Britannica Concise Encyclopedia defines public health as the “science and art of preventing disease, prolonging life, and promoting health through organized community efforts.”

As the name suggests, public health is focused on entire populations rather than individuals. In that sense it is different from clinical health. While clinical health is concerned with providing diagnoses and treatment for diseases to individuals, public health is involved with promotion of health and prevention of illness in a community.

Public health professionals promote wellness in a community by identifying and controlling health threats, developing and implementing education programs on hygiene and sanitation, and monitoring environmental hazards.

Some of the reasons why this is an exciting time to pursue a career in public health are:

While public health professionals come from varying academic backgrounds, a Master’s in Public Health degree is perhaps the most appropriate educational credential for this field. That’s because an MPH degree usually covers courses in various public health specialties such as community health, environmental and occupational health, biostatistics, epidemiology, healthcare administration, etc.

Other than an MPH degree, those interested in a public health career can also explore degree programs in healthcare administration or community health. However, these degrees will be focused on a specific field rather than provide a foundation in all disciplines of public health.

Let’s look at some of the popular public health disciplines:

Environment Health: Environment health is the branch of public health that is concerned with the theory and practice of assessing and controlling environmental factors that impact human health. According to World Health Organization, environment health services involve developing and implementing policies aimed at preventing environment health hazards and promoting public health and environment.

Biostatistics: Biostatistics is the application of statistics to a variety of biology disciplines. Biostatistics has widespread application in the field of public health. It uses statistical science to identify health trends and analyze public health problems.

Epidemiology: Epidemiology refers to the study of factors affecting the health of a community. This branch of public health studies the risk factors for a disease and how to control its spread in a community, among other things.

Healthcare Administration: Healthcare administration is concerned with ensuring the smooth function of a healthcare organization. Public health administrators plan, coordinate, and supervise community health programs or manage the day to day operations of a public health organization through activities like employee supervision, staffing, budgeting, policy making, etc.

Health Education: Health educators work with communities to promote healthy lifestyles and wellness. They educate populations about disease and injury prevention and other health problems. Health educators are responsible for planning and implementing various community health education programs as well as evaluating their success.

If the above mentioned fields pique your interest, then a Master’s in Public Health degree is what you need. With the availability of many public health online programs, it’s become more convenient than ever to enter this remarkable profession!

In March 2010, Congress passed a new Health Care Reform Bill. One of the many components of this Bill is the creation and funding of state health insurance pools that will help people gain access to insurance that were otherwise turned down for health insurance. Backed by a 5 Billion dollar subsidy, the health care risk pool will provide states with the ability to offer premiums and health care for those uninsured and with pre-existing medical problems. But is this State health insurance risk pool a good option?

First, we need to further understand the details of State health care risk pools.  State insurance risk pools are a type of health care program created by state legislatures to provide health care for the medically uninsurable due to pre-existing health conditions.  A risk pool in these cases is really helpful as it provides the bare minimum insurance to those in need.

A study by United Health Foundation reported that 15.9 percent of Americans have no health insurance.  For those insured, 60 percent have health insurance through a group or employer.  The remainder is made up of individuals covered by government health care, military programs and other federal programs and private health insurance.  For people without insurance, they have no other option than to purchase individual health insurance from private health insurance companies. For people with existing medical conditions or other health problems, finding a health insurance company with reasonable prices is next to impossible.

Insurance companies make money if you pay premiums and don’t get sick or hurt. They work with tables called “actuaries” that predict who, at what age, genetic background, part of the country and other variables will get sick or hurt and need medical care. The less likely you are to get hurt or sick the better your insurance premiums. This is one of the reasons larger businesses get better rates than an individual. With a large group there is a diverse range of age and health conditions which help the insurance company distribute their risk as many will pay in with fewer paying out. At least that is the insurance company’s hope. For those uninsurable high risk individuals, this is where a State insurance risk pool is useful since it is affordable and backed by Government.

In most states, 34 right now, there is a state sponsored pool that you can apply for if you have been turned down by an insurance company. Some states have good pools, some not so good. The coverage can be expensive and may not have the coverage you had at one point, but it is better than no insurance at all.

How do you apply for the new federal risk pool? Well here is what we know so far; the program will be set up in the 90 days following the March 2010 signing of the bill, you must have been uninsured for at least 6 months to apply, and you must have a yet-to-be-defined medical problem.

To learn more about the specific programs your state offers, go to your state’s website. Once you are there, find the search box and type in “high risk insurance”. This should bring up the department of insurance in your state, along with articles that will help you apply for it. This will also bring up articles about how your state is working with the federal government and the new bill to provide coverage for their uninsured residents.

State risk pools and where to contact them

Alabama Health Insurance Plan Toll-free 1-800-513-1384 or (334) 353-8924

Alaska Comprehensive Health Insurance Association Toll-free 1-888-290-0616

Arkansas Comprehensive Health Insurance Plan Toll-free 1-800-285-6477

California Major Risk Medical Insurance Program Toll-free 1-800-289-6574 or (916) 324-4695

CoverColorado (303) 863-1960 or toll-free 1-866-787-9129 (M-F 8am–5pm)

Connecticut Health Reinsurance Association Toll-free 1-800-842-0004 (M-F 9am-4pm EST)

Florida Comprehensive Health Association (closed to new enrollees since 1991) (850) 309-1200

Idaho Individual High Risk Reinsurance Pool (link is to a PDF on program) Toll-free 1-800-721-3272 (In-state only)

Illinois Comprehensive Health Insurance Plan Toll-free 1-866-851-2751 (in-state only) or (217) 782-6333

Indiana Comprehensive Health Association (click “guest” for access, then choose “ICHIA”) Toll-free 1-800-552-7921 or (317) 614-2000

Health Insurance Plan of Iowa Toll-free 1-877-793-6880 (M-F 8am-5pm CST)

Kansas Health Insurance Association Toll-free 1-800-362-9290 (M-F 8am-5pm)

Kentucky Access Toll-free 1-866-405-6145

Louisiana Health Plan Toll-free 1-800-736-0947 or (504) 926-6245

Maryland Health Insurance Plan Toll-free 1-888-444-9016 (M-F 8am-5pm)

Minnesota Comprehensive Health Association Toll-free 1-866-894-8053

Mississippi Comprehensive Health Insurance Risk Pool Toll-free 1-888-820-9400

Montana Comprehensive Health Association Toll-free 1-800-447-7828

Nebraska Comprehensive Health Insurance Pool (402) 343-3574 or toll-free 1-877-348-4304 (M-F 8am-4:30pm)

New Hampshire Health Plan Toll-free 1-877-888-6447

New Mexico Medical Insurance Pool (505) 622-4711

North Carolina Health Insurance Risk Pool (NCHIRP) Toll-free 1-866-665-2117

Comprehensive Health Association of North Dakota (North Dakota health insurance risk pool) Toll-free 1-800-737-0016 or (701) 277-2271

Oklahoma Health Insurance High Risk Pool Toll-free 1-800-255-6065 or (913) 362-0040

Oregon Medical Insurance Pool Toll-free 1-800-848-7280 or (503) 225-6620 (M-F 8am-5pm)

South Carolina Health Insurance Pool Toll-free Phone 1-800-868-2500, ext. 42757, or 1-803-788-0500, ext. 42757

South Dakota Risk Pool 605-773-3148 (ask for a Risk Pool representative)

Tennessee’s Tenncare Program 1-888-486-9355

Texas Health Insurance Risk Pool 1-888-398-3927

Utah Comprehensive Health Insurance Pool Toll-free 1-800-705-9173 or (801) 442-6660

Washington State Health Insurance Pool Toll-free 1-800-877-5187

West Virginia Health Insurance Plan 1-866-445-8491

Wisconsin Health Insurance Risk Sharing Plan Toll-free 1-800-828-4777

Wyoming Health Insurance Pool (307) 634-1393

Who is Responsible for the Health Crisis in America?

A baby born in the U.S. in 2004 will live an average of 77.9 years. That life expectancy ranks 42d in the world, down from 11th twenty years earlier.

- Source: Census Bureau and National Center for Health Statistics

BLAME-STORMING THE HEALTH CRISIS

Who is responsible for the health crisis in America? Is it the government? The state of the economy? Parents? Schools? What about you and me? Restaurants? Grocery stores? Or is it our busy schedules? How about those get-togethers and parties you attend? Maybe the presented food choices are to blame. Yes! “Blame.” That is the word I was looking for! We are looking for someone or some institution to blame for our health crisis.

IS THERE A GOVERNMENT CONSPIRACY?

Is there a government conspiracy? If so, just who are the conspirators? Let us get one thing straight. You and I do not need anyone′s help in creating a health crisis. There is a reason for this. You and I are the greatest conspirators of our own lives. We have received more than enough information to let us know what to do to enhance our health and yet we, in many cases, do not act and make the changes. I think that clarifies the conspiracy theory in a nutshell. When I speak of this health crisis, I am not talking about medical insurance or medical costs or treatment. True, this is an important issue. However, this issue only touches on the surface of the problem. How we think, eat and live is the real cause. So who or what is responsible? Do you have an idea? Who is the villain or culprit?

YOU ARE RESPONSIBLE FOR YOUR HEALTH

You are personally responsible for all the decisions you make. Do not blame any institution or anyone else for your poor choices that lead to disease, illness and poor health.

WHY AMERICANS RANK LOW ON LONGEVITY

What has caused America to fall so far behind the statistics on longevity in the world? The ranking went from 11th to 42d. Americans do live longer, but not as long as 41 other countries, according to National Center on Health Statistics. Why is one of the richest countries in the world not able to keep up with other countries? Some say it is because the United States has no universal health care. I do not see that as the primary reason since we have never had universal health care. Here is what I think are some of the primary reasons for this trend:

SAM MADE ME DO IT

Kids sometimes will do the craziest things. Once upon a time, there were two brothers. We will call them Sam and Jake. As school-aged brothers, Sam challenged Jake to climb a tree, and so he does. Then Jake is challenged, on a dare, to go farther out on a long, thin branch of the tree. He gets about half way out before the limb breaks, and he comes falling to the earth with a thump. Jake broke his nose and got some cuts and bruises. Both kids report to their mother and of course Mom asks Jake, “How did this happen?” Jake responds, “Sam made me do it!”

There are many complaints I hear about all that enticing processed food in the grocery stores. There are remarks about the special challenge of eating out: The portion sizes are too big, and there are all those irresistible, unhealthy “choices” available. I see no difference between Jake’s response and these complaining adults’ reactions to their plight – or, should I say, dilemma. Jake said, “Sam made me do it.” Translation: Sam is responsible for Jake’s poor decision to go out on a limb. That is nonsense. Jake is responsible for his own decision to go out on a limb. We adults are too frequently “going out on a limb” with our health by making poor choices while laying the blame on external circumstances or institutions — whether commercial, social, or governmental. Cease fire with such thoughts of blaming external circumstances or other people. Take charge. Be accountable for your own actions.

INSTITUTIONAL RESPONSIBILITY

Are our institutions off the hook when it becomes to responsibility? No, they are not. I use the term “institution” in a broad sense, to include the following:

INSTITUTIONS ARE RESPONSIBLE TO LEAD BY EXAMPLE

What kind of leadership responsibility do institutions have when it comes to healthy eating and exercise? Institutions, as well as all leaders, have a heightened level of responsibility beyond rules and regulations of the organization.

Our institutions have the special responsibility to “walk the talk,” clarify the goals of health and fitness, and assume a more visionary role to set and implement standards for a solution to our health crisis. Our institutions are morally obligated to set the example by living by the higher standard required of them as leaders. This can be accomplished through legislation, executive orders and both internal and public policy making. Our institutions need to deal with the problem directly and use their special influence to save lives and prevent suffering.

HEALTH INSURANCE DOES NOT EQUATE TO A HEALTHY LIFESTYLE

Health insurance will not accomplish this. Are you looking for true medical insurance? Make your premium payments in the form of living a healthy lifestyle void of dependence on a home pharmacy of medications. Most of our medications are prescribed because of our lifestyles, not because we simply got sick. I am talking about the overwhelming rule and not the exception.

There are exceptional cases where, despite a healthy lifestyle, serious disease or illness happens. Would you cease to drive a car simply because someone had an automobile accident? In addition, you certainly should not cease to lead a healthy lifestyle just because someone you know lived to be 100 years old as a smoker. That would be a fatal error in thinking. It is just this type of thinking that is killing and maiming Americans. Ban this type of thinking from your mind.

Take the educational institutions for America’s young people. Schools are primarily focused on delivering on educating our youth with an approved curriculum. Schools need to go beyond mere curriculum, to consider the whole child, setting improved fitness and healthy eating as a priority. Fitness and healthy eating should be a part of the curriculum, as they play a major role in the development of a child.

TEACHERS ARE ROLE MODELS

Teachers are role models and leaders when it comes to eating and exercise habits and how they portray their attitudes about fitness and health in school. John Maxwell defines leadership as “influence – nothing more, nothing less.” Moving beyond the position of the teacher to assessing the ability of the teacher to influence others as a leader is essential. This refers to those who would consider themselves followers, and those outside that circle.

Leadership builds character, because without maintaining integrity and trustworthiness, the capability to positively influence will disappear. There are many other definitions of leadership. They all point to a leader having influence on others and providing to them the guidance and direction necessary to envision a long-term view of the future.

POINT OUR CHILDREN IN THE RIGHT DIRECTION

Policy is made from the top down through legislation, executive order, mission and policy statements. Where there is a void in such top-down leadership, the initiative must begin from the ground up. Educational institutions by virtue of their access to vast blocks of our children’s time, have a unique responsibility to go beyond mere curriculum to consider the whole child. By offering and stressing healthier choices, they are setting precedent for the rest of that child′s life.

Early in America’s pioneer history, schoolteachers were expected to be morally beyond reproach in every detail of their own lifestyle. This reflected how those communities wanted to influence their children’s future and the future of the country as a whole. Today’s America likewise needs today’s schoolteachers to be wholeheartedly health conscious for the same reason. Our future depends on it.

That is not to say that all schoolteachers should be fashion-model thin or good-looking or in any way shaped by the media’s image. An overweight teacher who is working to improve her fitness would be preferable over the Size 4 who is proud to eat candy bars and drink sodas in front of her pupils.

Institutions are role models in all that they say and do or do not say or do.

Their policies and actions set the standards.

WE ARE KILLING OUR CHILDREN

Look at some statistics on childhood obesity in America.

About 15 percent of children and adolescents ages 6-19 years are seriously overweight.

The percentage of children and adolescents who are defined as overweight has nearly tripled since the early 1970s.

Centers for Disease Control and Prevention’s (CDC), 1999-2000

National Health and Nutrition Examination Survey (NHANES)

CHILDHOOD OBESITY ONLY AN INDICATOR AND NOT THE REAL PROBLEM

Childhood obesity is only the indicator of an underlying problem of a sedentary lifestyle and unhealthy eating habits. Address these underlying issues, and childhood obesity will be significantly reduced.

SCHOOLS, TEACHERS AND PARENTS HAVE A HEIGHTENED LEVEL OF RESPONSIBILITY

Our schools, teachers and parents have a heightened level of leadership responsibility to address the statistics that are just a few of many indicators of the direction of the state of health of our children. Once these children become adults, they, too, will pass on their lifestyles to their children and will in all likelihood perpetuate poor eating and exercise habits. The consequences will manifest themselves as learning disabilities, increased crime, and socioeconomic problems which our children’s generation cannot afford to inherit.

THE MOTHER OF ALL INSTITUTIONAL EXCUSES

What is the number one excuse institutions use for not doing more to fight the poor state of health of Americans?

Answer: It is each individual’s own decision as to how he or she wants to live, how he or she wants to eat and exercise or not. This is the mother of all institutional excuses. An institution using this excuse relinquishes its leadership responsibility as a visionary to lead and guide by example and exercise that institutional influence it possesses. The institutions need to ask the visionary question of what can they do to influence, guide and inspire each individual to make healthy lifestyle choices.

WHY PYRAMIDS AND DIETARY GUIDELINES DON’T WORK

Dietary guidelines, pyramids and charts have all failed to make Americans healthier. Why are they not working? Institutions are made up of individuals who are a cross-section of society who are therefore personally dealing with the same lifestyle issues about eating and exercise, as are all consumers.

Dietary guidelines do not work, because the vast majority of the food and beverage industry does not incorporate them into food choices and portion sizes we see on the shelves. Remember, this is from the perspective of the institution and its responsibility and in no way diminishes the personal responsibility of every individual to take charge of their own lifestyle and choices. Our children need special guidance to learn what personal responsibility means. That guidance must come from adults.

GOVERNMENT SETS THE STANDARD AS A LEADER

Emission controls in the automobile industry have resulted in smaller, cleaner, and more fuel-efficient cars; though more work remains to be done. These successes were accomplished through government regulation through the Clean Air Act and similar initiatives. We have another just as pressing form of pollution going on in America: health pollution.

HEALTH POLLUTION

We have a health pollution crisis on our hands in America, and – as with automobile emission regulations – the food and beverage industry needs to be regulated to meet improved standards for healthy eating through strict labeling, reduced portion sizes, and regulation and disclosure of unhealthy ingredients in our country’s food supply.

The free market society needs some governmental fine-tuning in order to save American lives and prevent suffering. The cost of not doing so is enormous. Heart disease, cancer, stroke, and diabetes (the four leading causes of death in the U.S.), and obesity, hypertension, and osteoporosis are all linked to diet and exercise. Americans and their children are the most over-fed and under-nourished group of people in the world.

One out of two Americans is overweight.

One-third of Americans are obese.

Being overweight is the second leading cause of preventable death in the U.S.

ILLNESS AND DISEASE IS COSTING AMERICA BIG BUCKS

*Statistics compiled from the Pennsylvania Health Care Cost Containment Council “Hospital Performance Report: 28 Common Medical Procedures and Treatments” (December 2002)

FOOD AND BEVERAGE INDUSTRY

The food and beverage industry as well as the health and wellness industry have a leadership responsibility to clean up their marketing. Misinformation and misleading claims are rampant. Observe carefully and you will detect the emotion-laden words, which are associated with poor choices and portion sizes:

In addition, the list goes on:

Fun, exciting, easy, time saver, feels great, low-carb, no sugar, no fat, healthy, look great.

Will the food and beverage industry have an economic price to pay for such changes? Yes, the transitional period will have some associated costs, in the short term. In the end, the food and beverage industry as well as consumers and our country as a whole will all benefit from a healthier America with healthier food choices. In fact, this will result in innovation and new areas of revenue for the food and beverage industry, all while actively contributing to making Americans and America healthier and stronger.

THE PUBLIC′S BASIC RIGHT TO KNOW

Disclosure is the law for government in Florida and many other states and federal entities. The Sunshine Law of Florida establishes a basic right of access to most meetings of boards, commissions and other governing bodies of state and local governmental agencies or authorities. It has led to not only a more informed public, but also actually better government.

Full disclosure on food labels would likewise inform the public and result in healthier foods being produced and marketed. True full disclosure for the average consumer must be in the form of a simple “level of healthiness” and “level of nutrients” grade. The factors determining the simple, easy-to-understand grade must be clearly defined in easily understandable language.

HEALTH POLLUTION A NATIONAL SECURITY ISSUE

The present health pollution of America is a national security issue because the consequences go much farther into sociological issues, such as increased crime and poor learning ability. An unhealthy America cannot perform or think as well.

LOOKING FORWARD

Whatever challenges our country faces will be better met if we are healthier in mind and body. Sick and unhealthy Americans are living longer and living with meds. These Americans need to be weaned back to health and off the meds, where possible. In most cases, lifestyle changes will result in improved health, independent of meals. Our physicians are challenged with a special institutional leadership role in strategizing to prescribe lifestyle-based changes and not just medication so that they and not just medication so that they truly can take on the role of healers, not only for the patient but also for the nation. Keep America strong. The medication mindset without healthy eating and exercise is killing Americans.

We have what it takes to change our culture for the betterment of all by taking personal responsibility for our lifestyles we lead. Our institutions have an equally important role model responsibility to set the tone and standard necessary to keep America healthy. Regardless of political affiliation, there should be complete agreement about personal and institutional responsibilities.

No sooner had President Obama signed the last piece of the health care reform package on March 30 than he hit the road, traveling to a number of states to sell the public on the new health care law of the land. On their Easter/Passover recess break, many members of Congress were engaged in their own hearts and minds campaign on health reform back in their home districts. A new Gallup poll, however, seems to show that Democratic supporters of the bill have the tougher selling job. The poll shows that 47 percent of Americans believe it is a good thing that the bill passed while 50 percent believe it to be a bad thing. And, the results show that both opponents and proponents agree that the new law does not do nearly enough to address rising health care costs. Health plans, such as Aetna, have maintained that the success of health care reform will hinge on addressing health care costs, and we have pledged to continue working toward reforms that would achieve affordability. Federal Since Congress was in recess last week, there is no Federal report this week. States ARIZONA: After a lengthy debate in special session, the legislature voted along party lines to permit a lawsuit challenging the newly enacted federal health care reform law. It is unclear whether Governor Jan Brewer will join other states in the lawsuit filed in Florida, since the attorney general has advised that he will not participate in any litigation on this issue. Brewer had asked lawmakers for authority to go around the attorney general and sue on the state′s behalf. COLORADO: A bill prohibiting the use of gender as an underwriting factor in setting rates for individual policies passed both chambers and will become effective with plans issued or renewed after January 1, 2011. The bill is part of Governor Ritter’s health reform package. GEORGIA: A bill that originally would have imposed a tax on health plans – the language regarding a health plan tax was removed recently — was passed out of the Senate last week. However, whether the Governor will sign the bill in its current form is not clear. IDAHO: The legislature adjourned a week early last week, but not before passing a number of items to close out the session. Governor Otter has signed a number of the bills, including the “Idaho Health Freedom Act″, reserving citizens’ right to choose or decline health care services without being penalized by the federal government and authorizing the state attorney general to seek legal recourse to uphold this policy. Also signed were bills regulating the relationship between third-party administrators and insurers, and establishing an immunization board to maintain a single distribution center for providers and determine an assessment on carriers to fund the program.  Another bill amends the duties of the Commission of Health Information Technology Planning to include monitoring the state′s health data exchange and recommending improvements to IT capabilities. Bills awaiting the governor’s signature include a proposed prohibition on a carrier’s ability to require a participating dentist from charging a member at a non-par rate for services that are not covered under the provider contract, and a proposed requirement that both the prescribing physician and patient be notified by the pharmacist of generic substitutions for epilepsy or seizure drugs. Defeated were mandates for oral chemotherapy parity and prosthetic limbs, an any-willing-provider requirement, and a bill permitting small employers to enroll in the state employees’ plan. ILLINOIS: The House has unanimously passed the Illinois Health Information Exchange and Technology Act to establish a state authority to operate the Illinois Health Information Exchange. Expected to pass in the Senate, the bill supports the adoption of electronic health records among health care providers in Illinois, and building the infrastructure necessary to make HIE possible. Aetna was one of three insurers supporting the new act as part of a coalition of provider, consumer groups and unions. The HIE is designed to promote and facilitate the sharing of health information among health care providers within Illinois and in other states, and foster the widespread adoption of electronic health records. The bill also sets forth the Authority’s powers, with public and private representation, to facilitate the secure exchange of electronic health records to deliver better health care. No later than January 1, 2015, each state agency that implements, acquires, or upgrades health information technology systems shall use systems and products that meet minimum standards adopted by the Authority for accessing the HIE. IOWA: The Iowa legislature ended its annual legislative session last week and passed bills that include a clinical trial mandate for cancer patients, a prohibition of dental fee schedules for non-covered services, and an increase in the amount the guaranty association will pay for hospital, med-surg and major med coverage. Also, an Insurance Department omnibus bill that passed includes several insurance reform amendments, including making rate increase applications public record and requiring an annual report from the Commissioner to include information from health plans on medical loss ratios, rate increase data, health care expenditures in Iowa and their effect on premiums, ranking and quantification of the factors that result in higher and lower costs, the plan’s current capital, surplus and reserves, any apparent medical trends affecting insurance costs, and any other data the commissioner might deem pertinent. Carriers now must also notify policyholders of any application for a rate increase exceeding the average annual health spending growth rate stated in the most recent national health expenditure projection published by CMS. Additional amendments included a mental health & substance abuse mandate for veterans, an expansion of IowaCare, the establishment of a health information clearinghouse/exchange, and prohibition of plans using genetic information to discriminate among patients. Bills of interest that died would have created mandate-light health benefit plans, a public access cost and quality transparency portal, mandated coverage for autism, and income tax deductions for section 125 health plans. MAINE: The legislature passed legislation that would prohibit health plans from imposing annual, lifetime or other caps on the amount they will pay for covered medical services. If signed by Governor John Baldacci as expected, the bill would take effect January 1, 2011. The legislation defines “health plan” as a plan offered or administered by a carrier that provides for the financing or delivery of health care services to persons enrolled in the plan (other than a plan that provides only accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care or other limited benefit coverage). A similar provision in the federal health care reform legislation recently enacted by Congress abolishes lifetime or annual dollar limits on essential health benefits. The federal reform law allows health plans to establish restricted annual limits on essential health benefits prior to January 2014 and to place limits on benefits that are considered non-essential health benefits. MASSACHUSETTS: The Massachusetts Division of Insurance (DOI) has rejected 235 of 274 rate increases filed for small businesses, using 90-day emergency regulations that require HMOs to file any proposed increases to small group rates or changes to small group rating factors at least 30 days in advance of their effective dates. The emergency regulations also require HMOs to provide a significant amount of additional information when filing any proposed small group rate increases or rate changes. The DOI sent letters to carriers outlining the reasons for its actions, including: the disapproved rate filings failed to illustrate how the carriers pay similarly situated providers differing rates of reimbursement based solely on quality of care, mix of patients, intensity of services, and geographic location at which care is provided; the disapproved rate filings failed to demonstrate that carriers have renegotiated provider reimbursement rates; and the disapproved rate filings were significantly above the medical consumer price index without an adequate explanation for the wide difference. MICHIGAN: Pulling attention away from the legislature′s individual market reform bills, Governor Jennifer Granholm implemented an executive order that would put into motion a cabinet level workgroup titled “Health Insurance Reform Coordinating Council” on federal health care reform issues to be implemented in Michigan. Her goal is to identify steps that must be taken to ensure that Michigan citizens reap the full benefits outlined in the federal reform bill, including benefits for dependents to age 26, tax credits for small business, Medicaid expansion beginning in 2014, insurance reforms (e.g., eliminating pre-existing condition exclusions and rescissions),a health insurance exchange, preventative services without co-pays, and changes in the Medicare donut hole. Office of Financial and Insurance Regulation Director Ken Ross will be part of the overall implementation. His immediate assignment is to create a health insurance ombudsman office, begin the framework for the health insurance exchange, as well as have ongoing communication with Health and Human Services and NAIC on the overall rules. SOUTH DAKOTA: As the legislature adjourned last week, Governor Mike Rounds vetoed a subrogation bill that would have prevented insurers from any subrogation rights until the injured party was first “made whole.” The Senate tried but failed to overturn the veto.  Legislation that was signed by the Governor included a bill prohibiting contracts between an insurer and a dentist that require the use of a fee schedule for non-covered services, a bill changing the premium rate-setting procedure for the high-risk pool,and a Joint Resolution opposing the federal health care reform proposals passed in the U.S. Senate and House. Several significant bills that died included a provision to allow South Dakota to opt out of federal health reform and a bill repealing premium and annuity taxes for insurers. TEXAS: Last week, the Senate Committee on State Affairs held a joint hearing with the Senate Committee on Health & Human Services to discuss the impact of federal health care reform on the state. The committee heard from Health & Human Services Commissioner Tom Suehs, Texas Department of Insurance Commissioner Mike Geeslin and Special Projects Director Dianne Longley, and the Employees Retirement System. Suehs estimated the cost to the State would total $27 billion over 10 years. When asked why his estimate was so much higher than that of the CBO, Suehs stated that “I know that I’ve got a higher population of uninsured than most states have total population.” Commissioner Geeslin focused his opening comments on the massive scope of the bill and how much change it will bring to consumers. In response to a question, Geeslin said that a new rate review authority could respond to a rate increase they deemed unjustified not with an enforcement action but only to inform the public that the rate increase was deemed unjustified. He also pointed out that the state can opt out in 2017 if it can demonstrate that it could provide similar coverage. He clarified that the exchange function could be outsourced but not to a Medicaid agency or a private insurer. Both agency heads confirmed that their need to add staff to implement the law will be substantial. The Committee members were in agreement that many future hearings would be required to keep up with the pace of reform implementation. Aetna will continue to monitor these hearings. WASHINGTON: Partisan debate over federal health care reform is moving from the nation’s Capitol to the states. Several states, including Washington, are challenging its individual mandate in federal court. Governor Chris Gregoire, a supporter of the health-care overhaul, is threatening to file a lawsuit against Attorney General Rob McKenna in an effort to block his participation in the suit organized and funded through the Florida Attorney General’s office. At the same time, the Democrat-controlled legislature may try to block McKenna’s participation by cutting funding to the Attorney General’s Office, or requiring that McKenna receive approval from the Governor prior to continued participation. Fourteen states are now participating in the lawsuit. Author Resource: Easy To Insure ME http://www.easytoinsureme.com/

Health Insurance Help Online

Illness for non-work related injuries can be financial devastating. Insurance keeps you protected against disastrous health care expenses and lost wages. There are enormous health insurance plans available day-to-day, the health insurance cost and its benefits vary from one plans to another. Before enrolling for a health insurance, an individual should consult with the insurance agencies, read the policy to get the complete information about the benefits and costs and also the way the plan works.

Today, there are many more kinds of health insurance to choose from than were available just a few years ago. Traditional differences between and among plans do not longer any more. Also, there is been an increased emphasis on the role of consumers in managing their own health care and health care finances. There is a focus on providing information on the cost of care and health care quality—at the level of the physician, physician group, and hospital—to help consumers and employers choose among the many options available to them. The things have changed a lot, when most people in the United States had health insurance has indemnity insurance (also called as fee-for-service or traditional insurance). This type of health insurance coverage assumed that the medical provider i.e. doctor or physicians will be paid a fee for each service provided to the patient.

When we talk about health insurance, we usually mean the kind of insurance that pays medical bills, hospital bills, and typically, prescription drug costs. Nowadays, the health insurance also covers Medicare and Mediaid that provides health insurance coverage for certain people, senior citizens, people with disabilities and also an individual and families with low income. Today, the online information helps an individual to compare two best insurance policies and choose best among it. The health insurance help an individual for financial planning and accordingly choose the best suitable for the family. The health insurance helps to avoid the burden of expensive medical bills and ensure the penny paid in health insurance is paid for your care. It protects you and your family financially in the event of an unexpected serious illness or injury that could be very expensive.

In spite of available health insurance help online, unfortunately many Americans are still uninsured or underinsured. Some may be eligible for private or government but may have difficulty in finding the maze of complex rules and insurance jargons. Many more may not even have chosen the health insurance plans due to non-affordability coverage or may not be eligible for any. To help you choose right health insurance plan, we give you an overview of programs and strategies for seeking free or reduced-cost health care and managing medical debts.

Why does an individual require health insurance?

As the science and medical care advances, the ways of treatment are also increasing simultaneously. The main purpose of health insurance is to help in paying for care. It protects you and your family members in an unexpected serious illness and injury that may be high in cost. Additionally, you are more likely to get regular and routine checkups, if you have a health insurance. Every individual requires health insurance because you cannot predict your illness, injury and your high paying medical bills. One must seriously consider the need for health insurance for own and family. We also know that there is interlinking between having health insurance and getting protective health care. The research states that people having health insurance are more likely to have a regular doctor and get care when it is needed.

How should one get health insurance?

Most of the people get health insurance through their employers or company which they belong to. This is formerly known as group insurance. Some individuals don’t have access to group insurance. In this case, one may choose to purchase their own individual health insurance directly from public or privately owned insurance company. Most of the Americans in North America get health insurance through government programs that operate at National, State & Local Levels. Health Insurance- whether provided by your employer or purchased by you – can be both expensive and complex. To understand better option, you must take health insurance help from the experts and advisors.

Group Insurance is basically offered by the employers or else by an organization of which you are a member of union, professional association wherein you may get group coverage. The employee has to choose between several plans been offered by an employer′s including both indemnity insurance and managed care. Some employer may only offer one single plan. Some group plans may also include dental care with the health and medical benefits. Hence, it is a very important decision to be taken by and employee before choosing any health insurance benefits offered by employer or an organization. It is also essential to compare plans to find the one that offers the benefits as per your need. Once you choose a health insurance plan, you usually cannot switch over to another plan until next open season, usually set once a year.

In group health insurance, employer usually pays portion or all of the premiums. This means your costs for health insurance premiums will be lower than they would be if you paid the entire premium alone.

If you are a member of group insurance offered by an organization, you are benefited from being a member of a large group. You will have to pay lesser premium than an individual would be paying. However, the organization often does not pay a share of premium, meaning you are responsible to pay complete premium by yourself.

In an individual Insurance, you get the coverage directly from the Insurance Company. You don′t have any access to the group insurance offered by an employer or an organization. When you buy you own health insurance, you have to pay entire premium rather than sharing with an employer according to Group Insurance. In individual insurance, you do not share any cost of premium with your employer. You should analyze and choose an individual insurance plan that fits your needs at a price that you are willing to pay; you should also consult a tax advisor to find out whether you are eligible for any tax deduction as per the insurance plan.

Insurance variably differs from one company to another within an insurance industry, from one plan to another and one product to another. Hence, choosing right company, right product, right plan are the important criteria before choosing any plans.

Mineeda Vital is an innovative Australian company in the vitamins, supplements and natural health industry. The supplements, natural healthcare and wellbeing company has recently released VitalVMH: a one per day multivitamin, multimineral and multiherbal formulation with natural extracts for mens and womens general health and wellbeing. Mineeda Vital will launch a range of premium vitamin, mineral and herbal products for health conscious Australians for online sale over the next 12 months. Mineeda Vital’s supplements, natural healthcare and wellbeing products are only available in Australia and New Zealand online via Mineeda Vital’s website.Mineeda Vital’s first health and wellbeing product, VitalVMH, is a brand new multivitamin, multimineral and multiherbal product with natural extracts for Australian and New Zealand men and women. It is a one per day softgel multivitamin health product.”We offer our natural health and wellbeing customers health and wellbeing products with a strong emphasis on natural ingredients, scientific formulations and convenience via online ordering with free delivery anywhere in Australia or New Zealand″, says Doug Crowther, Director of Mineeda Vital, Australia.”Health conscious Australian and New Zealand men and women want health and wellbeing products with as much vitamin, mineral, supplement and naturally derived herbal active ingredients as possible. We fill VitalVMH softgel capsules with vitamin, mineral and naturally derived herbal ingredients we believe deliver better value for money to Australian and New Zealand online natural health and wellbeing customers concerned about health, wellbeing and natural health products”, says Doug.Natural healthcare company, Mineeda Vital, has thus designed an Australian made multivitamin product, VitalVMH, which contains vitamins, minerals and natural herbal extracts in a one per day formulation for men and women seeking health and wellbeing products with an emphasis on natural ingredients.”VitalVMH is a multivitamin health supplement with natural extracts for everyday health and wellbeing”, says Doug.”We provide Australian and New Zealand natural health and wellbeing customers concerned about mens health or womens health and wellbeing with a convenient commitment-free subscription service. Thus, we give wellbeing conscious men and women many options to change their VitalVMH multivitamin subscriptions”, says Doug.”Mens health and womens health and wellbeing conscious Australians and New Zealanders want multivitamins with antioxidants and natural herbal ingredients in them. VitalVMH is a scientifically formulated product with natural herbal extracts for mens health and womens health”, says Doug. Mineeda Vital’s VitalVMH health and wellbeing multivitamin contains vitamins, minerals, antioxidants, and natural health extracts. The product is available in Australia and New Zealand for mens health and womens health. VitalVMH contains natural extracts of pomegranate, bilberry, gotu kola and Japanese knotweed in addition to natural antioxidant-rich green tea extract.”We placed a lot of emphasis on natural herbals and natural health ingredients when developing VitalVMH for mens and womens health and wellbeing. The idea was to provide a mens health and womens health multivitamin which contained all the major vitamins as well as significant amounts of minerals and other supplements in addition to a natural health herbal tonic”, says Doug.”One thing all consumers should be aware of: complementary healthcare and natural health products are intended as additions to a balanced diet and exercise regime. Dietary supplements do not replace a balanced diet. Consumers must always read the label, check all indications, warnings and dosages. Finally, only use the product as directed. Mineeda Vital promotes our products as an addition to good diet and exercise- no complementary healthcare or natural product can replace these for mens health or womens health”, says Doug.

The importance of Health Insurance, popularly known as Mediclaim has significantly increased in India in the recent years. Awareness and importance of health and health related issues has induced this growth. Along with the awareness, expenses on health care have seen a steady increase in recent years. Health care expenses can rise to a huge amount in a year, thus, in this situation, finding a cheap health insurance in India is matter of concern for the people. Health insurance generally covers hospitalization expenses including ailment or surgery. Health care and medical insurance can be categorized into Individual Medical Insurance, Group Medical Insurance and Overseas Medical Insurance.

Some of the leading insurance companies have come up with affordable health insurance policies. An affordable health insurance plan is designed to take complete care of the customer’s medical needs and requirements. There are certain benefits of an affordable health care insurance plan; it will secure your future. You will be relieved of meeting exorbitant expenses and other associated costs with an affordable health insurance policy. Whatever your age is, you will need to insure yourselves with a health insurance policy and health care plan. Amongst the most affordable health insurance plans, like Health Advantage Plus, Health Guard and Health first deserve special mention.

Buying a health insurance plan online is the cheapest way of securing your health.  You can purchase your policy online with the help of a quote. Your digitally signed document is available in your online account. You can access it whenever you want to. Just log in to any of the popular health insurance website company, get a quote and purchase instantly. Worried about the premium calculation? Here is the answer:

The premium is based on the amount of the coverage of the person and whether he is opting for individual or group insurance. Payments for the health insurance premium can be made on a quarterly/half-yearly/monthly basis. These Affordable health plans not only reimburses your costs but also enables you to save up to Rs. 5099, stated under Section 80 D of the Income Tax Act. Thus, buying a health insurance plan is a major step towards making a better future!

MAJOR HEALTH PROBLEMS OF ORISSA

By Dr Nihar Ranjan Ray

Orissa is a high focus state for its culture, heritage, rich with minerals and diseases as well. It has rated as one of the measurable state so far the health care is concerned. Badly affected by the poverty, illiteracy, natural disasters Orissa registered very poor health indicators as per the WHO reports. Its state with a population of 3.68 crores, comprising of 85% rural habitants, with 22% Scheduled Tribe and 16.5% Scheduled Caste population. From a lot of health issues I need to focus the following topics with bird vision felling their importance and seriousness.

 Infant mortality

Infant Mortality Rate (IMR) is only 53 per 1,000 live births in urban areas as compared to 76 in rural areas, only 26.4 per cent of tribal children are immunized when compared to 43.7 per cent among the general population in the State and anemia is very high of 61.2 per cent among women.

The State needed to arrest the malnutrition trend as early as possible. “The level of malnutrition in the State is quite high. Over 30 per cent of children are severely malnourished. As per the latest survey, 40.7 per cent under age of 3 are underweight, 45 per cent are stunted and 19.5 per cent are wasted. About 65 per cent of children aged between 6 and 35 months are anemic.

Maternal mortality rate

One woman dies every seven minutes from complications related to pregnancy and child birth in India and in Orissa nine women die everyday for the same reasons. The MMR in the state has come down from 367 per one lac (100,000) child births in 1993 to 358 deaths per one lac births in 2003 which is a very negligible drop. In fact there has not been any significant reduction in the rate of maternal deaths in the last few years and this is a worrying factor, said participants at the “Know Your Entitlements” organized here to coincide with the National Safe Motherhood Day. The White Ribbon Alliance-Orissa in collaboration with Department of Health and Family Welfare, government of Orissa, Unicef and UNFPA organized the workshop. With a view to curb this problem by minimizing maternal death rate, the White Ribbon Alliance for Safe Motherhood unites individuals, organizations and communities who are committed towards increasing public awareness on this issue and promote Safe Motherhood. This year, the Central government declared, “Know your Entitlement” as the theme of the National Safe Motherhood Day. The objective was to generate awareness amongst women and family members on their entitlements under various schemes and policies taken up by the government. Several NGO’s working in the health sector across the state including the Nehru Yuva Kendra which has trained 12,000 youths for the purpose participated in the workshop here today.

Flood ravaged Orissa

Floods cause health problems in Orissa: Oxfam India has warned that 8.5 million people affected by July’s floods are facing serious health threats. 78 870 cases of diarrhoea have occurred, resulting in 41 deaths; 124 cases of jaundice were reported, with two deaths. 300 people have been bitten by snakes, leading to 22 deaths.

Malaria

Malaria is the foremost public health problem of Orissa contributing 23% of malaria cases, 40% of Plasmodium falciparum cases and 50% of malaria deaths in the country. The tribal population are badly affected by the  Malaria. More than 60% of tribal population of Orissa live in highrisk areas for malaria. Though the tribal communities constitute nearly 8% of the total population of the country, they contribute 25% of the total malaria cases and 15% of total P.falciparum cases. Various epidemiological studies and malariometric surveys carried out in tribal population including primitive tribes reveal a high transmission of P.falciparum in the forest regions of India, because malaria control in such settlements has always been unattainable due to technical and operational problems. In a specific

study conducted in undivided Koraput district, it was observed that the district is endemic for malaria and is hyperendemic in top hills where Bondo primitive tribes are residing.

Diarrhoeal Disorders

Water-borne communicable diseases like gastrointestinal disorders including acute diarrhoea are responsible for a higher morbidity and mortality due to

poor sanitation, unhygienic conditions and lack of safe drinking water in the tribal areas of the country. In a cross sectional study conducted by RMRC, Bhubaneswar in 4 primitive tribes of Orissa, the diarrhoeal diseases including cholera was found to occur throughout the year attaining its peak during the rainy season .Generally the infants ,preschool children and adolescent groups are mostly affected.

Micronutrient Deficiency

Orissa is very much infamous for starvation death cases. Micronutrient deficiency is closely linked with nutritional disorders and diarrhoea. Deficiency of essential dietary components leads to malnutrition, protein calorie deficiency and micronutrient deficiencies (like vit A, iron and iodine deficiency). Vitamin A deficiency in the form of Bitot’s spot, conjunctival xerosis and night blindness was observed

Skin Infection

Skin problems like scabies is a major health problem amongst the rural population of orissa and the problem is much worse in the primitive tribes because of overcrowding and unhygienic living conditions as also close contacts and lack of health awareness. In a study conducted by the RMRC, Bhubaneswar.

Intestnal Paracitism

Intestinal protozoan and helminthic infestations are the major public health problems and were observed in Most of these infections are due to indiscriminate defecation in the open field, bare foot walking and lack of health awareness and hygiene. The problem enhances in the rainy season. These are preventable with repeated administration of anti-helminthic and protozoal treatment at 4 months interval which can be used effectively in national parasitic infection control program.

HEALTH INDICATORS OF ORISSA

             The Total Fertility Rate of the State is 2.6. The Infant Mortality Rate is 73 and Maternal Mortality Ratio is 358 (SRS 2001 – 03) which are higher than the National average. The Sex Ratio in the State is 972 (as compared to 933 for the country). Comparative figures of major health and demographic indicators are as follows: 

Table I: Demographic, Socio-economic and Health profile of Orissa State as compared to India figures 

S. No.

Item

Orissa

India

1

Total population (Census 2001) (in million)

36.80

1028.61

2

Decadal Growth (Census 2001) (%)

16.25

21.54

3

Crude Birth Rate (SRS 2007)

21.9

23.5

4

Crude Death Rate (SRS 2007)

9.3

7.5

5

Total Fertility Rate (SRS 2006)

2.6

2.9

6

Infant Mortality Rate (SRS 2007)

73

57

7

Maternal Mortality Ratio (SRS 2001 – 2003)

358

301

8

Sex Ratio (Census 2001)

972

933

9

Population below Poverty line (%)

47.15

26.10

10

Schedule Caste population (in million)

6.08

166.64

11

Schedule Tribe population (in million)

8.15

84.33

12

Female Literacy Rate (Census 2001) (%)

50.5

53.7

 Table II: Health Infrastructure of Orissa 

Particulars

Required

In position

shortfall

Sub-centre

7283

5927

1356

Primary Health Centre

1171

1279

-

Community Health Centre

292

231

61

Multipurpose worker (Female)/ANM at Sub Centres & PHCs

7206

6768

438

Health Worker (Male) MPW(M) at Sub Centres

5927

3392

2535

Health Assistant (Female)/LHV at PHCs

1279

726

553

Health Assistant (Male) at PHCs

1279

168

1111

Doctor at PHCs

1279

1353

-

Obstetricians & Gynaecologists at CHCs

231

NA

NA

Physicians at CHCs

231

NA

NA

Paediatricians at CHCs

231

NA

NA

Total specialists at CHCs

924

NA

NA

Radiographers

231

8

223

Pharmacist

1510

1984

-

Laboratory Technicians

1510

311

1199

Nurse/Midwife

2896

637

2259

(Source: RHS Bulletin, March 2007, M/O Health & F.W., GOI) 

Health Institution

Number

Medical College

4

District Hospitals

32

Referral Hospitals

City Family Welfare Centre

Rural Dispensaries

Ayurvedic Hospitals

8

Ayurvedic Dispensaries

624

Unani Hospitals

-

Unani Dispensaries

9

Homeopathic Hospitals

-

Homeopathic Dispensary

603

Conclusion

     Despite the above said problems we have to make our stands strong to fight against the disease, poverty, illiteracy and natural as well as the man made disasters(Naxlite problem).Now under the able leadership of Mr Naveen Pattnaik Orissa has registered record foreign investment as well as an appreciable economical growth. Now it is time to flex our muscles and brain to expedite our development in health care system. Orissa is doing well in the influence of NRHM .Orissa has many a miles to go to improve its health indicators that needs a lot of patience, composure and brain storming.

                                                                       Dr.Nihar Ranjan Ray

                                                                       Dt.29th july 2008

Once you’re done comparing health insurance quotes and plans and you’ve settled on employer-based health insurance, it’s good to keep in mind the Department of Labor’s Employee Benefits Security Administration (EBSA) administers a number of laws that cover these health insurance plans.

Here is a list of some of the laws affecting health insurance :

1) The Employee Retirement Income Security Act – This law protects people in retirement, health and other benefit plans through private employers by providing rights to information and a grievance and appeals process for private employer health insurance participants.

2) The Consolidated Omnibus Budget Reconciliation Act – This law only applies to special instances, but if you qualify as a former employee, retiree, spouse or dependent child you can purchase a temporary continuation of health insurance at group rates.

3) The Health Insurance Portability and Accountability Act – This law applies to working Americans and families with preexisting medical conditions. Through this act there is a guarantee of individual health insurance policies for eligible people and it prohibits discrimination in health care coverage.

4) The Newborns’ and Mothers’ Health Protection Act – Just as it sounds, this law offers rules on minimum health insurance coverage on how long the mother and child can stay in the hospital after childbirth.

5) Mental Health Parity Act – This law ensures mental health is given as much emphasis as physical health by requiring annual, or lifetime, limits on mental health benefits to be no lower than limits for medical and surgical benefits provided by a group health insurance plan.

6) Women’s Health and Cancer Rights Act – Breast cancer is a frightening diagnosis and treatment runs a wide range of intensity and invasiveness. This law protects breast cancer patients who want to have a breast reconstruction after a mastectomy. When you are part of an employer – based health insurance plan the Department of Labor’s Employee Benefits Security Administration is a great source of information on subjects such as your rights to information on how your plan works, how to quality benefits available in your plan and how to make claims on your health insurance plan.Remember EBSA administers these laws that help protect your health insurance when you lose coverage, change jobs or if you suffer from certain special medical conditions. Also remember when choosing employer-based plans to carefully compare your health insurance options to make sure your plan works best for you and your family′s medical needs.Find out more about EBSA on the web at -www.dol.gov/ebsa.

In a country like the United States, if you do not want to be buried in debt; you need a good health insurance for yourself and your family. Whether you are an employee or self-employed, it is necessary that you have a good health insurance coverage to cover your medical bills. However, there is no unique health insurance plan good for every one; benefits and costs vary from an individual to another (due to age, medical condition, etc.). To make a good choice, you need to know what benefits you are looking for, and examine each plan to find the one that best responses to your needs.

Although you have many options in choosing your health insurance, finding the right plan can be difficult. In general, individual health insurance is a form of contract between you and an insurer (insurance company )to repay all or almost all of your medical bills, which may includes hospitalization, medications, dental care, seeing a specialist, and certain therapies (radiotherapy, chemotherapy, etc.).  Whatever your needs, you will most likely have to choose one of these plans, Fee-for-service, HMOs (Health Maintenance Organizations), or (PPOs) participating provider organization.

Fee-for-service – also known as indemnity plans, is a type of insurance plan where you, patient, have to pay all medical expenses out of your own pockets, and then request a reimbursement from your insurance company. These types of plans have their advantages and disadvantages.

Advantages: they offer more flexibility in choosing your own doctor. You can decide the time to see your health care provider, and what type of treatment you want; as long as you remain in the limit that your insurer will repay

Disadvantages: in indemnity plans, most doctors require upfront payment, so you have to submit claim forms to the insurance company to receive a reimbursement. That requires paper work, and sometimes many phone calls. Fee-for-service plans offer limited benefits; they do not cover annual physical exam and educational programs.

HMOs (Health Maintenance Organizations) – Health maintenance organizations (HMOs) are managed care plans that offer health care coverage to their members through hospitals, doctors, and other health care providers that are in their network. That is, having their service, you are limited to members of their network.

Advantages: unlike Fee-for-service plans, you do not have to pay up front; although some of them require a copayment. You do not need to submit forms after forms to receive reimbursement. In addition, HMOs usually charge a lower cost.

Disadvantages: you can use only health care providers who are associated with the organization. Most HMOs (Health Maintenance Organizations) tend to disapprove certain treatments. Although some HMOs accept their members to see physician or specialists who are not in their network, they often charge you additional costs.

(PPOs) participating provider organization – also known as Preferred Provider Organizations,  is a form of managed care organization of physicians , hospitals, clinics and other health care providers that sign a contract with an insurer to provide health services to its member at reduced rates .  Usually, PPOs cost more than traditional HMOs, but offer more options to their members.

Advantages: Preferred Provider Organizations provide more flexibility to their members; they have a bigger network of doctors and hospitals. You can take service from health care providers that are not part of their networks (certain charges often apply). You pay Lower copayments for care from primary care physicians. In addition, you do not need a referral to see a specialist.

Disadvantages: PPOs cost more than traditional HMOs. You will more likely to make co-payments (usually from $10 to $30) when you visit a health specialist.

Do some health insurance companies offer better service to their members than others?

Yes. Some insurers offer better service to their members. To learn more about health insurance companies that provide satisfying individual health insurance plan in the US, visit our top rated list visit careand.com, or click on the link in About Author/Resource box.