Premium Calculation by Health Insurance Companies

Have you been intrigued about how a health insurance company calculates the premium you are required to pay? Here are some of the answers. While getting an insight of any individual company may not be a simple exercise, but they all follow certain broad guidelines and these will be highlighted in this article for the consumers.

Premiums are calculated based on the insurance product (or plan) purchased by the individual. These insurance products may be packaged in various ways to either provide a general coverage or may meet the needs of a particular age group. To decide on the amount that one would need to shell out, the insurance company takes all costs into considerations. Some of these factors are enlisted below.

a) Personal History: It takes into consideration the individual’s health, present health status, past medical history, family history, age of the individual, personal habits (e.g. smoking, alcohol addiction etc.). For purchasing a health insurance cover, the insurance companies may/may not conduct an initial medical examination of an individual before issuance of health cover.

b) Mortality Rate: These are charges incurred by an insurance company to cover the risks incase of any eventuality to an individual. The mortality expenses differ depending on the age and the ‘Sum Assured’ being availed by an individual. Important points to be remembered in co-relation with mortality rate are.

i) Premiums increase, as you grow older.

ii) Premiums increase in co-relation to hereditary or lifestyle ailments such as Diabetes, Hypertension, Obesity etc.

iii) In principle, premiums increase by availing higher Sum Assured by an individual.

c) Administration and marketing expenses: Such expenses are incurred by the organization as part of their operational expenses. These operational expenses are recovered in the form of premium that a policyholder pays while purchasing an insurance product.

Administration and marketing expenses also incorporate the costs incurred on designing the insurance product, market publicity, advertisements, brochures, leaflets, booklets, pamphlets etc to create awareness amongst the public regarding the option of various insurance products and services in the market.

Under this heading, expenses pertaining to payment of monthly salaries to their employees, commission to insurance brokers, insurance agents
, marketing and sales of insurance products and overhead costs are included, that constitute payment of premium by the policyholder. It also incorporates the costs required to meet the operational expenses on daily basis.

d) Savings component: This portion of the premium is invested in various public investments approved by the Government of that country. Investments in private sectors are generally not practiced. This is based on the guidelines issued by the Regulatory Body which is approved by the government of that country.

In India, IRDA (The Insurance Regulatory and Development Authority), at Hyderabad is the regulatory body and it controls the activities and functioning of Life and Non-Life (General) insurance organizations.

e) Medical Underwriting: Underwriting of various insurance products is done to create a balance between an organization and an individual. This is done with a view to analyze risks from various angles and broad-spectrum factors so as to contain fiscal bleeding and containment of losses in the insurance sector. It takes into consideration the number of individuals covered under the health policy and conducts a review pertaining to any claims history pertaining to that individual or that group or an entire organization.

Medical Underwriting is done with a view to establish eligibility, set premiums or deny coverage. For example premiums can significantly increase in case there is an individual with a past medical history of any chronic ailment or with a long-standing prevailing illness or has had a severe Road Traffic Accident etc.

In case, a group or an organization is involved, medical underwriting is done uniformly for that particular group taking into consideration a host of factors.

f) Adjusted or Modified Community Rating: This factor takes into consideration the geographical location, topography, physical factors of the region, economic factors involved in that region, financial stability, political stability, industrial development, trade activities, lifestyles and other varied factors.

For example developed regions have to shell out higher premium in comparison to regions with minimal development, for example a village area.. This means that if you live in metropolitan city like Kolkata, Mumbai, Delhi or Chennai, you have to pay higher premium in comparison to people living in Tier-II and Tier–III cities, as your risks are higher of falling sick or being injured in an accident.

In addition, recently another method of calculating premium has evolved called as Experienced Rating. In this method, usage of historical data is used to decide upon the rates based on the number of claims and the claim amount made during a given period. As a result, the data that is generated is used to calculate and predict the probability and potential for claims in the future. With extensive data that is now available on Internet, the experienced rating method has proved to be a boon for the underwriters and the insurance companies. The method uses a comparison of past or historical data. This data forms the ground-work for analyzing the future premiums.

g) Rating Bands: Under this category, the insurance company fixes a base rate that can be charged for a particular group possessing the same characteristics. The case characteristics include factors such as age, gender, geographical region, family composition, group size, occupation details, industry etc. For example a workforce comprising of healthy employees who are in their youth in the age group of 25-30 years will pay less premium as compared to the workforce who are in the age range of 45-60 years.

We have given only broad guidelines to educate you about how a health insurance company is likely to decide what you will end up paying as premium to insure your health against disease and accidents. Companies that take group insurance are likely to benefit by getting a group discount, depending on the numbers of the staff that they may wish to insure,

Is mandated health insurance Constitutional?

Along with the economic arguments against the health care bills circulating Congress, is a fascinating exposition of the legality of mandated health care. An article by two former Justice Department officials, David Rivkin and Lee Casey, posed this very question in The Washington Post this summer, “… can Congress require every American to buy health insurance? In short, no. The Constitution assigns only limited, enumerated powers to Congress and none, including the power to regulate interstate commerce or to impose taxes, would support a federal mandate requiring anyone who is otherwise without health insurance to buy it.” ¹

Supporters of the mandate argue that Congress’ power issues from the “Commerce Clause”, Article 1 Section 8 of the Constitution: “To regulate commerce with foreign nations, and among the several states, and with the Indian tribes;” It is the second part upon which Congress relies not only to regulate health insurance as “interstate commerce”, but to mandate its consumption. There is an important distinction, though, between regulating a market and obligating citizens to participate in it. In addition, Rivkin and Casey observe the Supreme Court frowns on Congress’ application of the Commerce Clause to regulate non-economic activity: “… in two key cases, United States v. Lopez (1995)² and United States v. Morrison (2000)³, the Supreme Court specifically rejected the proposition that the commerce clause allowed Congress to regulate noneconomic activities merely because, through a chain of causal effects, they might have an economic impact”. Even in these two cases the United States attempted to regulate or proscribe action, not mandate activity, which is much higher threshold.

Since our nation’s founding, application of the Commerce Clause has been deracinated from its original intent. James Madison, in Federalist Paper No. 42, argues that the Commerce Clause was written primarily to allow Congress to regulate foreign commerce, and that the interstate clause precludes the circumvention by individuals and states of foreign treaties or duties: “… it may be added that without this supplemental provision [regulation of interstate commerce], the great and essential power of regulating foreign commerce would have been incomplete and ineffectual.” ⁴ One can only fantasize about this debate: Resolved, the proposed mandate for all Americans to buy health insurance fulfills the Framers’ intention to regulate foreign commerce. For the affirmative, Nancy Pelosi. For the negative, James Madison.

Carson Holloway writes in the Witherspoon Institute’s Public Discourse: Ethics, Law, and the Common Good, “… Rivkin and Casey have performed an important public service by raising this kind of argument. For it is no small measure of the corruption of our public discourse that most political leaders and citizens no longer ask what constitutional provisions, if any, authorize Congress to act when some of its members propose to ‘solve’ some national ‘problem.’ ” ⁵

Holloway thus reminds us that Congress’ power is limited by the Constitution. This is explicit in the 10^th Amendment: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.” Pelosi’s office tried to preempt 10^th Amendment arguments, but in the most tortured way imaginable: “The 10th amendment does not authorize states to constrict Congress’ power under the commerce clause.” ⁶ This is backwards. States do not constrict Congress’ power; rather the Constitution constricts all powers not authorized specifically to Congress and affords them to the states and to the people. Have we forgotten about people’s individual liberty and free choice in this debate?

And yet we have seen this before. In 1994 during the debate on Clinton’s health plan, the Congressional Budget Office concluded, “A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action. The government has never required people to buy any good or service as a condition of lawful residence in the United States. An individual mandate would have two features that, in combination, would make it unique. First, it would impose a duty on individuals as members of society. Second, it would require people to purchase a specific service that would be heavily regulated by the federal government.” ⁷ This was prior to the Lopez and Morrison decisions, so one would think that the CBO would be more cautious today, but, alas, they are curiously silent on the matter.

The legal arguments portend philosophical differences that are striking and ominous if the people allow Congress to stretch the Constitution to the breaking point. We have a tradition of giving incentives to encourage positive behavior and of instituting regulation to prevent harmful behavior. The mandated approach to health care turns this tradition upside-down: it institutes regulation to force positive behavior while creating incentives to encourage negative ones; to wit, if businesses see the mandate, taxes and penalties in these bills as added costs, they will have economic incentive to invest in overseas markets over the United States. The mandate is an accretion that may have the unintended effect of leaving more workers without health care or on the “public option”.

How, then, to solve the problem and make health insurance more accessible and affordable? The answer lies in the correct application of the Commerce Clause. In 2002, legal scholar and former Appeals Court Judge Robert Bork and former Chief Counsel for the Food and Drug Administration Daniel Troy analyzed the devolving of the Commerce Clause through Supreme Court cases over the years and concluded, “ … the purpose of the Commerce Clause was to remove barriers to interstate commerce, and that the original understanding of the Clause permits federal regulation of the purchase and sale of goods in commerce to address barriers created by discriminatory or inconsistent state laws.” ⁸

Removing barriers is certainly a better idea than obliging purchase from state-sanctioned oligopolies (private insurers) or a federal monopoly (public option). The proper application of the Commerce Clause is to open the barriers erected by the states that prevent an interstate market in insurance. Encouraging everyone to buy health insurance is a salutary objective. Making it easier and less costly through free markets and personal choice is in keeping with American tradition and Constitutional limits on power.

Ghanaians satisfied with health insurance scheme – Survey

Ghanaians are generally satisfied with the performance of the National Health Insurance Scheme (NHIS), a survey report released by the National Development Planning Commission (NDPC) said on Thursday in Accra.

The 95-page report indicated that 59 per cent of all households who were insured under the scheme had said they were satisfied with another 31. 7 per cent saying they were “very satisfied” with the scheme’s performance.

The report, launched by Dr Ebenezer Appiah-Denkyira, Director, Human Resource, Ministry of Health on behalf of the sector Minister indicated an increasing level of registration under the scheme with a total subscription increasing from a low of 1,797,140 in 2005 to 12,518,560 in 2008 though significant variations in registration existed across geographical and socio-economic groups.

The survey however indicated that although more than half of Ghanaians were enrolled in the scheme, a large portion of the population remained uninsured with 41 per cent of households not registering any member at all.

Analysis of the NHIS subscription by socio-economic groups revealed that about seven out of 10 people in the lowest socio-economic group had not registered with the scheme.

The NDPC in ensuring the implementation of the Growth and Poverty Reduction Strategy (GPRS II 2006-2009), conducted the 2008 Citizens’ Assessment of the National Health Insurance Scheme on the theme: “Towards a Sustainable Health Financing Arrangement that Protects the Poor”.

The survey conducted between September and November 2008 in collaboration with the Ghana Statistical Service, Ghana Health Services, Ministry of Health and the National Insurance Authority was to find out whether the NHIS was providing an affordable health care financing arrangement that protected the poor as envisaged under the GPRS II.

The findings revealed substantial positive effect of the scheme on several aspect of health care delivery in Ghana, indicating that the proportion of those who consulted skilled health care providers for general health conditions had risen from 45 per cent to about 62 per cent between 2005 and 2008, during the implementation of the scheme.

The result also noted an increase of 72 per cent of babies delivered with the assistance of skilled personnel.

“This suggests that the scheme has significantly improved access to health care by pregnant women or women in labour, with positive implication for maternal mortality and complications associated with child birth.

The report noted that the greatest expectation of Ghanaians about the scheme was to reduce the burden of health care cost on households, with the survey suggesting that households registered with the scheme benefited in terms of out-of-pocket expenditure reductions at health care facilities than those who were not registered.

Poorer households who were not insured suffer even more and would find it more difficult to access health care.

It therefore recommended further improvement in the exemption policy, which was necessary to adequately serve the health needs of the poor, adding that women who benefited from the policy of free medical care for pregnant women should be encouraged to subscribe to the scheme even after delivery.

Dr Regina O. Adutwum, Director-General, NDPC said the survey focusing on the NHIS after four years of implementation provided the opportunity for citizens to share their views on the various aspects of the scheme, with the view of obtaining feedback to improve its implementation.

“As government undertakes a review of the NHIS our hope is that this report and the subsequent discussions on the subjects will contribute to strengthening its implementation and the achievement of its objectives”, she added.

Dr Appiah-Denkyira urged the private sector to come on board to help expand the health infrastructure by establishing more health centres to help in providing quality health care for the people.

Dr Kwabena Opoku-Adusei, Vice-President, Ghana Medical Association stressed the need for the sustainable improvement of the NHIS since “it is one of the best health systems that has ever happened in Ghana”.

Mr K. Kamalideen Resident Manager, United Nations Development Programme who sponsored the survey said such research would help identify lapses in the scheme and so stakeholders, particularly, government should accept its recommendations and work towards improving on the service.

Forcing Us to Buy Health Insurance Is Not the Same as Mandatory Car Insurance

I thought this analogy had been thoroughly destroyed, but it’s baa-aack. The One is claiming it’s no biggie that the new “health care” bills require every American to buy insurance because most states require everyone to buy car insurance. He goes back to that analogy as he downplays the fact that if you don’t buy health insurance you will eventually be sent to prison.

The President said that he didn’t think the question over the appropriateness of possible jail time is the “biggest question” the House and Senate are facing right now.

I’m thinking it’s a pretty big question for people who don’t want to buy health insurance and don’t want to pay a fine. The only way a “mandate” works is that, eventually, jail time is the punishment. Otherwise, people can ignore the mandate.

Back to the car insurance analogy:

“What I think is appropriate is that in the same way that everybody has to get auto insurance and if you don’t, you’re subject to some penalty, that in this situation, if you have the ability to buy insurance, it’s affordable and you choose not to do so, forcing you and me and everybody else to subsidize you, you know, there’s a thousand dollar hidden tax that families all across America are — are burdened by because of the fact that people don’t have health insurance, you know, there’s nothing wrong with a penalty.”

Here are the problems with that:

1. Everybody doesn’t have to buy car insurance. You can choose not to drive and then you don’t need to buy the insurance.
2. The only way to avoid mandatory health insurance will be to stop breathing. Our federal government has never required us to buy something just to exist in America.
3. Driving is a privilege, Living and breathing is a right.
4. You can choose liability coverage only for your car. Government will mandate what’s covered in your health insurance.

If this passes, it’s time for a class action lawsuit challenging the constitutionality of such a mandate.

By the way, if Obama is going to relate health care insurance to car insurance then it’s time to allow health insurance to be sold across state lines, remove expensive mandates, give the same tax breaks to individuals that businesses get and decouple insurance from your place of employment. Actually, those are the ways the two types of insurance should be the same.

Short Term Medical Insurance, Considering Your Health Insurance Purchase

Short term health insurance is a good way to have a low cost alternative to your standard health insurance plan. If you’re someone that is both fairly young and in good physical condition then you should consider getting some short term health insurance in opposition to a more extensive health insurance plan.

You’ll find that with many of the short term health insurance plans the monthly premium that you’re going to have to pay to the insurance company is going to be quite low. You’ll find that most typically these plans are going to be around $30-$60 dollars rather than the hundreds you’re going to be paying with a more standard plan. This is even going to be cheaper than if you go with a company plan as your monthly premium is going to be right around the same amount as your monthly premium with the short term medical insurance plan.

The one thing that you’re going to need to keep in mind is that there are going to be a lot of things that won’t be the same as if you were to have a full health insurance plan so you need to make sure that you’re completely aware of the differences and make the best and wisest decision for you.

We talk about some of those things below.

Benefit Eligibility

The major difference with the short term health insurance plan is that you’re not going to be eligible for the many benefits that you’d receive if you had a standard health insurance plan. Rather than having than having non-emergency doctor’s visits; such as, yearly checkups, elective surgical procedures fully or partially covered you’ll have to pay for all of this out of pocket with the short term medical insurance.

The costs for your prescription drugs and if you’re a woman your ob-gyn visits won’t be covered either. Additionally, the maternity related costs as well as delivery aren’t covered by a short term health insurance plan; although you can potentially be covered from other sources.

If you are someone that has complications or have genetic predispositions for illnesses; etc… you’re going to want to consider a full health insurance plan rather than a short term plan. Also should you be a woman that is planning on having children a full health insurance plan is well worth the premium when it comes to the costs of having to have a child. If you’re a male that has his spouse on the medical policy you should consider the full health insurance policy if you’re going to have kids like in the previous example.

Medical Emergencies

With medical emergencies, should you have one your short term health insurance policy will compensate you to a capped amount which is usually no less than 100k though. This would payout after you’ve reached your deductible you signed up for with the policy and then the short term plan would pay out after that up to your policy limits.

The deductible on most short term health insurance plans is going to range anywhere around $1k-$10k and when it comes to the deductible the higher the deductible the lower the premium and vice versa.

Insurance Cap

You’ll be looking at a 6 month to 1 year cap on most of the short term health insurance plans; however, once the cap has expired you’re then free to sign up with another short term health insurance provider.

Considerations

Getting a short term health insurance policy is not going to be the right decision for everyone. Like mentioned above if you have medical problems and you need to see a doctor regularly and need to make purchase of expensive prescription drugs you need to start looking to a standard health care provider so you’ll be able to get assistance in helping in the cost of these bills.

If you don’t have a health insurance option through a job and cost is a high factor you’re going to find a very reasonably priced option with the short term medical insurance policy. It might not cover everything but it is definitely better than nothing should you have a major medical emergency; at that point it could be invaluable.

Many Veterans Are Without A Health Insurance Plan

Two stories have been dominating the news prior to Veteran's Day this year: the tragic Fort Hood attacks, and the continued battle over healthcare reform. These important issues are more interrelated than it appears at first glance. Thirteen people, many of them soldiers, died at Ft. Hood; many others were injured. While Americans are mourning the victims, we must also take care of the members of our military that are still living. Unfortunately, quite a few soldiers who were honorably discharged are now suffering due to their ability to buy a health insurance plan.

Doesn't the Veteran's Administration provide health insurance and medical to veterans? That is largely the case. However, many veterans uninjured in combat are--surprisingly--considered ineligible for VA insurance. The post-military income levels deemed too high to receive benefits are surprisingly low; a veteran with no dependents can only take advantage of the government's health insurance plan if he or she earns under $29,400 per year, while one with four dependents can earn around $41,300 before losing eligibility for VA benefits. Such incomes aren't quite poverty level, but are the domain of working-class Americans (including civillians) unable to afford private insurance if their employer doesn't offer it. Troops returning from Iraq and Afganistan are also struggling with unemployment, and are a disproproportionate percentage of the nation's homeless. Many are working low-paying jobs that push them just above Medicaid and VA elibility. This makes it even harder for them to become insured.

Uninsured veterans also face unique challenges when buying health insurance plans. Although they may not have been physically injured in combat, serving in a war zone can affect their mental health. One-in-five of the veterans of our current wars has been diagnosed with Post-Traumatic Stress Syndrome. Some health insurers could consider PTSD a pre-existing condition and refuse to cover a returning veteran. Treatment sufferers PTSD can be expensive, making it out of reach for uninsured vets. If sufferers are not properly cared for, they have the potential to act out in ways that hurt themselves or others. Quality health care would prevent a large portion of that.

Studies have shown that, controlling for other factors, being uninsured leads to a 40% increased risk of death. According to the Harvard Medical School, nearly one-and-a-half million veterans went without health insurance during 2008. Out of those uninsured veterans, who were too young to be eligible for Medicare, 2,266 are said to have died as a result of medical conditions that could have been prevented. The Walter Reed scandal nonwithstanding, Veteran's Administration hospitals have received high praise for the quality of their care...if veterans are able to access it.

Regardless of one's feelings on healthcare reform for the civillian population, don't the soldiers that risk their lives to protect us deserve better? As we remember the veterans who have fallen in battle, we should also resolve to take care of the ones who made it home.

What to do When you Lose your Health Insurance

Unfortunately, the reality of losing health insurance is an all too common situation in today’s economy. If your position has been eliminated or if the company is going under, your job isn’t the only thing you may face losing.

Employer-based health insurance benefits are a very important aspect of many individuals’ employments, and living without them, even for a short period of time, can be devastating for most families. From expensive prescription medications to emergency care and doctors’ visits, employer-based health insurance is not a luxury, it is a necessity.

However, if you find yourself on the verge of losing your employer-based health insurance, there are a number of options you may have:

• COBRA - Larger companies of more than 20 employees, under a federal law, are required to offer you an extension on your health insurance of 18 months while you look for other employment. Called COBRA (Consolidated Omnibus Budget Recognition Act), this health insurance extension must be enrolled in no longer than 60 days after you lose your health insurance. Although you will enjoy the same benefits that you did under your employer health insurance plan, the costs will be significantly higher.
• You spouse’s health insurance - For many individuals, it just makes sense to sign up for their spouse’s health insurance when they lose their coverage. Luckily, most large companies will bypass the annual enrollment time period to allow you to sign up for your spouse’s health insurance if you lose your coverage.
• Private health insurance - For many individuals, purchasing private health insurance is often less expensive than purchasing COBRA, so you may want to consider contacting a reputable insurer and ask them for their private health insurance costs.
• Free or lost-cost programs - If money is an issue, you may want to consider some of the free or lost-cost health insurance options. You can check with your state’s Department of Health regarding free health insurance for your children; you can also check with your state’s insurance department or consumer services department to see if your state offers lost-cost health insurance.

Hints On How You Can Save Big Money On Your Prescriptions

person who takes prescription drugs knows that the cost of prescription medicine is increasing in this country. For a bunch of us, medications help us live a more useful, happier life, but only if we can afford to pay for them. Here are a number of thoughts that may help you pay a smaller amount.

Prescriptions help many patients.

1. Chat to your general practitioner. Not being able to pay for medications is nothing to be embarrassed about. Your doctor wishes to see all that affects your health care, as well as whether or not you can pay for your prescription medication. If the cost means you might not fill your prescription medication and take your medication, then it is key to be direct about this with your physician. Taking your drugs helps him help you! There may well be a cheaper generic drug or a similar medication that you can receive, but your doctor may not consider these unless you clarify that you can’t shell out for the more costly medicine. Your doctor may also have samples of your drugs that he can hand you at no charge.

2. Shop from one place to another. Studies have shown that prices can differ a substantial amount from pharmacy to store. Out of the blue, a drug may possibly be lower priced at one store than at another. As much as you may possibly love to have the whole lot at one pharmacy and may well like a specific pharmacist, shop about to help bring down your prescription medication expenses. You must ask your pharmacy if it can equal the lesser charge. You can as well ask the pharmacist for part of the prescription medication if there is the opportunity that the side effects will suggest you can’t swallow this drug. Ask your pharmacist if you can fill the remainder of the medication at no extra cost if the prescription works for you.

3. Deliberate buying online. Savings can be huge. A number of very dependable Canadian drug stores provide the original, brand name drugs and can save you up to 70 %! Be awfully watchful though. Do not purchase from sites that will promote medicines without a prescription. That is the main indicator that they are not legit. If it’s too good to be true, it doubtless isn’t true – don’t send off cash or a credit card number.

4. Look for $4.00 Generics. Recently, Target announced that their stores now offer generic prescription medicine for $4.00 per prescription fill or refill. Rite Aid and other pharmacies are considering meeting this price. Be knowledgeable that not all generic prescription medicine are obtainable through these programs and some area pharmacies have been offering the medicines, on the lists, at a comparable price. A number of critics say that this pricing is a “bait and switch” maneuver since several of the drugs on the lists are older generics that are infrequently used. For example, Wal-Mart hopes individuals who can’t acquire their medication for $4.00 possibly will purchase it at the higher charge then shop at the store before leaving.

5. Consider your medical benefits conscientiously. If you possess coverage, understand what is covered and whether or not there is a cutoff point to the complete sum of coverage every year. The individual can find assistance with presciption insurance questions through a SHIP (State Health Insurance Assistance Program).

6. Look for Prescription Assistance Programs (PAPs). If you have a low salary and haven’t checked out these programs, do so. Rx Help is obtainable to individuals who meet criteria set by each specific drug company. PAPs provide low-price or free prescription medication for individuals who qualify. Bear in mind to look for each and every one your medicines, not simply the most costly.

7. Check out Assistance for Specific Diseases and Conditions. In this type, you can acquire help with a mixture of health bills, ranging from health insurance co-pay assistance to health supplies. These programs are listed by particular disease and are from time to time restricted to particular geographic areas.

8. There is prescription drug assistance out there; you only need to be ingenious and assertive to get the prescription medication that you very much need.

Personal Health Programs and Prescription Assistance Programs For Americans

Individual medical coverage offers benefits for health care. Prescription assistance programs can be included in some programs. Certain policies may possibly provide for payment of medical expenses incurred on a reimbursement basis by paying benefits to the plan owner, payment on a service basis by paying those who provide the services directly, or payment of an indemnity by paying a prearranged sum regardless of the amount charged for medical expenses. Medical expense or hospitalization insurance could be issued on an individual or group basis. Some of these programs will provide prescription help.

Even though there are numerous types of benefits offered, private medical expense insurance can normally be categorized as basic medical expense coverage, major medical coverage, comprehensive medical coverage, and special policies. These Programs ought to cover prescriptions because prescription drugs help so many patients. Nearly all of these plans have for the most part been replaced by managed care policies and are no longer offered as stand-alone plans. These types of plans have been adapted and replaced in answer to changes in the health care field relative to cost control and market competition.

Basic medical insurance provided by a private medical expense plan includes hospital expense, surgical expense and medical expense. These three basics may be sold as one or separately. Often this is issued as “first dollar” coverage, which means it does not have a deductible.

Like the name implies, hospital expense coverage offers benefits for visits incurred for the period of hospitalization. Hospital indemnities are as a rule classified into two general groups:

• Room and board, with nursing care and special diets

• Miscellaneous medical charges, plus x-rays, laboratory fees, prescription drugs, medical supplies, and operating and treatment rooms

In several cases, surgical benefits possibly will be included for certain types of surgery and related costs. Hospital expense coverage provides benefits for daily hospital room and board and miscellaneous hospital charges while the insured patient is confined to the hospital. The plan could provide for a guaranteed dollar amount for the daily hospital room and board benefit, although the trend is in the direction of health insurance of not more than the semiprivate room charge unless a private room is medically required. The room and board benefit may possibly be paid on either an indemnity basis or a reimbursement basis, depending on the specific policy.

Indemnity programs are every now and then called dollar amount plans. Room and board rates change by geographic location, but it is not unusual to find room and board rates ranging from $250 to $600 per day or more.

More often than not, the maximum number of days is from 90 to 500 . More frequently, room and board expenses are paid on a reimbursement basis. This is {frequently called an expenses incurred basis~This is also known as a expenses incurred basis~This is commonly called a expenses incurred basis}. Under this agreement, the health insurance will pay in one of two ways.

• The actual expenses for a semiprivate room are covered.

• A percentage of the actual expense is paid, with no explicit dollar limit.

Under the first reimbursement option, the medical insurance carrier will pay the full actual semiprivate room rate, regardless of what it is. Under the second reimbursement option, the health insurance carrier pays a specified percentage, regardless of what the actual charges are. A normal percentage is 80%.

To recap, with the actual expenses form of reimbursement policy, the health insurance will pay the actual amount charged for a semiprivate room without regard to a specific dollar limit. With the percentage type of reimbursement insurance, the plan might pay a specified percentage of the actual charges.

Can You Get Cheap Health Insurance?

Today, it is easy to find one of any number of health insurance companies that provide coverage for hospital costs and medications. You can assure yourself that you are getting the best deal by understanding some of the basics of health insurance policies.

Most people agree that health insurance is essential for meeting unforeseen medical expenses. During these times a good health insurance policy can save you a considerable amount of money. Unfortunately, there are those who fail to recognize the importance of having a good insurance plan. They neglect this vital aspect of their lives, deeming it an unnecessary expenditure. Most of the insurance policies offer basic medical coverage; this can prove immensely beneficial when a medical problem occurs.

There are a number of different insurance plans available in the healthcare insurance market. This enables you to choose a plan that best suits your needs and finances. Benefits which are routinely offered in these insurance plans include regular check-ups, surgeries, pregnancy, other hospitalizations, and prescription coverage.

Most health care policies cover only a portion of your medical expenses. The rest of the costs must be paid for by the individual. The benefits of each plan will vary according to the insurance policy. You can better understand your needs and policy provisions by asking the assistance of an insurance healthcare provider.

These plans provide health care benefits to the individual in the event of unexpected life events, such as accidents, serious injuries, or life threatening illness. The policies are designed to cover some portion of the cost in times of emergencies. Preferred Provider Organizations (PPO) offer discounted premiums and access to some of the best health care specialists and hospitals, which are signed up with the policy provider. Facilities and services are offered at discount prices for families and individuals under this plan.

Health Maintenance Organizations (HMO’s) are a type of insurance construction which benefits policy holders by providing reduced health care costs on annual physicals and other medical treatments. Using this healthcare plan, patients pay a smaller portion of their medical bill, but the cost of the health insurance policy is usually greater. A benefit of this type of insurance is that you can get access to specialists once you acquire a reference by your regular healthcare provider.

Group insurance plans are provided by employers to provide health care benefits to their employees. These plans provide access to relatively low cost of medical treatments and low cost insurance premiums. Both individual employees and their families can take advantage of group healthcare benefits.

Can You Really Save With a Health Savings Account?

Before we talk about saving money in a Health Savings Account (HSA) let’s talk about what an HSA really is all about.

HSA are tax preferred savings accounts for use to pay for qualified medical expenses. HSAs must accompany a qualified high deductible plan (QHDP) to be allowed. Individuals or business can participate in HSA offerings. Money put in to an HSA by an employer is not considered income to the employee. Employees who put money in to their HSA can deduct the contribution on their taxes.

There are many rules that surround HSA offerings and we are not going to delve into all the requirements needed to set up an HSA. This article will talk about the savings aspect of an HSA.

HSA owners can put in $2,850 for single coverage in 2007 and $5,650 for family coverage in 2007. These numbers rise in 2008 to $2,900 and $5,800 respectively. Therefore, HSA account holders can put in a size able amount of cash to help pay for expenses. If the health plan you have accompanying the HSA covers wellness services like childhood immunizations or mammograms, no money will come out of your HSA.

I have seen figures that around 85% of consumers spend less than $1,000 per year on health expenses. Drawing upon this figure, it stands to reason that many consumers would have a significant amount of money in their HSA each year if they are on the low end of health care spending.

Conversely, many Americans have serious illness, diseases, maintenance drugs or other ongoing medical needs that may drain the HSA account. So there is no way to conclude that HSA accounts will have money in the account each year. However, if there is money remaining at the end of a year, this money will grow tax deferred and never be taxed should the funds be used for qualified medical expenses.

So what can you do to preserve the account balance in your HSA? Take care of yourself. Stop smoking, lose weight, exercise and eat better. All of these things will contribute towards a healthier you which could translate in to a weight to keep more in your HSA. You may even participate in an HSA that rewards you for this things. These rewards programs give incentives to individuals to lose weight, exercise and other things that should help to reduce their risk so that big medical claims do not occur.

In conclusion, it is hard to predict if you really can save money in your HSA. If you have modest medical needs, you probably can save significantly. If you have ongoing medical needs with expensive treatment, you probably cannot save in your HSA but your underlying health plan will protect you from catastrophic expenses. We will explore more details about HSA requirements in a later articles.

Health Insurance : Health Savings Account

Health insurance is a critical part of our health care system. For those that are lucky enough to have health insurance, they know that it shouldn’t be taken for granted. For a large number of the unfortunate who don’t have health insurance for their families, do so at great risks.

Health insurance has long been a popular political subject for our country. There are many that fill health insurance should be socialized. There are just as many feel it should be kept private. While both parties may have sound arguments, we have to accept what is available to us. So, unless you’re a government employee, or one of the dwindling corporate employees still receiving health insurance, you need to go out there and get it on your own.

There are a number of health insurance choices that should suit your specific needs. A Health Maintenance Organization, or more commonly called HMO, is one popular health insurance choice. HMOs are one of the most common forms of health insurance provided by employers. They allow you to visit a pre-selected hospital, doctors, or clinics, without restriction. This may or may not be totally covered by your employer, but usually comes at a fixed monthly cost.

The Preferred Provider Organization, or the PPO, is similar to the HMO concept. With the PPO, you are not forced to get a little dig their doctor or hospital. When you do, however, you receive a discount for doing so. This system works on the reimbursement, philosophy. Essentially, you are reimbursed by your insurance company after services are rendered. Sometimes, they will bill your insurer at the time of service.

Indemnity health insurance plans are eight other top and plan that has become quite popular these days. One reason is, you are able to choose any position or hospital you choose. The drawback to this of course is that it comes at a premium. In addition to higher costs ease typically require a larger deductible. For the hypochondriac this may not be the best choice. Those that like to make lots of visits to hospitals might find other plans more suitable. But for those that have to be on their deathbed to see a doctor, this may be an appropriate plan.

The Health Savings Account, HSA, has some similarities to the indemnity health insurance plans. As the Health Savings Account is probably most suitable to the individual that doesn’t require a lot health care, or checkups. These individuals, which most commonly are men, may find the Health Savings Account to be a good choice for them.

Health Savings Accounts are a way to both have a way to save and pay for medical expenses. Any contributions that are made to the Health Savings Account that go unused for medical purposes are retained in a savings account. This savings account can hold many popular investments, such as mutual funds. So, getting back to the individual that avoids medical care, this individual gifts for both best of both worlds. They get the protection of the much-needed health insurance. This provides protection against large medical or accident issues. But, if these funds go unused, they get the benefit of putting the money away for retirement. Any after-tax dollars that are contributed to the Health Savings Account can be detected, up to $2900 for 2008.

Choosing a health insurance plan may seem like a very confusing process. There is no open and shut method of choosing the best health insurance. Each individual is different, with different health needs. The most important step here is to get some form of health insurance. Go in without adequate health insurance puts you and your family at tremendous risks. And those risks just aren’t worth the possible consequences.

Saves you Money on Health Insurance Premiums

Do you remember the days of the 48 hour quote? Technology has made great strides to offer consumers an easier way to get health insurance quotes. Previously, it would take days or even a week to get the information needed to make a well educated decision. Luckily this is no longer the situation, and it is now possible to get various quotes from hundreds of companies in seconds–or a minute if you?re slow on the keyboard–by searching online through various Internet Websites. If you look any other place than for Florida health insurance online could leave you with less coverage for more cash, as well as unproductive customer service. Many online companies, on the other spectrum, strive to make every step of the process simple for our valued customers. We offer a host of plans for individuals, small businesses, and even large corporations. Just get quotes, choose plans, and apply online.

If you?re presently shopping for Florida health insurance online, be sure to properly compare the benefits offered. People seem to always compare price first–a much better agenda would be to compare plans with similar benefits first–then check rates second. Saving a small amount each month might not be worth it if it comes with a higher deductible–even though that is what we would probably suggest. You do in fact have to weigh out the risks associated with the rates. Most online insurance agencies have experts that can guide you through the process to make certain that you choose insurance that will fit your needs and budget.

Through transparency, online insurance agencies can help larger corporations save a minimum of 20% for group benefit premiums. Let us figure out a customized solution to your ever rising rates–as we have a decreasing trend with our clients that range from 50-40,000 employees in size. Whatever your insurance needs, find the company that suites you. www.FloridaHealthInsuranceWeb is a great place to shop and find to help you find concise, accurate, and usable information.

Why Abortion is Not Health Care

By: Elizabeth Marion

Over the past few weeks, abortion has become the focal point of the health care debate. Pro-life congressmen are arguing that it’s wrong to use taxpayer dollars to fund something that so many Americans are strongly opposed, an argument that could really be used against the entire health care reform plan itself. Pro-choice congressmen are claiming that not allowing taxpayer money to fund abortions is taking away women’s choices. The fact of the matter is that the issue of abortion doesn’t even belong in the health care debate, because abortion is not health care.

Pregnancy is not a disease, and abortion does not prevent any disease. It is not a treatment for any illness or condition, nor is it a procedure that improves one’s health. Health care insurance should cover medical treatments and preventive care. Abortion is neither of the above. Abortion is a choice. No taxpayer money should be used to fund the choices of individuals. And for that matter, while we’re on the subject of health care reform, no taxpayer money should be used to make more people dependent on the government.

While I disagree strongly with those who think it’s the government’s job to provide and pay for everyone’s health care, I understand where they’re coming from. Though misguided, the idea comes from a place of compassion. Most Americans who support health care reform feel it’s the best way to help those who don’t have health insurance, either ignoring or unaware of how drastically it will increase the government’s power. There is no excuse, however, for expecting the government to pay for individual’s choices. Too many people in America have bought into the idea that they shouldn’t be held responsible for themselves and their decisions. Too many want someone else to take responsibility for their choices. The amount of people who desperately want a government-run public option really shows how widespread the idea of no individual responsibility has become. With the encouragement of the Obama administration more people are turning to the government, expecting to be bailed out, when they realize a poor decision has put them in a tough spot. And those who have made good decisions are becoming more aware of the fact that this administration intends to take money away from them to help out those who have made poor decisions.

To me the idea that the government can and should provide health care for all Americans is ludicrous. It is a power the government has never been given and was never intended to have. What’s even worse is the suggestion that the government should cover choices such as abortion. It probably won’t be long before people start demanding that the government cover some of their recreational activities, such as attending concerts and amusement parks. After all, the argument can be made that overall happiness and regular amusement can contribute to the well-being of one’s mental or emotional health. Car insurance should not cover a trip to the salon. Health insurance should not cover abortions, especially with taxpayer money.

10 main thoughts on health insurance

Choosing amongst many plans of health care might be an intimidating thing to do. Here we offer 10 main areas to think over in cases you have to meet the best health insurance plan for your necessities:

1. Your doctor: Certain health care plans demand you to employ their physicians’ network. If you have a doctor you want to keep seeing, learn if this doctor is comprised in the considered health care plan. Consider examining doctor’s warrants by phoning the office he or she is working for or verifying with the AMA, in case you want to select another doctor from the health insurance plan. Other considerable factors are availability and location.

2. Specialists: If you have particular medical matters or think you might have to use specialists hereafter you will want to pry how to employ a specialist. See if you will have to permanently contact your initial care doctor first.

3. Pre-existing matters: Sometimes when selecting health insurance plans many forget to check if their pre-existing conditions will be covered or one just undertakes as it is. Pre-existing matters can vary between exclusion plans to full coverage and at times something intermediate as coverage after a precise time extent. Accountability Act and the Health Insurance Portability assures coverage for pre-existing matters if you join your employer’s group plan and you were insured the foregoing year.

4. Hospital and emergency care: You’ll want to learn what hospitals and emergency rooms are in your coverage. Besides, inquire about what composes an “emergency.” Occasionally your emergency explanation might differ from the considered health care plan and perhaps it could not be covered.

5. Standard health screenings and physicals: To get regular health screenings and physicals you should make sure they are covered. Many managed care plans cover these yearly screening, but several independent insurance plans don’t cover them altogether.

6. Prescription drug coverage: If you consume prescription drugs on a regular basis or think you might need to further, you’d have to contemplate a good prescription drug coverage plan. It may extraordinarily change from plan to plan. Alternatives might involve no coverage at all to full coverage and various kinds of drugs co-pays.

7. OB-GYN: If you constantly see an Obstetrician or Gynecologist, check if your physician is covered in the plan. See what might be covered as some plans include different kinds of birth coverage, if you consider fertility therapies. The same is with pregnancy coverage: if you’re pregnant or thinking of it, check how much you will need to spend for pregnancy and birth care.

8. Supplementary services: Check additional services coverage when choosing health plans. Several additional services that might be useful to you involve: Mental Health Care, Nursing Home Care, Drug and Alcohol Rehabilitation.

9. Costs: See what deductibles you’ll first have to pay before coverage money will come, or either of services will be accessible for usage. Learn what amount the health insurance will pay after the deductible, same as what amount they will pay in case you’ll be using a service out of network. You also need to know what your co-payments are. These are the fees you have to pay when visiting your emergency room, doctor, or hospital. Lastly, know your limits. Some plans have life limits on health insurance plan’s amount and some have life limits together with annual limits.

10. Exceptions: You need to survey each of the plan’s exceptions to learn what isn’t covered and to see if any condition you have or suppose to have further, is involved on the list.

Insurance for students

No-one said life ever has to be fair but, as parents, you quickly discover the world is not set up to make things easy for you. There are challenges at every turn. Of course, all the healthcare needs can be put on the back burner if you or your partner have a family plan provided by your employers. Now all you have to do is read the small print to see what coverage is provided for children while they are at elementary school or high school while still under the magic age of 18 years. After they pass the threshold of their eighteenth birthdays, the coverage gets more patchy. They are still family members but the extent of the coverage may change. If you have not been fortunate to find an employer offering health coverage as part of the pay package, the world has been less welcoming. It’s entirely possible that you and your family are one of the growing millions who are uninsured or underinsured. This leaves a number of options to explore for the children.

For some years, the federal government has recognized that children are the future of our country. If they do not grow up strong, the future may not see the US remain so dominant internationally. So, with federal encouragement, states have been offering a safety net for children. The alternatives are Medicaid and the State Children’s Health Insurance Program (SCHIP) which was established by the Balanced Budget Act of 1997 to expand health insurance coverage to uninsured children in families with income too high to qualify for Medicaid. For the record, Congress has provided about $40 billion to fund SCHIP through 2007. Federal funding is currently available. Outside the federal and state programs, some elementary and high schools group together to offer health coverage for their students where the families are uninsured or underinsured. Some states have not set generous criteria for access to their SCHIP and the group policies help the modestly well-off families bridge the health plan gap.

Once children turn adult at 18, they are mostly on their own. If you as parents provide private coverage, this can represent the best outcome as they work their way through college and university. Otherwise, this leaves the young adults to live with the risks of no cover, or accept one of the “affordable” policies offered by their college or university. It’s a sad fact your children will consider themselves invincible. Many are lucky and survive the education part of their life without accident or illness. But if anything serious goes wrong, they will add significant medical expenses to the burden of loans and credit card debts. Local community clinics can only provide basic care. The college or university policies are often highly affordable. More importantly, starting a health insurance policy at low student rates gives them track record when they later seek coverage as an employee. But one word of caution. These are not comprehensive policies and they often limit or exclude serious injuries or disease. As parents, you may feel it wise to top up the basic cover. Get multiple health insurance quotes to find the best value additional cover. Even if your children are enrolled as medical students, they cannot expect anything more than routine treatment from the medical professionals in their area. They will be treated as “ordinary” students when it comes to paying the deductible and any copayments.

Health Insurance, Abortion and Symbolism

An article in today’s WSJ goes through the numbers explaining why restricting insurance coverage for abortions as now being debated on Capitol Hill would do little in practical terms to change the affordability of abortion for the vast majority of women.

Yet the financial impact of the restrictions — the House’s overhaul bill, H.R.3962, would prohibit insurance bought with government subsidies from covering abortions –- isn’t the whole story. People on both sides of the debate say another issue is that when insurance covers abortion, it reduces the stigma associated with the procedure.

Amy Hagstrom Miller, who owns abortion clinics in Texas and Maryland, instructs her staff to ask patients if they want to pay with insurance. One reason is because the very question conveys the message that abortion is a mainstream procedure, to be treated like any other aspect of medical care.

Critics of the House bill say the coverage restrictions would send the opposite message. “It makes it even less likely that abortion will ever be normalized in this country,” Carole Joffe, a sociologist who supports abortion rights and studies the issue at the University of California at Davis.

Exactly the point, say abortion opponents.

They hope that pushing abortion out of the mainstream will discourage more women from making an appointment. There is some evidence that state laws requiring women get counseling at a clinic, then wait 24 hours before terminating a pregnancy cuts abortion rates. The House bill could have the same effect, activists say.

“You want to communicate that abortion is in a different moral category than a tonsillectomy” and eliminating insurance coverage is one way to do that, said Charmaine Yoest, president of Americans United for Life, an advocacy group opposed to abortion.

The debate on Capitol Hill about abortion coverage is mostly symbolic, said David DeWolf, a law professor at Gonzaga University who opposes legal abortion. “But it’s symbolic,” he said, “in a way that deeply matters to a lot of people.”

Disability Applicants Report Facing Foreclosure, Lost Health Insurance, Drained Retirement Savings and Worsening Illness

An overwhelming majority of Social Security Disability Insurance (SSDI) applicants face grave setbacks and wish they would have known from the start that expert representation to assist them was available, according to a national survey. People with disabilities experienced financial crises, extreme stress and declining health while stuck in the federal disability backlog, according to results compiled and released by Allsup, a nationwide provider of Social Security disability representation and Medicare services.

Arthur Blair, of Gaithersburg, Md., was a program manager at a group home before a combination of osteoarthritis, severe back pain and depression made it impossible for him to keep working. During his two-year wait for SSDI benefits, Mr. Blair tapped deep into his savings and had to sell his home after he and his wife were unable to make their mortgage payments. His condition also worsened.

"I think the process takes away our humanity," said Blair. "There are no resources to help you. You are in a financially devastating position, and by the time you're approved, you have accumulated so much debt and lost everything you've worked for. It's almost impossible to recuperate what you lost."

A survey of nearly 300 successful SSDI claimants who came to Allsup after having their initial disability applications rejected by the SSA finds:

* Nearly 80 percent of respondents reported facing "barriers to handling the SSDI process on [their own," including problems with understanding (48 percent) and completing (61 percent) the necessary forms.

* Three-fourths (75 percent) said the level of stress they experienced while applying for SSDI benefits was either "extreme" (39 percent) or "significant" (36 percent).

* Only half (51 percent) of all applicants knew third-party representatives could help them apply for SSDI benefits.

In addition, almost 90 percent of applicants said they faced negative repercussions while waiting for their SSDI award. These included:

* Stress on family - 63 percent

* Worsening illness - 53 percent

* Draining of retirement/savings - 35 percent

* Lost health insurance - 24 percent

* Missed mortgage payments - 14 percent

* Foreclosure - 6 percent

* Bankruptcy - 5 percent

Almost nine in 10 (85 percent) survey respondents said they would have found it useful for the SSA to inform them in advance of their options for receiving help with their SSDI application. Another 83 percent would have found it helpful or valuable if the SSA had provided them with a list of authorized third-party representatives to choose from.

"Because applicants too often don't know help is available, too many initial claims are denied for simple mistakes that have nothing to do with the applicant's disability status," said Jim Allsup, president and CEO of Allsup. "If they only knew third-party assistance was available to professionally review their application and help properly document their disability, thousands of claimants could get through faster and avoid painful financial and personal repercussions of getting stuck in the system."

Allsup conducted the survey by mail June 29 through Sept. 4, 2009. For more information and full survey results, please contact Colleen O'Boyle, (703) 683-5004, ext. 122, coboyle(at)crcpublicrelations(dot)com.

About Allsup

Allsup is a nationwide provider of Social Security disability, Medicare and workers' compensation services for individuals, employers and insurance carriers. Celebrating its 25th anniversary in 2009, Allsup employs more than 600 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis. For more information, visit www.Allsup.com

What Is Health Insurance?

In a world full of unforeseen dangers insurance is the best way to ensure that you are financially protected when something goes wrong. Health insurance is a coverage that pays for medical expenses when a person falls ill and health insurance is considered an important investment by most people. This article will provide in-depth information about various aspects of health insurance.

Health insurance services are purchased from companies that ask for a fee for their services. These companies ask the person who wants to be insured to opt for a policy that suits his requirements and in return the company gets a fee for their services. The fee which is charged is known as a premium and this premium is usually charged on an annual basis. Most health insurance companies pay a large percentage of the total bill amount which means that after being insured the person needs to pay a small amount of the bill amount.

All insurance companies pay only for certain services and procedures like plastic surgery are not paid by health insurance companies. Majority of the health insurance companies also pay only up to a certain amount each month which means that after a certain amount you will need to pay your bills on your own. The policy booklet covers all these aspects in detail and they are usually handed to the person at the time of being insured.

Individual insurance is a term that is used to imply that a single individual is being insured. Group insurance is a term used to imply that more than one person is being insured. Many insurance companies offer group insurances to families of four or more and a discount is usually offered if groups opt for health insurance.

Company insurance is provided by an employer to its employees as part of the salary package. The insurance limit and policies depend on the agreement between the employer and the insurance company.

Health insurance is often mistaken for life insurance but it is not the same. Health insurance policies are applicable when a person is alive and needs to be hospitalized where as life insurance policies are applicable when a person dies due to an accident or natural event. Health insurance companies do not provide life insurance unless it is mentioned in the policy.

While opting for health insurance it is always advised to ask questions about policies and procedures before you sign up with any health insurance company. It is also recommended to read the fine print in the policy before you pay the premium or sign the agreement.

Women closing health-insurance coverage gap

While there are still inequities between women and men in terms of health-insurance coverage, public pressure and legislation have helped females close the coverage gap.

The new national health-care bill that passed the House of Representatives by a slim 220-215 margin has advocacy groups concerned about the direction of health insurance.

One part of House Resolution 3962 -- the Stupak/Pitts amendment -- has outraged Cecile Richards, president of Planned Parenthood Federation of America and the Planned Parenthood Action Fund.

"Planned Parenthood serves three million women every year through its more than 850 affiliate health centers across the country, and has worked tirelessly on behalf of those patients for affordable, quality health care," Richards said on www.plannedparenthood.org. "On behalf of the millions of women Planned Parenthood health centers serve, the Planned Parenthood Federation of America has no choice but to oppose HR 3962."


Richards explained her group's frustration, which centers around the Stupak/Pitts amendment.

"The bill includes the Stupak/Pitts amendment that would leave women worse off after health-care reform than they are today, violating President Obama's promise to the American people that no one would be forced to lose her or his coverage under health reform," Richards said.

Richards said the amendment "violates the spirit of health-care reform, which is meant to guarantee quality, affordable health-care coverage for all."

"In fact, this amendment would create a two-tiered system that would punish women, particularly those with low and middle incomes, the very people this bill is intended to assist," Richards said. "The majority of private health-insurance plans currently offer abortion coverage, and the amendment would result in the elimination of private abortion coverage in 'the exchange,' the new insurance market created under health-care reform, as well as in the public option, if one is created."

Dr. Thomas Ayoub, head of the obstetrics and gynecology department at Norwalk Hospital, believes the state of Connecticut has done a great deal to close any disparity gaps in insurance coverage between women and men.

"The state has made a big effort to equalize (insurance coverage) a lot, and the state has mandated reproductive services be covered by all private insurers," Ayoub said. "It's hard to say any disparities are discrimination; it's really an economic issue. Certain plans cost different prices. The biggest problem we have as patients is we have no damn clue what we will be paying."

Ayoub hopes that private insurance coverage might become like a restaurant, where a $25 steak costs $25.

"Most people are straightforward in ordering things," Ayoub said. "We have to have some veracity."

Nationally, there are still impediments to women receiving insurance coverage to men. According to Web site www.healthreform.gov, women's reproductive health requires more regular contact with health-care providers, including yearly pap smears, mammograms and obstetric care.

Women are also 21 percent less likely (52 to 73 percent) to be employed full-time than men, making them less likely to be eligible for employer-based health benefits themselves. In fact, less than half the number of women have the option of obtaining employer-based coverage on their own, according to www.healthreform.gov.

That Web site notes that even women with the option to get health coverage through their employer, they are twice as likely as men to go on their spouse's plan, 15 percent versus 7 percent.

Another myth that has been debunked is that Viagra is covered by insurance, but women's reproductive services are not. According to pharmacists Mike Grimaldi and Joe Schuler at the Norwalk Community Health Center, Viagra is only covered in a lower dose to help curtail pulmonary hypertension.

"Viagra is not covered by federal money," Grimaldi said in reference to Medicare and Medicaid. "Anyone using federal money (for Viagra) is not using it for erectile dysfunction."

Schuler said he and his wife have experienced in vitro fertilization firsthand.

"My wife has gone through (in vitro) twice, and on my own we weren't covered," Schuler said. "She changed to a plan to cover in vitro. Finding the right plan may take some digging. Open enrollment is very general, and people may come to find out their plan does not cover everything they need."

Schuler added that cancer coverage can vary by insurance plan.