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Health Insurance Explained In Plain English – Part 1

Understanding health insurance and the health industry is much easier if you recognize some of the basic terminology and how it applies to you and your health insurance policy. If you have a health insurance plan and arent sure how it works or what the terminology means, take a few minutes to read the explanations below. Knowing these terms and what they mean to you can greatly aid you in dealing with your health care providers, insurance company, insurance agent, or during the health benefits shopping process.

Benefit Year
This is the 12-month period in which your benefits are calculated. Most insurance companies use a CALENDAR year, which is January 1 to December 31, but a few will use a 12 month period from when your policy goes into effect. For example, if your insurance goes into effect on June 1, the END of your benefit year is May 31. Make sure that you understand how your benefit year will be calculated.

Deductible
Deductible means the amount of money you must pay out of your pocket for medical expenses EACH YEAR before your health insurance begins paying out. Deductibles are usually reset to 0 at the beginning of each calendar or benefit year. Many insurance companies offer health plans that have benefits that are not subject to having to meet your deductible each year such as doctors office visits, immunizations, wellness or routine exams, etc. An easy way to remember what this term means and how it works is this:

When you have incurred medical expenses, all bills must be sent to the insurance company. When the insurance company looks at your bills, they then look at your policy and see how things are covered. They will then add up what the combined medical expenses have been for the year to date: determine what your deductible is and how much you have already paid towards meeting your deductible for the year, and pay out according to how your insurance policy says it will.

So in a nutshell, the insurance company is deducting your financial responsibility for medical expenses each year from the total combined medical expenses before they have any responsibility to pay outhence the term deductible.

Co-Pay
A co-pay is an amount that is paid by the patient to a provider at the time of service. It will either be a flat fee (like $15 or $20) or it can be a percentage of the service provided. The percentages or fee may vary depending on the type of service provided. A co-pay is different than coinsurance see next.

Coinsurance
Coinsurance is the percentage paid by the insurance company after you pay the deductible. Example: Your health insurance pays 70%, you pay 30%. The insurance company pays 70% coinsurance, you pay 30% coinsurance. Most health insurance policies will have a limit on the amount of coinsurance you have to pay out each year this is known as your Annual Coinsurance Maximum or Stop-loss.

Annual Coinsurance Maximum
After paying your deductible and after paying your coinsurance (classically 20% or 30% of medical expenses) to a certain dollar amount, your health insurance will pay 100% for the remaining costs in the calendar year. Example: After you pay your deductible, your health insurance pays 70% of medical expenses and you pay 30%. Once you reach the coinsurance maximum, you no longer pay 30% of the medical expenses because the insurance pays 100%.

Out of Pocket Maximum or Stop Loss
Stop Loss is the maximum amount of money you will have to pay out of your pocket in the benefit year.

Lifetime Maximum
This is the limit of the money the health insurance will pay out over your lifetime. Most major medical health insurance policies will be a $2 million lifetime maximum, while others will go as high as a $12 million lifetime maximum. In general, it is not recommended to have a policy with less than a $2 million lifetime maximum.

Office Visits
When you visit a doctor in their office they normally bill the health insurance company for an “office visit.” Most health insurance plans pay office visit expenses at the coinsurance (generally 70% or 80%) after the deductible. Some health insurance plans pay office visit expenses at the coinsurance rate but waive the deductible, which means you dont have to reach the deductible amount before they will cover their portion of the expense. Still other health insurance plans pay office visit expenses in full after a co-pay (usually $25 or $30). It should also be noted that office visits can be classified in two different categories. One category is usually called Routine Care, Wellness visits or Preventative care (see definition below). The other type of office visit is deemed as Medically Necessary (see definition below). Certain health insurance policies cover each of these types of visits differently and other plans do not cover them at all. If having these types of office visits covered by your health insurance policy is important to you, make sure you let your agent know so that they can help find the right plan for you.

Preventive Care
Preventive Care is classically defined as routine exams, immunizations, well child care, and cancer screenings. These include your yearly exams and checkups for things such as physicals, pap smears, mammograms, etc. Not all plans cover preventive care. It may not be a wise use of your money to have preventative care included in your plan if you never go to the doctor. A good health insurance agent can help you determine if this is necessary coverage for you.

Medically Necessary
These are the visits utilized for your smaller ailments such as colds, flu, ear infections or minor accidents. Not all plans cover medically necessary visits, so make sure you know if your policy includes these exams if you need them covered. You may consider purchasing accident insurance or adding a rider (explained below) to your policy to cover these types of issues.

Diagnostic Lab and X-Ray
These are tests involving laboratory or imaging services (such as x-ray, CAT scan, etc.) to diagnose a health problem. These services are usually paid at the coinsurance (typically 70% or 80%) after the deductible.

Chiropractic Care
When you visit a chiropractor for spinal manipulation or other services, these expenses are customarily paid at the coinsurance rate (70% or 80%) either after the deductible is met, or by waiving the deductible. Most health insurance plans limit the number of chiropractic visits/services to 10 or 12 per year especially if the deductible is waived. After this, additional visits are not paid by the health insurance plan, and you will be responsible for the full amount of the bill.

Inpatient or Outpatient Care
When you receive care from a hospital (inpatient or outpatient services), these expenses are customarily paid at the coinsurance rate (70% or 80%) after the deductible has been met.

Emergency Room
When you receive care from a hospital emergency room, these expenses are customarily paid at the coinsurance level (70% or 80%) after the deductible. Most health insurance plans also require you to pay an additional co-pay (commonly $75-$100) for each emergency room visit. A number of plans waive this additional co-pay if you are actually admitted to the hospital through the emergency room and the plan will pay as an inpatient service. A plan can sometimes be structured to have separate coverage for accidents as an additional rider (see definition below) to your policy.

Prescription Medications
Prescription medications can be classified as generic, brand name, or non-preferred brand name (see below for definitions). Please Note: Not all health insurance plans pay for prescription drugs, so if you already take prescription drugs or think you will need help in the future with prescription drugs, you will want to make sure that you are purchasing a plan that includes this coverage. Prescription drugs may be covered at the coinsurance rate (70-80%) after a deductible specifically for prescription drugs is met, other plans may include Prescription drugs in the total deductible for the plan.

Generic Medications
Drug manufacturers are permitted to sell a generic version of a medication after the patent expires for the brand name medication (generally 20 years after the brand name medication was registered). Generic medications are equivalent to the corresponding brand name medication, but are much less expensive than the brand name medication. Health insurance plans frequently provide better payment for generic medications as an incentive for you to ask for the generic version. About half of all prescription medications filled in the United States are filled with generic medications.

Brand Name Medications
Brand name medications are more expensive than generic medications. Most health insurance plans create a limited list of brand name medications that they will pay for and many health insurance plans also provide less coverage for brand name medications than for their generic counterparts.

Non-Preferred Brand Name Medications
Most health insurance plans create a limited list of brand name medications they will pay for. If your brand name medication is not on this list, it might be paid at a lower level under “Non-Preferred Brand Name Medications.”

Maternity
Some health insurance plans cover the cost of maternity, which includes doctor and hospital charges for prenatal care as well as labor and delivery. Maternity is expensive to add into a health insurance policy because it is considered a guaranteed expense for the insurance company. If a woman becomes pregnant, it is a safe bet that there is going to be medical expenses incurred! If there are no complications and the birth goes well, the insurance company will be out a large monetary portion of the cost of delivery and even more if there are problems with the delivery or the newborn. Insurance companies price maternity so that they can still maintain profits. In some cases it may be best to save your money and pay for the prenatal care and the delivery out of your own pocket (or on a credit card) and let the insurance cover the catastrophic events. The difference you save in the monthly cost of having maternity coverage may be well worth it to you. Remember, once you have a policy that covers maternity, you cant just remove the maternity coverage after the pregnancy is done! You will continue to pay for that maternity coverage for as long as you have that policy.

Mammography
Mammography is a specific type of imaging that uses a low-dose x-ray system for the examination of breasts to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms. Current guidelines from the American Cancer Society (ACS), and the American Medical Association (AMA) recommend a screening mammography every year for women, beginning at age 40. Various plans will have automatic coverage for mammograms but some will not. Several states (like Washington State, for example) have specific guidelines that require companies to have coverage for mammograms in their policies as an automatic benefit.

Mental Health
Outpatient mental health services include visits to a licensed counselor, therapist, or psychiatrist. Inpatient mental health services include admission to a psychiatric hospital. Many plans do not cover mental health services.

Rehabilitation Therapy
Rehabilitation therapy may include physical therapy, occupational therapy, speech therapy, message therapy, cardiac rehabilitation, and chronic pain therapy. Most health insurance plans limit rehabilitation therapy to a certain number of visits per calendar year or to a certain dollar amount that they will pay for rehabilitation for either the year or for a lifetime.

Rider
Anything that changes the way your policy acts by default is called a Rider. A rider can be anything from an exclusion of coverage for a medical condition, or additional coverage for potential conditions. (As in an accident rider mentioned earlier in this report)

Occupational Coverage/On the job coverage
The largest portion of health insurance plans do not cover occupational related medical expenses. This can be a HUGE pitfall for self employed people. Always make sure that if you need to be covered while you are working that your plan will give you on the job coverage. If you get injured or sick while you are on the job and you do not have Workmans Compensation or Labor and Industries accident coverage, you may have to pay for ALL medical expenses out of your own pocket.

Vision Coverage
Vision coverage is usually broken into two parts: vision exam, and vision hardware. Vision exam benefits include the cost of a refractive exam used to test vision acuity (20/20, 20/40, etc.). Vision hardware represents the cost of eye glasses or contact lenses. A number of health insurance plans do not cover vision exams or hardware. However, medical issues relating to the health of the eye (like Glaucoma) are almost always covered under the regular medical portion of the health insurance plan.

Doctor Directory
Each insurance company will have a list of doctors that the company has negotiated terms for payment of services with. You can go to the insurance company’s website to find a listing of contracted preferred providers.

This information may help you understand a policy that you already have, or aid you in understanding a policy that you may be thinking about purchasing. The more knowledge you have about what the industry jargon means, the more you will be able to make informed decisions about the insurance you choose to use.

Exercises To Encourage Creativity

Introduction

Before I list some very helpful and powerful exercises to encourage creativity, let’s take a moment to consider what constitutes creativity, why we aspire to encourage creativity in the first place and what is required from the person who wishes to encourage creativity through exercises, be it her own creativity or that of others.

Definition of Creativity

If one wishes to encourage creativity, it is advised that she first has a clear definition of this term. However, Creativity is an illusive and complex term that seems to defy definition, so let me list some options and choose what fit you most. Creativity has to do with original and flexible thinking, the ability to pay attention to details, the ability to cope with uncertainty. Creative individuals possess a high motivation to overcome obstacles and solve problems, the willingness to take calculated risks, the desire to work hard in turn for recognition.

Benefits of Creativity

Encouraging creativity through exercises is a proven way to develop young minds. Weaving creativity exercises into children’s education greatly improves their chances of becoming successful and constructive adults who are able to cope more aptly with a rapidly changing world. An environment that encourages creativity is also a solid foundation for mental health. Creativity exercises cultivate highly motivated students who are less prone to adverse psychological states such as stress and boredom.

Creativity Exercises – What Is Required of the Teacher

First and foremost: you have to practice what you preach, you have to walk the talk, or in other words, if you want to encourage someone’s creativity, be creative! Show them. Don’t tell them. Be a role model for exercising creativity and they will follow.

Creativity is to be handled with respect and care. Therefore, you have to create a special and suitable physical environment for creativity exercises. Such environment should be comfortable and enabling, and guarded from outside disruptions.

What’s even more important than the physical environment is the emotional one. Your responsibility is to create a safe place to express ideas, make mistakes, be silly, and not be judged or be subjected to ridicule. I can’t stress this enough. Passing judgment kills creativity. Eliminate corrections and advice to a minimum. Abandon the right and wrong, black and white, good and bad mentality. Enable your students to fearlessly express their thoughts, their individuality. To achieve a safe environment for self expression, be sure to incorporate in your creativity exercises the following ingredients: humor, laughter, music, art, drama, dance, and movement.

Some of the following creativity exercises require certain materials. Be sure to provide these materials. You should probably provide additional materials that are not directly related to your planned exercises, in case your students will come up with fresh ideas and require materials to realize them.

Expose your students to creative artwork in order to inspire them and wet their appetite, but beware not to over do it. You want to give your students ideas, to jump start their creative muscles; you want them to be encouraged, not discouraged.

Creativity Exercise #1 – Image Streaming

This exercise is to be carried out in pairs or individually. The exercising student closes her eyes and asks herself a question. The exercising student then describes out loud her mental visual imagery either to another student or to a tape recorder. Describing of the mental images should be flowing and streaming. In the process of describing the images she sees in her mind, the student should concentrate on sensory details. For example, “I feel the softness of the fresh laundry”, “my feet are pressed against the cold tiles”, “I smell the rain-soaked air.” The student should aim to make her live or potential listener vividly experience what she sees. In order to develop and maintain the flow of streaming imagery, the student should ask herself new questions as to the nature of objects she sees in her mind and explore them in detail. Relaying the mental images should be done in a hastened pace to avoid judgment and critical thinking. Image streaming is to be exercised for at least 10 minutes each time. Over time, this exercise improves creativity and intelligence.

Creativity Exercise #2 – Challenge Traditional Thinking

This exercise can be practiced in a group or individually. Routine thinking is good for every day tasks, since you perform the task without employing your mind and wasting energy on the thinking process. For example, if you take the same route to work every day, you soon drive on auto-pilot. If, however, you have a task that requires you take a different route, then you have to concentrate and be aware of the left and right turns you make. If your thoughts drift, you will find yourself going unintentionally in the regular route. If you wish to exercise creativity in solving problems, you have to stay clear of routine thinking. This can be achieved by forcing the mind to find new routes. Instructions: make a list of words and write each word on a card. For each word instruct the students to come up with 2 related words and write these down on separate cards as well. You now have groups of three words each. And now for the creative part: randomly pick two unassociated words and instruct your students to come up with an association between the two seemingly unrelated words. This will force their thinking process to form an unfamiliar route, a connection between two dots that were unconnected until now. Forcing our mind to find new trails that connect A and B is exactly what enhances creativity. Along the same lines, you can try these variation: make a basic outline map of the United States without state names. Instead of state names, write down names of world countries. For example, instead of Texas write Canada, instead of California write France. And so on. Now ask your students to find associations between the state and the country. Remember that we are not after any correct answer. We are exercising this in order to create new roads. So don’t test your students’ knowledge. Encourage them to come up with any association they can think of. It can relate to culture, economy, language, but it can also relate to the spelling of the names or to their pronunciation. Be open.

Creativity Exercise #3 – The Gods Must Be Crazy

An African Bushman, unaware of white culture, discovers an empty Coca Cola bottle in the Kalahari Desert. The bushman closely examines this mystical object (casually dropped by a passing pilot), wondering what it is good for. He then tries blowing into it, and is very pleased to learn that it makes a noise. In this creativity exercise you encourage your students to become Bushmen. I mean it. You need to collect 5 to 10 props. You display a prop to your students and ask them to find a new use for it. This exercise encourages creativity since it forces the thinking process to erase or ignore what is known and come up with fresh ways of looking at something familiar.

Creativity Exercise #4 – Music’s Story

Play a piece of classical music, preferably one that your students don’t know. Dim the lights, instruct your students to close their eyes and listen closely to the music. The music tells a story, it tells about the weather, about a poor or rich man, about mad love that is now dying. Ask each student to follow every plot twist, every change of atmosphere. Then stop the music and ask your students to write down their stories, with as much detail as possible.

Beware Of Sissy Hypnosis A Shady And Disreputable Practice

The therapy of hypnosis has been used for centuries to help people overcome a variety of illnesses and mental disorders such as schizophrenia, bi-polar disorder, depression, anxiety syndromes, obsessive-compulsive disorders, and even mood swings. Illnesses such as arthritis, irritable bowel, lupus and other autoimmune diseases have been reportedly helped by hypnotic therapy practices as well.

Yet, some disreputable practitioners of hypnosis use their talents and skill in a more subversive and demented way, such as those who perform what is known as sissy hypnosis, a form of trying to hypnotize a man into acting the role of a woman in his mind. This practice is truly a despicable misuse of what could be an otherwise helpful practice to some.

Feminizing Men With Sissy Hypnosis

Some men may have a twisted desire to be more feminine like a woman, whether they are homosexual or heterosexual. These men may desire to live out their unfulfilled fantasies in some way in order to become the sissy that they have always dreamed they would be. These men may suffer from an identity disorder, as they may have always wanted to secretly become women for one of many reasons.

These men could have been abused as children, and now they are living in homosexual lifestyles as a result of that abuse. They could also be married men who desire to live out some kind of dark, demented fantasy to be a woman. Those who practice sissy hypnosis are not true professionals at all but a fringe group of pleasure seekers who want an erotic thrill.

Sissy hypnosis should not be considered as a viable therapy of any kind for anyone. This so-called hypnosis is really a deviant form of inducing repulsive thoughts into someone’s mind for simple sexual pleasures. Sissy hypnosis often goes in the same category as those promoting bondage and sado-masochist forms of sexual torture techniques and other revolting ideas.

These practices are a sad fact of life in our modern times, yet they should be avoided by all people who seek a pure and moral life. With ideas such as these which abound in our landscape, it is imperative to try and protect children from practices such as sissy hypnosis, as much brainwashing in these matters is geared toward children.Pedophilia follows close on the heels of such practices as well, and even while there is freedom in the United States, practices such as this should not be tolerated, as they are beneficial for no one who participates in them.

How To Stop The Runaway Train Of Mental Illness By Betty Byrd

One in six adults and nearly one in ten children in the United States suffer from bipolar disorder. Yet, there remains a stigma associated with being bipolar and being related to someone who is. Never mind that Edgar Allen Poe was bipolar or that President Theodore Roosevelt was too. Or that people with bipolar disorder can lead extraordinary and meaningful lives. Look at Winston Churchill, Virginia Wolf, and Rosemary Clooney. No matter how talented or famous someone is, if they’re in a situation dictated by mental illness, it can at times feel like a runaway train. Jim Carey and Robert Downey, Jr. know what it’s like, so do Robin Williams, Jean-Claude Van Damme, and Ben Stiller.
Dealing with a mentally ill family member is anything but a cakewalk. I should know. My mother, a Christian Science fanatic, refused to take medication to manage her sickness. During my formative years, I lived through extremes; from minute to minute I didn’t know what she might do. My childhood was spent being tossed around like a ping-pong ball. At sixteen, a Harvard-trained psychiatrist reluctantly told me to leave home and never look back because I was living in an incurable situation. Sadly, I hit the road, riddled with pot holes, lacking any parental advice. During those formative years I didn’t have a choice, but now, in 2011, things are beginning to change.

I went on to become an actress and later a novelist. I took it to heart when I read that Ernest Hemingway said, “A writer’s style should be direct and personal” For me, it’s therapeutic to write about the disease that robbed me of my mother and stole any chance I may have had to enjoy a normal childhood. I use larger-than-life characters on a backdrop of big oil and big tracts of land to show life on high octane, which, in my experience, is what it’s like to live with the ups and downs of mental illness.

One of my main characters, Olivia Harrison has a history of undisclosed schizophrenia. My novel, Utopia, Texas, shows the terrifying ramifications on a family whose young daughter’s problem goes untreated. Some call the book, which is a stand-alone sequel to my first novel, Trinity’s Daughter, a riveting tale. The character of Maggie Harrison is fashioned after me. Olivia is my mother. Olivia’s mother, Brya, is actually the novel’s protagonist. I use my books as a tool to educate others about what it’s like to live with mental illness, and if not treated it can be devastating to all involved.

As a member of the International Bipolar Foundation, I’m on a mission to try to help erase the stigma associated with this dreaded disease which often goes undiagnosed or misdiagnosed. What’s missing in the equation is proper education, but through advancement of research, medication and support services life can begin to stay on track. Having been one of those children affected, I’m committed to encouraging family members to openly discuss mental illness so that healing can begin.

Currently, I’m working with organizations, such as the Boy Scouts of America and the Girl Scouts of the United States. Through public education, I hope the shame associated with mental illness will be erased. For many, the stigma can be as great a challenge as the disease itself. For people with bipolar disorder or schizophrenia, their life is like trying to navigate an unstoppable train-one that’s prone to skipping tracks and changing depots on a quick whim. There is no stopping this locomotive, but it can be slowed down in hopes of reaching a more positive destination.