Health Insurance Policy

A Health insurance policy is a contract between an insurance company and an individual. The contract can be renewable annually or monthly. The type and amount of health care costs that will be covered by the health plan are specified in advance, in the member contract or Evidence of Coverage booklet. The individual policy-holder's payment obligations may take several forms[7]: Premium: The amount the policy-holder pays to the health plan each month to purchase health coverage. Deductible: The amount that the policy-holder must pay out-of-pocket before the health plan pays its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of their health care is covered by the health plan. It may take several doctor's visits or prescription refills before the policy-holder reaches the deductible and the health plan starts to pay for care. Copayment: The amount that the policy-holder must pay out of pocket before the health plan pays for a particular visit or service. For example, a policy-holder might pay a $45 copayment for a doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service is obtained. Coinsurance: Instead of paying a fixed amount up front (a copayment), the policy-holder must pay a percentage of the total cost. For example, the member might have to pay 20% of the cost of a surgery, while the health plan pays the other 80%. Because there is no upper limit on coinsurance, the policy-holder can end up owing very little, or a significant amount, depending on the actual costs of the services they obtain. Exclusions: Not all services are covered. The policy-holder is generally expected to pay the full cost of non-covered services out of their own pocket. Coverage limits: Some health plans only pay for health care up to a certain dollar amount. The policy-holder may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some plans have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs. Out-of-pocket maximums: Similar to coverage limits, except that in this case, the member's payment obligation ends when they reach the out-of-pocket maximum, and the health plan pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year. Prescription drug plans are a form of insurance offered through many employer benefit plans in the US, where the patient pays a copayment and the prescription drug insurance pays the rest. Some health care providers will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay, as the insurance company pays according to "reasonable" or "customary" charges, which may be less than the provider's usual fee. Health insurance companies also often have a network of providers who agree to accept the reasonable and customary fee and waive the remainder. It will generally cost the patient less to use an in-network provider. Health plan vs. health insurance Historically, HMOs tended to use the term "health plan", while commercial insurance companies used the term "health insurance". A health plan can also refer to a subscription-based medical care arrangement offered through health maintenance organization,HMO, PPO, or POS plan. These plans are similar to pre-paid dental, pre-paid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a fixed number of services (for instance, $300 in preventive care, a certain number of days of hospice care or care in a skilled nursing facility, a fixed number of home health visits, a fixed number of spinal manipulation charges, etc.) The services offered are usually at the discretion of a utilization review nurse who is often contracted through the managed care entity providing the subscription health plan. This determination may be made either prior to or after hospital admission (concurrent utilization review). Inherent problems with insurance Insurance systems must typically deal with two inherent challenges: adverse selection, which affects any voluntary system, and ex-post moral hazard, which affects any insurance system in which a third party bears major responsibility for payment, whether that is an employer or the government. Some national systems with compulsory insurance utilize systems such as risk equalization and community rating to overcome these inherent problems.

Older Adult Addiction Treatments

The aging of baby boomers results in a higher number of elderly people and aging adults. Older adults with a history of lifetime drug use, plus different cultural norms and general attitudes about drug use, and increases in the availability of psychotherapeutic medications, may cause a higher number of older adults with substance use problems. Although no drug treatment programs exclusively target older adults, research to date indicates that current addiction treatment programs can be as effective for older adults as for younger adults. However, substance abuse problems in older adults often go unrecognized and therefore untreated.

Sunscreen

Sunscreen agents prevent sunburn. Limiting exposure to the sun and using sun block and sunscreen when in the sun may help prevent early wrinkling and skin cancer. There are two kinds of sunscreen agents: chemical and physical. Chemical sunscreen agents protect the skin from the sun by absorbing the ultraviolet (UV) and visible sunrays, while physical sunscreen agents reflect, scatter, absorb or block these rays. Sunscreen agents often contain more than one ingredient. For example, products may contain one ingredient, which provides protection against Ultraviolet A (UVA) sunrays, and another ingredient that protects the skin from the Ultraviolet B (UVB) sunrays, which are more likely to cause sunburn than the UVA rays. Ideally, sunscreen coverage should include protection against both UVA and UVB sunrays. The sun protection factor (SPF) found on the label of these products indicates the minimum amount of UVB sunlight the product protects from. It compares the redness associated with protected versus unprotected skin. Sunscreen products with high SPFs provide more protection against the sun.

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Melanoma

Melanoma is a malignant tumor of melanocytes, which present in skin but also in the bowel and the eyes. It is one of the more rare types of skin cancer, but causes the majority of skin cancer-related deaths. Malignant melanoma is a serious type of skin cancer. Uncontrolled growth of pigment cells, called melanocytes cause cancer. Despite many years of intensive laboratory and clinical research, the sole effective cure for melanoma is surgical resection of the primary tumor before it achieves a Breslow thickness greater than 1mm. Each year doctors diagnose around 160,000 new cases of melanoma and it presents more frequently in males and Caucasians. It is more common in Caucasian populations living in sunny climates than other groups. According to a WHO report, about 48,000 melanoma-related deaths occur worldwide per annum.

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