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Home Explore Finally, A Simple Break Down Of How California Health Plans Work.

Finally, A Simple Break Down Of How California Health Plans Work.

Published by ellen, 2015-01-10 08:02:29

Description: Understanding California Health Plans
This may be the best explanation you ever get in order to understand the many options available
to you for California health insurance. This is just a simplified view of the plans so make sure to
look at the details of any prospective plan. At the end of the article, we will discuss the various
plans that differ from this simplification but this break-down will help with 80% of the plans on
the market. Now...
California health insur...

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Title:Finally, A Simple Break Down Of How California Health Plans Work.Word Count:954Summary:Understanding California Health PlansThis may be the best explanation you ever get in order to understand the many options availableto you for California health insurance. This is just a simplified view of the plans so make sure tolook at the details of any prospective plan. At the end of the article, we will discuss the variousplans that differ from this simplification but this break-down will help with 80% of the plans onthe market. Now...California health insur...Keywords:california,health,insuranceArticle Body:Understanding California Health PlansThis may be the best explanation you ever get in order to understand the many options availableto you for California health insurance. This is just a simplified view of the plans so make sure tolook at the details of any prospective plan. At the end of the article, we will discuss the variousplans that differ from this simplification but this break-down will help with 80% of the plans onthe market. Now...California health insurance plans break down into three main categories.1. Office consultation. With most health insurance plans, you will have a copay or co-insuranceto pay for office consultations. The copay or co-insurance are typically not subject to the maindeductible of the plan. A copay is a fixed amount such as $30 for an office visit. Co-insuranceis a fixed percentage such as 30% for an office visit. An example of co-insurance would be:Office Visit: $100 chargeNegotiated rate: $ 60 charge

Co-insurance: 30%In this case, the subscriber would pay 30% of the negotiated rate of $60 for a total of $18. Thenegotiated rate is the charge that an in-network doctor or provider has agreed to in order toparticipate in that network. This usually applies to PPO type plans.The office copay or co-insurance is only for the consultation itself. If the doctor runs labs,performs procedures, or does other services in addition to the consultation, these charges arehandled in the third section and will be in addition to the copay or co-insurance.The office consultation is one of the key items when looking at your California health insurancequote for Individual Family or Small Group insurance. You will typically see \"$25\" or \"30%\" inthe results.A quick note. With HSA qualified high deductible plans, the office visit consultation is subjectto the main deductible. This means you must meet the deductible before you get a copay orco-insurance benefit. You will get negotiated rates for seeing an in-network provider even if thebenefit is subject to the deductible. For example, in the case above, you would pay the $60 aspart of your deductible. Some plans do not cover office visits at all. They tend to be the leastexpensive hospital or catastrophic coverage plans.2. Prescription coverage and California health insurance. With most plans, prescriptioncoverage is broken out separately from the main deductible in the form of copays. Almost allplans on the market today distinguish between Generic and Brand name.Insurance companies have a Formulary, or list of drugs they deem to be effective andcost-effective.The lower-priced drugs are Generic and typically you have a smaller copay (around $10 onaverage) which is not subject to any deductible.Brand formulary drugs are more expensive and tend to be the patented drugs that are heavilyadvertised and marketed. Essentially, they are newer drugs. Usually, these drugs are handledwith a higher copay (average around $30) after a separate brand name deductible is met. Thisdeductible tends to run $250-750 annually (per member) for individual family California healthinsurance and $150-250 for California Small Group health coverage. The deductible is usuallyper person (in a family policy) and it resets January 1st regardless of when the plan starts. Oneyou pay the brand drug cost up to the deductible amount, following brand formulary drugs willjust require a copay ($30 for example).There is sometimes a 3rd category call Brand Non-Formulary. This essentially means the drugis very expensive and there are less expensive alternatives. With most plans, you will have topay a percentage of the cost so there can be quite a bit more out-of-pocket with BrandNon-Formulary.You can reduce your cost by asking your doctor if there a Generic equivalent. Some plans donot cover Brand drugs at all so double check this as the trend towards very expensivemedications (10's of thousands of dollars) for more exotic conditions.3. Pretty much everything else. Most other coverage benefits (labs, x-rays, emergency, surgery,hospital) are typically subject to the main deductible. This is another item listed when you

request your California health quote. The average deductible amounts run from no deductibleup to $5000 on average. The deductible is typically per person (usually up to two people afamily) and it resets January 1st as well. When you see \"2 member max\", this means that if twopeople meet their deductible in a calendar year, the other family members do not need to.One note...HSA Health Savings Account plan deductibles are cumulative. This means that thefamily deductible (for two or more people on one policy) is not met for any individual on thepolicy until the family deductible is met. For example, if the individual deductible is $2400 andthe family deductible is $4800, one individual on the family plan would not meet the deductibletill the $4800 was met. Other family members would have their deductible satisfied as well.Essentially, all individuals on the family plan are working towards one $4800 deductible.Once you meet the deductible you either go into a co-insurance sharing percentage or the carriertakes over 100%. For example, if your deductible $2500, and the co-insurance percentage is30%, with a max out of pocket of $7500. Let's say you have an $80,000 hospital charge(in-network for covered benefits). You would pay the first $2500, then you would pay 30%until you hit another $5000 out of pocket. Essentially, you will pay $7500 (max out of pocket)and the carrier will pay the $72,500. With some plans, the max out of pocket is in addition tothe deductible. The Deductible and Out of Pocket Max are two other important items listedwhen you get your health insurance quote.With the Office Visit, Prescription Coverage, Main deductible and Max out of Pocket, you nowcan read the health quote results with confidence.Title:Individual Health And Dental InsuranceWord Count:326Summary:Both individual health and dental insurance plans have confusing, yet important, abbreviations.Below is an explanation of each to help you learn the things you need to know about individualhealth and dental insurance plans.Health Maintenance Organization (HMO): An HMO is a health insurance plan that allows you揼to choose a primary care physician who will act as your o between?in the event you need to抯see a medical specialist outside of your primary care physician fi...Keywords:Article Body:Both individual health and dental insurance plans have confusing, yet important, abbreviations.Below is an explanation of each to help you learn the things you need to know about individualhealth and dental insurance plans.

Health Maintenance Organization (HMO): An HMO is a health insurance plan that allows you揼to choose a primary care physician who will act as your o between?in the event you need to抯see a medical specialist outside of your primary care physician field. If you have an HMO損health insurance plan, you repay?for services rather than pay a deductible.Preferred Provider Organization (PPO): PPOs are available with both individual healthinsurance plans and dental insurance plans. Like an HMO, a PPO lets you choose your doctoror dentist within a particular network. Unlike an HMO, you only pay for the services you aregiven by the doctor or dentist.Point of Service (POS): A POS is a health insurance plan that combines features from HMOsand PPOs. Like an HMO, there is usually no deductible, low co-pay, and a primary care抮physician. Like a POS, you e allowed to go out of the network of doctors, in which case you抣l pay a deductible and possibly higher co-pay.Indemnity Plan (IP): The IP is a very popular dental insurance plan. Coverage is limited, butyou usually have the option of choosing your own dentist, which actually helps you savemoney.抰Dental Health Maintenance Organization (DHMO): After paying one annual premium, aDHMO guarantees a certain number of visits, though it doesn allow you to choose yourdentist.抰Dental Discount Plan (DDP): Although a DDP isn a traditional dental health insurance plan,抯you can get discounts from dentists who agree to participate in the plan. There no limit andyou choose your own dentist.Rather than let abbreviations complicate things, learn the meanings to easier find the rightindividual health and dental insurance plans for you.Title:Understanding The Glycemix Index - For Weight Loss and Better HealthWord Count:654Summary:Whether you want to lose weight, or are simply interested in eating to lower the risk ofcardiovascular disease, understanding the glycemic index is important. This article describeshow the glycemic index works, what it means for dieters in terms of being able to stick with adiet, and some tips foKeywords:glycemic index, weight loss, lose weight, heart health

Article Body:The Glycemic Index (GI) is a way of rating carbohydrate foods according to how quickly thecarbohydrates are broken down into glucose, and thus how quickly that glucose enters thebloodstream. The reasoning behind this is that carbohydrates that enter the bloodstream quicklyraise blood sugar levels rapidly, causing a spike in energy, that is followed by a drop after theeffects of insulin are triggered.Insulin is one of the hormones that help regulate blood sugar levels, and tries to keep themstable. When too much glucose enters the bloodstream at a time, the body reacts by releasinginsulin to remove some of that glucose back out of the blood and into our cells. Its simply a wayof keeping the balance. However the effect is that when all the glucose we just ate, in the formof carbohydrates, is removed from the bloodstream, we feel tired and hungry, often cravingmore carbohydrates. Thus a cycle is created, where we eat more than really necessary.Carbohydrate containing foods are rated from a scale of 1 to 100. A score of 100 is the highest,and this is akin to eating glucose in its pure form. A score of 55 or lower means a food isclassified as having a low glycemic index. Thus, it theoretically breaks down in the body moreslowly.I write theoretically, because the picture is a little more complicated than that. For example, fatlowers the GI of foods. Potato crisps have a lower GI than do oven roasted jacket potatoes.However, that does not mean that potato crisps are a better choice, in terms of nutritional andfat content. So, it's important to look at the whole equation when considering meal choices andthe glycemic index.Some suggestions for using the glycemic index in terms of one's diet is to balance a highglycemic index food in a meal with a low one. And try to make more low or mid range GIchoices than high.Other factors that can affect a food's glycemic index, beyond its GI rating, are the amount offood eaten. Chocolate has a low GI, but it is 30% fat. And any excess nutrients, whether theyare fat, protein or carbohydrates, will be stored in the body as fat. So eating too much of low GIfoods that are high in calories is not going to help with weight loss.Another issue when considering using the GI of food, is that the time of day we eat a food mayalso impact its effect on blood sugar levels. This is because the GI rating given to a food isbased on fasting. So, for example, we fast at night - meaning we are asleep and thus not eatingfor a period of hours. A food thus eaten in the morning may more accurately reflect the GIgiven to it than at other times of the day, when we haven't been fasting.Yet the GI does have benefits. One study on obese young adults found that a low glycemicindex diet was associated with a reduction in the risk factors associated with heart disease,when compared to similar children with a low fat diet. Both groups lost weight, and kept it off,which is good news for dieters! And the researchers suggested that a low glycemic index dietmay not lower metabolism as much compared to low fat diets. This is important for dieters as itmeans they would feel less cold, tired and hungry, and as a result, would find it easier to stickwith the changes made during the diet period.The GI should not be used in isolation. Both common sense and other food guidelines, like

avoiding excess fat and salt,and making sure foods are full of vitamins, minerals andantioxidants, should still be used with the glycemic index.References:1. Australian Healthy Food, November 20052. nutraingredients.com/news/ng.asp?id=661513. nutraingredients.com/news/ng.asp?id=60035


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