Monday, August 27, 2012

Health and Medical Insurance - Comparing Managed Care Health Plans

Health insurance plans have been forced to take action to contain costs of quality health care delivery as health care costs have skyrocketed. Health insurance premiums, deductibles and co-pays have steadily increased, and health insurance companies have implemented certain strategies for reducing health care costs. "Managed care" describes a group of stratgies aimed at reducing the costs of health care for health insurance companies.

There are two basic types of managed care plans; health maintenance organizations, or HMOs, and preferred provider organizations, or PPOs. So which health plan is best? How do you choose what type of health insurance best suits the health care needs of you and your family?

Both HMOs and PPOs contain costs by contracting with health providers for reduced rate on health care services for its' members, often as much as 60%. One important difference between HMOs and PPOs is that PPOs often will cover the costs of care when the provider is out of their network, but usually at a reduced rate. On the other hand, most HMOs offer no coverage for health care services for out-of-network providers.

Both HMO and PPOs also control health care costs by use of a gateway, or primary care provider (PCP). Health insurance plan members are assigned (or select) a primary care practitioner (physician, physician assistant, or nurse practitioner). usually a family practitioner or internal medicine doctor for adult members or a pediatrician or family care practitioner for childern. The primary care provider is responsible for coordianting health delivery for plan members. Care by specialist physicians require referral from the primary care provider. This cost containment strategy is intended to avoid duplication of services (for example, the cardiologist ordering tests that have already been done by the PCP, or a sprained ankle being referred to an orthopedic) and avoid unnecessary specialist referrals, tests and/or procedures.

HMO and PPO plans also contain costs by requiring prior approval, prior authorization, or pre-certification for many elective hospital admissions, surgeries, costly tests and imaging procedures, durable medical equipment and prescription drugs. When such services are required, the provider must submit a request to the health insurance plan review department, along with medical records that justify the service. The request is reviewed by the health insurance company to determine whether the services are justified as "medically necessary" according to the health plan policy and guidelines. Review is usually performed by licensed nurses, and, if the reviewer agrees that the service is necessary, approval is given and the service will be covered by the health insurance plan.

As health care costs continue to rise, many indemnity health insurance plans, or "fee for service" plans are being forced to adopt some managed care strategies in order to provide quality health care and keep health insurance premiums affordable. And as long as health care costs continue to rise, the distinctions among PPO, HMO, FFS and other health insurance plans will become blurred. Rest assured, however, that managed health care is here to stay.

Can I Afford Health Insurance?

In light of today's health care costs, a better question would be, "Can I afford NOT to have health insurance?". Indeed, medical expenses are a leading cause of bankruptcy in the US. A health insurance plan should be an essential part of any responsible financial plan, whether married or single. Even young, healthy adults should bear in mind that a single emergency room visit can cost hundreds, even thousands of dollars, and intensive care can cost thousands per day. And that's not even counting the costs of prescription drugs.

There are steps to take to minimize the expense of health insurance. Many employers offer health insurance as a benefit for employees. Rates for group health insurance such as this are usually lower than private insurance rates; employers can negotiate better rates as a group. Labor and trade unions also may offer group health insurance for their members. Spouses and children can often be added to most employee health plan, though the rate will be higher. Premiums for employer-sponsored health insurance can be deducted from the employees' paycheck, often with pre-tax dollars, increasing the savings. Many employers offer multiple health plans. The employee may be able to select from PPO, HMO, and traditional plans. Compare the options, check the policy to determine what medical expenses are covered, and select the plan that most suits the needs of you and/or your family.

If a group plan is not available, private health insurance coverage is available. Private health insurance is usually more expensive than group health insurance, but there are ways to minimize the rate. Shop around and compare rates offerd by various health insurance companies. Health insurance companies usually offer lower rates for younger persons, for nonsmokers, and those with normal weight. Rates will be higher, or coverage denied for pre-existing health conditions, for those working in high-risk occupations, and those who engage in high-risk activities such as race car driving.

A relative newcomer to health insurance plans is the health savings account, or HSA. An HSA allows the individual to save money to pay routine health care expenses, deductibles and co-pays. The IRS allows this money to be set aside pre-tax as well. HSAs are paired with a health insurance plan with low premiums and high deductible to cover major health expenses. In a sense, the individual is "self-insured" for routine health care, with a major medical plan for bigger expenses. Many experts predict that HSAs will become more popular in time as an alternative to traditional health insurance plans.

Whatever health plan that you choose, health care coverage is essential. A major surgery and/or extended critcal care stay could easily bankrupt any individual or family. Consider the options available. Be certain of what is and is not covered, and consider how appropriate that coverage is for your situation.

What You Need To Know About Health Insurance

Having a reliable health insurance coverage contributes a great deal towards a person's sense of security.

As an individual, you are aware that you should take care of your health so you employ ways and make an effort to lead a healthy lifestyle.

In spite if this, there are unexpected circumstances regarding your health that no matter how hard you try to prevent, are rather unavoidable.

Thus, you need to make sure that you have a reliable insurance plan and ample coverage should you need to use them in the future, or should an emergency ensue.

Basically, health insurance coverage is divided into two categories: private and government-sponsored.

This is further broken down into several types:

- Private health insurance

This is a non-government health insurance coverage that is paid for by an individual.

- Employment-based plans

This health insurance plan is offered by the company that you work for. You may also take advantage of being a dependent for a relative's health insurance coverage that includes one's immediate family.

- Directly-purchased insurance plans

If you think that the coverage offered by the government or your employer is not enough, you may buy a separate plan that you can purchase privately.

- Government-sponsored health insurance packages

These are plans funded by the federal government. There are several levels, ranging from local, state to federal coverage.

This health insurance plan is required by law and has several types:

1. Medicare

This is a health insurance program which is offered on a national level. The people who can get Medicare benefits are those who are above 65. They may also be given to people with certain disabilities.

2. State Children's Health Insurance Program

This is a program administered by the state. It may have a different name for each state, but the main goal of this program is to offer health care to children whose parents cannot provide for them.

3. Medicaid

This is a health insurance package which is also offered by the state. This medical aid, as the name implies, may be known differently in other states. The basic principle, however, is to offer health insurance benefits for the needy.

4. Military and veteran health care

There are several health care benefits and insurance plans which are provided for retired or active members of the military. These plans extend to their immediate families and their survivors.

Also, the Department of Veteran Affairs offer health insurance coverage to veterans and their dependents.

5. Indian Health Service

Health insurance plans are also offered to eligible American Indians.

Sunday, August 26, 2012

You have been and will always be my hero


Neil Alden Armstrong was and will always be my
hero. Ever since I, as a young boy then, learnt that Neil Armstrong was the
first man to set foot on the Moon, I became fascinated with him, space and
space travel. I was amazed at how brave he and his fellow astronauts were.
Even today, I am awed by the fact that he travelled 380,000 km to the Moon and
landed over forty years. Forty years ago

Friday, August 24, 2012

Hari Merdeka : Cast aside your political allegiance and use your brains for a change


Next week, we celebrate the 55th Hari Merdeka and two weeks later, our 48th Hari Malaysia. I won’t go into the details of how important these days are for I am sure many other writers will be indulging in this.

I am sure many of you would have your own wish list this Merdeka Day. Some will wish to get married, some will wish for wealth, some will wish for improved national unity, some

Thursday, August 23, 2012

Say Something Nice


#SaySomethingNice is a 17-day campaign to change the mood of the nation. We want to
create a positive Malaysia. A Malaysia which focuses on our strengths
and not just our shortcomings.

From August 31st to September 16th, let us
call for a truce and just appreciate each other. During that period, we want
our political leaders and their supporters to #SaySomethingNice,
acknowledge the

Wednesday, August 22, 2012

Notes from Sicily : Mahathir, Marsala and Mafia


Greetings from Sicily, folks. Am here for the 7th time - attending
for the annual conference by the World Federation of Scientists called
“International Seminar on Planetary Emergencies” (sounds pretty grand, doesn’t
it). This year we will be discussing climate change, nuclear energy, terrorism,
and information security. 

The conference is held every year on the same dates (20 -23 August

Tuesday, August 21, 2012

We need more people like him

We need more people like him. Not only a great
badminton champion but also a champion for the orphans and those in need.
Bravo, Chong Wei.

Chong Wei to set up foundation to help orphans, needy
NST, 21August 2012

KUALA LUMPUR : National shuttler Datuk Lee
Chong Wei plans to set up a foundation to help orphans and those in need of
assistance. The foundation, to be named

Monday, August 20, 2012

Myanmar better than Malaysia ? Bodoh.


A number of people, blogs
and Facebook sites, in response to this BBC report that Myanmar is abolishing media censorship, have claimed Myanmar is
better than Malaysia.  They claim that
Myanmar respects press freedom, is transparent and does not censor anything –
hence better than Malaysia.

My point. Yes, there
have been some progress in Myanmar recently. If you speak against the

Saturday, August 18, 2012

Hari Raya and Yasmin Ahmad


Selamat Hari Raya. Maaf Zahir Batin, folks.

It is the time of the
year when I miss Yasmin Ahmad. Many a years, I (and I am sure many Malaysians)
eagerly awaited ads from Yasmin and Petronas – which never failed to impress
and touch the heart. RIP Yasmin.

Here are some ads for you to watch (and cry) again

Plastic bowl

Mak Ok Tak




Wednesday, August 15, 2012

Janji Ditepati – Monyet style

Rais Yatim’s Merdeka Day theme “Janji
Ditepati” received tonnes of flak. The theme has since spun multitude of jokes,
puns, etc, etc from janji dichapati to janji krabby patty. I think Rais simply
lost the plot and has done the government and the Prime Minister a great
disservice. The word “janji” has been sullied (and I hope the man will have the
decency to retire from politics come the GE13)

Monday, August 13, 2012

Two special children and unconditional love

Simply brilliant. I love it to bits.

Kudos to the folks at Bernas and their advertising people for coming up with this wonderful Raya ad. Folks, please do watch it in its entirety.

Sunday, August 12, 2012

A father’s Olympian sacrifice


A father’s Olympian sacrifice

New Straits Times, 12 August 2012

Those were the things Pamg Joheng drew upon to push
him to sacrifice everything for his children.

And if Malaysia’s new darling Pandelela Rinong drew
even a little from her father’s drive and sacrifice, those were the things that
started her journey towards Olympic bronze, a journey which by all indications,
is far

Thursday, August 9, 2012

Pandelela and a great Merdeka gift


Dear Pandelela,

Well done for winning
the bronze medal in the women’s 10m platform diving. I have been following your
performance since the start of the London Games – very impressive indeed. You
are the first Malaysian woman to win an Olympic medal. You are the first Malaysian
to win a medal in an event other than badminton. You are the 3rd best
diver in the world. Such a fantastic

Wednesday, August 8, 2012

Curiosity’s landing on Mars : What Malaysians said


The NASA’s most
sophisticated Mars rover, named Curiosity, landed on the Red Planet on Monday,
6 August, at about 1:30 PM Malaysian time. After travelling for
more than 8 months and over 540 million km, NASA landed the rover on Mars using
a series of very complex manoeuvres including the use of the hitherto untried sky-crane. It is a very
ambitious mission aiming to uncover
whether Mars

Tuesday, August 7, 2012

Lee Chong Wei and the weight of a lazy nation


A recent study by TheLancet, a scientific journal, put Malaysia as one of the 20 “laziest” countries
in the world. [note : the laziest here was in reference to the level of physical
activity]. It went on to state that 61.4% of Malaysians are inactive – meaning they
do not partake in spots, physical training, etc. 

I tend to agree with Lancet.
Malaysia is not exactly a sporting nation.

Sunday, August 5, 2012

Lee Chong Wei and dumbass Malaysians

Most of Malaysians were teary-eyed and celebrating Lee Chong Wei's heroic feat at the London Olympics. I think you will agree with me that Malaysians across all races, religion, gender and political affiliation were united in cheering and supporting our hero.

Unfortunately, at the same time, there were also a few jack asses who have seen it fit to make derogatory or downright dumb statements

Chong Wei, sports and Malaysians unite !


Well done, Datuk Lee
Chong Wei

The Olympics Committee
will give you a silver medal but you gave us something more valuable. You (at
least for today) brought the nation together - something that all our
porcupine-headed politicians will never be able to do.

Najib might try to unite
everyone under his 1Malaysia umbrella, Rais Yatim may think his crappy song and
stupid logo will unite

Saturday, August 4, 2012

KL 2020 Olympic Games : Official Sponsors Announced


If the Olympic Games are held in KL in 2020 (read my earlier article here),
the following will be the official sponsors and brands :


Official Song Writer          : Rais Yatim

Official Music Composer   : Rais Yatim

Official Singer                   : Rais Yatim

Official Logo Designer       : Rais Yatim

Official Song                      : Janji Pingat Didapati


Thursday, August 2, 2012

Whistle blower or whistle blown ?


You are walking with
your mother. A guy snatches your mum’s handbag and runs away. You chase and
catch him. Then you whack the shit out of him and he dies. Is it ok? Of course,
not. Two wrongs cannot make a right.

You suspect your neighbour
is abusing his dog. You break into his house when he is not around. You find
that the dog looks like it has been abused. You free the dog and burn