the insurer would have otherwise paid for this disputed item or items, usually 25% or occasionally even 50%, with a ceiling so that the insured will not truly become wealthy from this procedure.

Common complaints of publicly funded medicine
Price no longer influences the allocation of resources, thus removing a natural self-corrective mechanism for avoiding waste and inefficiency.
Health care workers' pay is often not related to quality or speed of care. Thus very long waits can occur before care is received.
Because publicly funded medicine is a form of socialism, many of the general concerns about socialism can be applied to this discussion.
People are afraid that they cannot choose their own doctor. The state chooses for them.
Countries which have publicly funded medicine don't do as much medical research and development as there is very low payoff to developing new drugs and medical techniques.

Future challenges
With the advent of DNA testing, previously unknown risk factors involving genetic makeup will become known and this is expected to lead to greater pressure on the private health insurance industry as they try to limit their exposure to high-risk individuals. As larger groups of these individuals are identified and charged higher premiums (if they can get coverage at all) the pressure on privacy laws to limit the flow of personal medical data will only increase.


See also
COBRA
Government ownership
Health economics
Health maintenance organization
Healthcare reform
Healthcare system
Health Insurance Portability & Accountability Act
Insurance
List of insurance topics
Medicaid
Medicare
Public health
Publicly funded medicine
Social security
Social welfare
Retrieved from "http://en.wikipedia.org/wiki/Health_insurance"
From Wikipedia, the free encyclopedia.









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What Is Health Insurance?

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What Is Health Insurance?
by Ron King


Health insurance is simply protection of the person or group insured against financial loss from illness or injury. Can you live without it? Probably. Should you? The answer depends upon whom you ask.

Like other forms of insurance, you don't need health insurance until you NEED it. Automobile insurance doesn't help until you get into a car accident. Life insurance isn't of value until you die. And health insurance doesn't do you any good until you need medical assistance. But, if you believe in Murphy's Law -- that whatever can go wrong will go wrong -- then you should consider getting health insurance.

Health insurance coverage varies greatly between policies, but basically, it pays a pre-negotiated percentage of the expenses for a policy holder's covered medical treatments.

3 Types of Health Insurance

In the United States, there are 3 basic types of health insurance:

1. Self-Insured/Uninsured. People with no insurance,and people who have health insurance but are responsible for paying 100% of the insurance premium. This group is estimated at 30% of the US population.

Managed Care Plans. They fall into 3 categories. All are essentially networks offering services from specific providers at contracted prices:

* Health Maintenance Organizations (HMO) are plans in which members pay a fixed monthly fee, regardless of how much medical care they need in a given month. HMOs provide medical services ranging from office visits to hospitalization and surgery, and usually require that you stay within the network when you need services from physicians and hospitals.

* Preferred Provider Organizations (PPO) are groups of doctors and hospitals that provide medical services only to members. PPO members typically pay for services as they are provided, and the PPO sponsor reimburses them for the cost of the treatment. In most cases, the healthcare providers and the PPO sponsor negotiate the price for each type of service in advance.

* Point of Service (POS) plans are less common than the other 2. Here you pay no deductible and usually only a minimal co-payment when you use a healthcare provider within your network. You also must choose a primary care physician who is responsible for all referrals within the POS network. If you choose to go outside of the network for healthcare, you will be subject to excess charges or deductibles.

3. Indemnity Plans allow participants to seek medical assistance whenever and wherever they need it. Participants can visit any doctor or specialist, as often as they feel necessary. There are no restrictions when it comes to seeking medical help. This is by far the most expensive type of health insurance plan.

Which of these types of health insurance is best for you will depend on your personal situation. Choosing a health insurance plan is a time-consuming task, but an educated choice will ensure you have the right insurance coverage when the need arises. And as we age, the need will inevitably arise.




About the Author
Ron King is a full-time researcher, writer, and web developer. Visit http://www.healthinsuring.com to learn more about this subject.

Copyright 2005 Ron King. This article may be reprinted only if the resource box is left intact.











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How To Choose A Health Insurance Plan

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How To Choose A Health Insurance Plan
by Ron King


Are you thinking about buying health insurance? With so many different alternatives, it is difficult to know which to choose.

When choosing a health insurance plan, never base your decision solely on the monthly premium. There are many other cost factors -- deductibles, co-payments, and the like -- that will determine the true price tag of your insurance. You'll need to read the fine print of the health insurance plan, including what it does and does not cover, the in-network versus out-of-network coverage and costs, claims processing procedures, and the coverage limits.

Know Your Health Care Needs

The first step is to review the scope of your needs: coverage just for yourself, for a large family, or something in between?

Next assess the health needs for all you intend to include in your health insurance plan. Are there any pre-existing conditions to consider? Does someone need to have access to certain medical specialists or medical institutions?

Research and Compare Your Options

The answers to the above questions will give you a good starting point in your search for the right health insurance plan.

Next, you need to explore your options. If you're getting group insurance through your employer, your options will be limited to what the company offers. Otherwise, you'll need to more research and comparison shopping. At a minimum, you have to understand the difference between the 2 basic types of health insurance plans offered today: the Indemnity Plan, and the Managed Care Plan with its variants.

Indemnity Plans and Managed Care

An Indemnity Plan offers the freedom to choose when and where you will seek medical assistance. Along with this freedom usually comes higher out-of-pocket costs. For many this is a fair trade-off.

Managed Care Plans are more restrictive, and require you to utilize the medical professionals and institutions that are part of the plan's "network." Participants often need pre-approval for medical services that are beyond basic preventive care. The costs for this type of plan are usually lower than Indemnity Plans. For those who are basically healthy, don't mind who provides their medical services, and who need to control medical costs, Managed Care Plans are usually the better choice.

This is a very basic comparison of the types of health insurance plans available. It is a first step in your own data gathering and analysis process.

Select The Right Company

Once you've done your homework and know what you want, you need to choose the right health insurance company. Many companies offer health insurance, from well-known corporate giants to small independent outlets. As with any major purchase, you'll want to research these companies before making a final decision.

Also, find out which state or federal agency regulates the type of health insurance you're considering, in case you have questions or experience problems.

Each type of health care plan has advantages and disadvantages. It is in your best interest to research thoroughly, so that the health plan you choose will be the right one for you and your family. For today and for years to come.




About the Author
Ron King is a full-time researcher, writer, and web developer. Visit http://www.healthinsuring.com to learn more about this subject.

Copyright 2005 Ron King. This article may be reprinted only if the resource box is left intact.










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