Healthcare Costs and the Medi-Cal Program In California

Has anyone else noticed the rise in healthcare expenses? Not only are the costs of medical care and prescriptions going up, but premiums are on the rise as well. More employers are shifting a higher portion of the costs of healthcare to the employees, including higher deductibles and co-pays in many instances.

And this issue is only enhanced by the decrease in monies provided for state and federal run healthcare plans, such as Medi-Cal in California or Medicaid programs. Those who may have previously benefited from these plans due to being in a lower income bracket are finding themselves having to fork out money for traditional healthcare plans. For those who are in these lower income brackets who barely fall outside of the required income guidelines, it is becoming increasingly difficult to live on remaining dollars after paying for healthcare alone.

For the purposes of the Medi-Cal program specifically, there are several requirements to qualify for the program. The qualifications are really based upon the qualifications for other programs that are state and federally run. If an individual qualifies for cash aid or food stamps, for example, they will likely qualify for Medi-Cal. However, if someone owns a certain amount of property, such as multiple cars or home that is over the allowable limit for the family size then the family would not qualify for health coverage assistance. The general guideline is for property limits starts at $2,000 for the first person and increases with each family member. In addition, the family's income plays a large factor in determining eligibility for the Medi-Cal program. As an example, a family of four can make a maximum of $4,167/month to receive health insurance benefits. Add an additional $708 for each additional family member to find the maximum amount of allowable income for larger families. Other factors include things such as: if a family member has a serious illness or disability, if the woman is pregnant, if there are children in the family, or if a family member needs specific health care, such as nursing home care, cancer treatment, or dialysis, to name a few.

Please don't get me wrong. I believe that abuse of the Welfare program (i.e. cash aid, food stamps, medical assistance, homeless assistance, etc.) is absolutely wrong. If someone is receiving assistance and not working because they choose not to work (not because they physically can't work), or if they are receiving assistance but are using the money to purchase drugs or are involved in other illegal activity, then I absolutely believe they should not be able to receive assistance. However, if they are a single-parent household, has a medical emergency, or just can't make ends meet while working a full-time job, then they should have the opportunity to receive assistance. That is what it is truly meant for.

So, if you don't qualify for Medi-Cal benefits because you are above their income limits, or you don't have children, or you don't have a specific illness or disability, then you'll likely find yourself paying for healthcare either through your employer or through a stand-alone private health insurance plan. I have had all types of health insurance plans over the years, and I have seen the rise in healthcare costs over the years.

**Please note that this information is current at the date and time of this posting. Please review the specific state requirements for state healthcare as they may have changed.

New Premiums Model in 2014 - Rating Rules For Businesses - Families - Individuals

New rating factors for businesses, as well as individuals and families, will play a key part in planning for 2014. Some businesses will be smacked with a 50+ percent increase based on some characteristics that are at play with the new rating rules. With that said, some businesses will be excited to know their premiums are slated to lower. There are some key items you need to know that go into the new rating model called Community Rating.

There are a lot of questions that come up regarding the healthcare law. Some think it will be for free. In some cases, it will be pretty close to free. Others will find out real soon when their premiums change, they may possibly go down, but for the most part they will go up due to changes in the Affordable Care Act.

Rates can vary based on if the plan covers an individual or a family. Health Insurance companies must utilize a per member rating process. The insurance company adds up the rate for each family member to arrive at the family premium. Rates for only the three oldest family members under age 21 will be taken into account in addition to the rates for those over 21.

A State may establish up to seven rating areas under the proposed ruling. The rating areas must meet one of the following: 1) There are no more than seven areas based on county, three-digit ZIP codes or metropolitan/non-metropolitan statistical areas. 2) There is only one area in the state.

Rates can vary based on age. They cannot vary more than 3 to 1 for adults. The rule establishes a uniform age bands. A child age band: A single age band from 0-20. An Adult age bands: One year age band stating at age 21 to 63. Lastly, a single age band for 64 and older.

Tobacco users were not left out of the equation. Insurance carriers can charge higher rates for people who use tobacco products. They are also limited on what they can charge. Rates for people who use tobacco products cannot vary by more than 1.5 times the rate of the non-tobacco user.

The premiums could have a toll one way or the other come 2014, depending on the variables in the census of the employer group and the new rating rules. The business may or may not have control on the ratings, however, you can start planning your strategy for 2014 and beyond. Making some adjustments now could off-set costs come next year. If you do not do anything, or the current agent or broker does not do anything, you could be suffering with the 50 + percent increase putting a huge burden on the cash-flow of the business. Cash-flow is so crucial for the survival of a business.

What Is a HIPAA?

The Department of Health and Human Services (HHS) of the United States designed a website that would help the public understand more about Health Insurance Portability and Accountability Act or better known as HIPAA. The HHS website provides a variety of training materials about the purpose and essence of the Act. Also stressed in the site material is the background of the Act. For a better understanding of HIPAA, read on.

Historical Background

Modern technology has a big potential to interfere with the confidentiality of patient's health information. That is why: HIPAA was enacted as a Public Law 104-191 in 1996 with objective to provide security against the misuse of patient's information that is held confidential. HIPAA requires HHS to implement U.S. National standards for health care transactions done via the internet. This particular law also points out that certain people giving health care services should undergo and complete a HIPAA Training Course. Also included in the training are the HIPAA organizational policies, protection of information as well as security awareness. Among the people who need to take a HIPAA course are nurses, doctors, pharmacists, researchers and those others who are working in the hospitals.

Significance of the Act

The Office of Civil Rights is the one who provides all the needed materials for the learning more about the Act. It is also the Civil Rights Office who supplies a complete outline of the principles as well as the full summary of the provisions of the Privacy Rule. The information about the administrative requirements needed in the workforce is also provided by the office. The office, however, does not provide a step by step training for the government. The good thing is that updates are being done as often as needed so the public could know of the HIPAA modifications made in the most recent time.

Education about the Act

Business owners may also offer some educational HIPAA information. The focus, though, of educational HIPAA data is how employers should handle the privacy of the health information of their employees. The policies of HIPAA are likewise outlined in the info that is shared, most often. Moreover, the material also includes proper ways and procedures to handle confidential information to be able to realize the protection required by the law.

Computer Training

One other effective media used to share information and to make HIPAA training available to the public is via computer training. If, for instance, a private entity needs to save and exchange private medical information through the computer system, certain requirements need to be fulfilled as mandated by HIPAA. Say, for example, keeping the computer system locked and password enabled or perhaps keeping the computer files accessible to only a few people. With this particular measure, employers may give computer training to staff members who have direct access to the computer system.

Every patient's information should be properly and closely protected. In order to know more about HIPAA and in order not to violate any of the rules stated in the private law, a thorough understanding about HIPAA law is needed.

Avoiding HIPAA Violations

Health care providers as well as businesses covered by the scope of the Health Insurance Portability and Accountability Act (HIPAA) are susceptible to serious penalties when caught not in compliance with the rules and regulations set forth by the privacy law. Even individuals who had violated the HIPAA can be sentenced to jail. In order to avoid chances of having HIPAA complaints and to avoid being under intensive investigations, the entities within the scope of HIPAA need to ensure that they are religiously adhering to the rules and regulations of the privacy law. To be able to ensure proper compliance, entities need to take necessary proactive measures which are outlined below.

1. Organizational Policies Review

It is vital that organizations featuring health care services review the policies and procedures of the organization in connection with the privacy law. The privacy rule of HIPAA sketches out who is entitled to gain access to a patient's protected health information (PHI). Also clearly stated in the rule is how the PHI can be utilized and obtained. In compliance with this particular rule of HIPAA, organizations are mandated to appoint a Privacy Officer who will be having the sole responsibility to monitor compliance with the privacy law.

2. PHI Security Review

It is also important that the PHI security's policies and procedures be reviewed in a timely manner. Clearly determined in the HIPAA privacy law are the requirements needed for the physical, administrative and technical protection of the patients' confidential medical records. In connection to this, HIPAA mandated the entities to have an assigned security officer who will ensure and incessantly monitor compliance. Apart from that, the security officer is the in charge in determining and analyzing the security systems of the organization. The security officer also needs to take necessary steps to identify and fix potential security threats. For added security, it is vital that the access to the patients' PHI be restricted only to those workers who need the information. The PHI should also be always protected by a strong password to ensure that only the authorized person can access the data.

3. Obtain a HIPAA Training Course

To avoid being penalized by noncompliance of the privacy law, HIPAA covered entities should provide necessary training to their employees. The best way to avoid penalty is by educating people. Educate your employees about the HIPAA and let them be aware of their responsibilities as per mandated by the privacy law. It is recommended that organizations offering health care services provide HIPAA training to their employees at least once a year in order to keep the employees updated of the most recent policies and procedures. Also, entities need to provide necessary HIPAA training to newly hired employees to ensure compliance.

Entities having business affiliates dealing with patients' PHI need to sign a mutual agreement stating that both parties should adhere to the HIPAA. Individuals or companies not within the scope of HIPAA but need to have access to PHI as needed for the services they provide are considered the business affiliates. A software salesperson, accountant and lawyer are good examples of business affiliates.

Different Sorts Of Health Insurance Plans

Health is the biggest asset for any human being and our motto of life must be to stay healthy so that we can enjoy our life till it comes to an end. However, our health is just like a machine, which is vulnerable for many damages with the advent of time. On top of these machines need occasional or regular repairing for their efficiency. Same goes for our health. Our body needs regular checkups so that the organs of our body can perform their task precisely. On the other hand, due to some external forces or influences, like - virus, parasites, etc. and due to some internal organ dispute (such as heart blockage or kidney blockage), we experience major, as well as casual health breakdown issues. Just like a machine, our health requires servicing and the process of servicing the health is call medical science.

Medical science has experienced so many changes due to the advent of technology and new inventions. Today's medical technologies are pretty robust and highly skillful enough to provide seamless healthcare support to the patients. As the technology has been integrated with the healthcare management and treatment procedures, healthcare or medical treatments also have become quite expensive. This is why we need to plan for our healthcare even if we are not experiencing any health issues at this moment. For a major or minor operation, immense expenses may happen and one needs to be careful about it. To aid people with their finance planning regarding their healthcare or medical treatment, medical insurances have been introduced into the market by the insurance companies, banking organizations and other financial organizations.

Presently, in USA, having a insurance is must for every citizen. To avail medical insurance, buyers need to find a suitable company first. Once the suitable insurance company has been spotted, the next step is to select a good health plan. Now, selecting a insurance plan can be really critical. Several health schemes and plans are there for the buyers to choose, but the million dollar question is - which is the most suitable for you, according to your age, budget and needs? So, let us have a look on different kinds of health:

1. Short Term Health Insurance - This is quite suitable for those, who are presently undergoing economical crunch situations. For short term health, investment is low as the term is short. The benefit is that you can still avail a health plan, even if you are in economic trouble. When, things will be back in shape, you can move to a long term or more beneficial health plan.

2. Full Service Health Insurance - Well, this is kind of a long term health insurance with lucrative offers. This kind of health insurance would be a bit costly and suitable for young or mid-aged servicemen or businessmen.

Apart from these, supplemental health insurance, pre existing condition health insurance are two popular forms of health insurances available in the market.

4 Truths Regarding Whole Life Insurance Policies

Prior to dealing with anything related to whole life insurance, you need to make sure your know as much as you can about the policy in order to take out the mistakes and have the ability to evaluate the pros and cons of specific items. Remember that a plan can be expensive and you could not manage to be wrong. Here are 4 truths you should take note of:

1. Obtain quotes or what they call estimates and inspect if they are well-founded and will the incentives be much better ultimately.

2. Remember that a whole life policy will only pay a case upon early premature death within the mentioned timeframe and you would certainly have to repay almost 30 years and in the end fail to get everything. It is a difficult sort of plan and you have to make certain if you truly want to get it. It is still thought about as a short-term plan.

3. It would certainly be most effective to get this type of policy if the agreements would offer a money value reserve. This must accumulate as an understood case and go as a survivor benefit. However in the plan, be sure to check if this will be credited as insured interest to the money worth account. Thus, you can be assured that when you pass away, your beneficiaries have something to claim.

If you are still alive, you need to be given the chance to get a loan that is worth the money your invested and forfeit the survivor benefit. You should pay them back with interest minus the returns. This can still be the most inexpensive means to access your money when you actually need some.

4. There are various types of insurance like minimal pay, premium, and single premium and financial. You definitely have to know what these plans call for before picking.

Adhere to these guidelines and you could be certain to land the best plan. Always keep in mind never to go for the initial policy you see online. Furthermore, never ever go with the most cost-effective one you see. This does not always translate to the most effective plan for you. It would be best to do comparison shopping by obtaining numerous quotes from different companies and then examining the benefits as well as the drawbacks before formulating a decision on which insurance coverage to invest in.

Top 3 Benefits of the Medical Health Insurance Policy

Even healthy people need medical insurance coverage. Having the right health plan goes a long way in maintaining and improving the health of the policyholder and his/her family. In the event of an illness or an accident, the cover will provide the necessary financial protection. Therefore, it is advisable for everyone to consider accessing medical health insurance quotes. The right medical cover helps you to take good charge of your health. The benefits of the medical health insurance cover include:

· Providence a peace of mind

You are unlikely to know when an accident or illness might happen. In case you or any other member of the family is injured or becomes ill and you are not insured, it will prove difficult to receive affordable health insurance cover later. The financial burden likely to be experienced in the event of an accident or illness can be devastating. With the right health care cover, the insurance plan will be able to cater for some medical costs. Through the preventive care, you will be in a position to avoid illness. Furthermore, you will be in a position to save money that would otherwise be spent on treatment.

· Takes advantage of wellness & health tools and resources

Apart from providing financial protection, the right health insurance plan offers incentives, resources and benefits that help the policy holder and his/her family to stay and get healthy. The wellness and health tools and resources include coverage for screenings and annual check-ups. The policyholder also gets an opportunity to receive discounts on alternative care treatments and exercise programs. Therefore, it is important to review the plans to take proper advantage of the programs that are being offered.

· Protects the family's financial future

The health care cover costs money. However, not having the money actually costs more. Medical needs that are unpredictable together with high costs of health care have the ability of leaving you with large bills in case you are not insured. Therefore, having the right health cover helps to lessen the possibility of dipping into the retirement savings to cater for unexpected medical bills.

It can prove difficult predicting the amount of money that you would need to spend on healthcare annually. However, a good health care plan offers financial protection for expensive medical costs that are unexpected. The health care plan helps you to cater for common services such as preventive care and annual check-ups.

Know the Difference Between an Individual Health Insurance Plan and a Family Health Insurance Plan

Individual health insurance plans and family health insurance plans, while basically the same, differ in degree of coverage as well as cost. Learn the difference between the two types of insurance products.

Individual Health Insurance Plans and Family Health Insurance Plans - Do You Know the Difference?

Trying to locate the right health insurance plan to fit your budget isn't always the easiest thing to do especially with the growing cost of health care here in the United States.  Determining what you want a health insurance plan to accomplish for you and your family and determining the needs to be covered will help you decide what health insurance plan may work best you and your family.

What are Individual Health Insurance Plans?

The first place to start our discussion is with the individual health insurance plan.  An individual health insurance plan is basically what it says it is.  An individual health insurance plan is a health insurance plan for one person.  If you find you have no one else to insure with a health insurance policy then this will be your best option from a cost standpoint.  Keep in mind however that individual health insurance plans may vary widely in affordability depending on the type of coverage you choose for yourself.

The more traditional individual health care plan is called an indemnity plan.  The indemnity plan normally covers your visits to the doctor of your choosing and will cover the procedures that this doctor may prescribe for you.  The cost for this indemnity plan will vary depending upon a deductible you choose for herself as well as your out-of-pocket limit.  Keep in mind though that overall this type of health insurance plan is the more expensive of the individual health insurance plans but does offer you the most freedom of choice.

Individual managed care plans such as HMOs are less expensive than the indemnity plans but you need to be aware that you do give up some of the freedoms that are offered by the indemnity plan.  Your freedom to choose your doctor is limited to the doctors on the HMO's approved list and any specialists that you may need to see will have to be referred by this primary doctor.  If primary yearly checkups and the occasional antibiotics describes your current health care needs, this plan may be the one for you.  This plan will cover health emergencies but there may be just a few more hoops you have to jump through than with the Indemnity health care plan. Both of these health insurance plans, the indemnity plan as well as the individual managed care plan, may include dental coverage and prescription coverage at an additional cost. 

What Are Family Health Insurance Plans?

As the name implies, family health insurance plans are designed for families.  However since these family health insurance plans are covering more than one person, the cost of these plans will be higher.  As you may already have guessed, the larger the family the larger the price tag.  In addition, factors such as the ages, gender, and habits such as smoking or tobacco use in general etc. will largely determine how much this policy will cost you.  As with individual health insurance plans, there are indemnity plans that are available for families.  And since these indemnity plans offer the same freedoms as they do for the individual plans, these plans can be a real help when having to deal with the health care needs of multiple people.

Family health insurance can also come in the managed care variety as well and pretty much work the same way as do the individual managed care health insurance plans.  The cost of the family managed care plans will be higher than that of the individual managed care plan, but will cost less than a family indemnity plan.

What Are Group Insurance Plans?
Many companies are now offering their employees group health insurance coverage.  These employers may pay the bill for some of the premium.  Since many of these employers now offer both types of health insurance coverage, the type of policy you choose will determine your out-of-pocket costs.  Generally these group health insurance plans will cost you less than a plan you were to purchase on your own.  If this type of group insurance plan is available to you at your workplace, you'll definitely want to take advantage of it.  If it is not offered at your workplace, perhaps you could suggest that your employer consider offering a group health insurance plan.

If your plan at work does not include a health insurance benefit or you are self employed or simply looking to provide health insurance coverage for yourself and your family outside the workplace environment, a great place to start your research is Blue Cross Blue Shield (www dot BCBS dot com) or Aetna (www dot aetna dot com). This is not necessarily an endorsement but is a good place to start in understanding the types of health insurance plans available out there today. These two large providers operate in most of our 50 states so your likelihood of learning about the types of health insurance plans available in your state from different insurers is high.

As always, seek the advice of a professional financial planner before deciding on a course of action that you do not fully understand.

Why Family Health Insurance Plans May Grow In Popularity

Health care costs are among the most expensive costs that people face. In fact, it is one of the leading causes of bankruptcy. The healthcare costs are going up for different reasons. There are many advanced technologies – such as robotic surgery – that allow for physicians and doctors to perform treatments with lower rates of complications. There are also some treatments that patients would have never seen, had it not been for these medical advances.    

The cost of drugs have been rising, but the rising costs have been slowed by expiring patents that allow for more affordable generic versions of brand drugs.    

Lab tests are becoming more frequent and have led to rising medical costs, given the inherent expense of these tests. There will likely be more lab tests in the future, as advances in genetics allow for physicians to perform tests that allow for customized treatments.    

The aging baby boomer population is leading to a growing number of patients who have to spend time in the hospital. As a result, the overall costs of a hospital stay have been rising. Given that a growing number of patients rely on Medicare and Medicaid, and given that these programs do not pay for all the treatments, the costs are passed on to patients who have insurance policies and who pay out of pocket.    

Family Health Insurance is One of the Best Options    

For those who are not multi-millionaires, the best way to avoid paying ridiculous medical bills is to locate a health insurance policy. For families, the best option is to get family health insurance plans. The family health insurance plans are generally created for those who do not have health insurance from an employer. It is a type of group insurance designed for families that has the cost of healthcare spread out across the family.    

When risk is spread out among many people, the amount of money that patients are able to pay is lower. This leads to greater cost savings for the insured. In some way or another, private healthcare insurance is the primary way that Americans pay for their healthcare.    

For those who do not have family health insurance plans, they will most likely be require to become insured in the near future due to healthcare legislation that has recently been passed by the U.S. government. Recent legislation has lead to a mandate – defined as a tax – that could lead to large fines for those who choose not to become insured. Fortunately, for those who cannot afford to obtain health insurance, there are health insurance programs that are designed to be highly affordable or even free.    

There are two main types of health insurance programs that are offered to patients. One type of health insurance program is comprehensive health insurance, which is designed to pay a certain percentage of healthcare costs after the patient pays a deductible. Another type of health insurance is the scheduled health insurance plan that is designed to provide patients with ongoing medical treatment. The comprehensive healthcare policies tend to be the most expensive because they have the potential to pay very large amounts. Some plans will pay as much as $5,000,000. In contrast, the scheduled health insurance plans sometimes only pay as little as $5,000.    

Family Health Insurance Will Grow    

Family health insurance plans may become more widely used as more Americans are forced to get health insurance. While some employed Americans typically receive health insurance from their employers, those who work part-time, who work for businesses with very few employees or who are self-employed will be responsible for paying for their health insurance for themselves and their families.

Mistakes to Avoid in a Personal Injury Claim

Have you recently been involved in an accident? Regrettably, there are some accidents that are unavoidable, that are simply bad luck or the consequence of inescapable circumstances - bad weather is a common factor in many of these inevitable accidents. What happens, however, if the accident could have been avoided? 

Unfortunately, there are many such situations that could have easily unfolded differently had proper care and caution been exercised. Negligence, carelessness and sheer reckless behavior can sadly all contribute to the unwitting and the undeserving suffering catastrophic injury. 

For victims, and the families of victims, following such an accident, it can be easy to become overwhelmed by the situation and become confused. Not only will you be suffering with the physical pain of an injury, but you will likely also be dealing with emotional trauma and the financial burden that can come from medical bills, lost wages, and in wrongful death cases, the expense of a funeral. 

It is therefore extremely important that every step is taken to look into filing a personal injury claim. By pursuing such a case, the liable parties can be held responsible for their fault in the accident. While an important process, this is not always an extremely simple one. Especially for someone who has never dealt with the process before, it can be easy to fall into common mistakes. 

Common mistakes regarding personal injury claims include a failure to document the accident scene, failing to seek medical attention, giving statements without legal assistance on your side, applying for damages that have not comprehensively been outlined in medical records or outright refusing to follow through with the treatment advised by a medical professional. 

While all of these are mistakes that should be avoided at all costs to give you the best chance of success in your injury claim, there is one that is even more dangerous. One of the largest mistakes commonly made, and the one can cause the most damage to your plight, is making the decision that you do not need professional legal representation. While it could be tempting to deal with a personal injury claim on your own, dealing with insurance companies without legal aid can be difficult and in many cases, outright impossible. 

Your claim could be denied, delayed or settled for a much lower numeric value than you actually require. Having a lawyer is an easy way in which you can fight to defend your rights. Insurance companies are much more willing to take you seriously if they see you are being represented by a heavyweight and could be more open for settlement. If they, however, are not � you will still have the support of a knowledgeable litigator who will be willing to fight for your rights in a courtroom setting. 

Effective Techniques Useful for HIPAA

There are only a limited amount of people who can directly have admittance or access to a patient's medical record. These are the patient himself (or herself), the health care professional and any family member or friend who the patient grants access to his records. To give needed security for patients' records, the Health Insurance Portability and Accountability Act (HIPAA) was approved by the US Congress. This law incorporates the right of the patient to make his medical information confidential and to know why the health care professional uses his records. Since this matter is sensitive and necessary, health care providers are obliged to give their employees proper training about HIPAA.

• Who is Responsible for the Training?

Though training for HIPAA is available, the question of who is responsible in providing the said training should be tackled first. The individuals or institutions that have direct contact with the patients' confidential medical records like hospitals, nurses, doctors, nursing homes, insurance companies and pharmacies must educate their employees regarding the HIPAA law. These individuals and institutions are responsible for the transfer and exchange of information of the patient.

• Giving the right training to the employees is a must.

An individual or institution mentioned above is required to offer HIPAA training to its staff members. Generally the employers pay for the training as the employees will undergo this continued education for the benefit of the institution. Thus staff members are then educated about ways to avoid any medical information leakage or abuse of the medical records usage. The employer should insure that his or her staff members are taught the necessary regulations to follow pertaining to the health records of the patients. Penalties for violations of HIPAA should also be discussed during the training so that the employees are made aware of the consequences he or she may suffer.

• After introducing HIPAA training to their staff members, continued training must be done regularly to keep up with changes in policies and regulations, etc. There are instances when HIPAA may undergo necessary alterations and improvements as for the betterment of the concerned entities, for example. Also distributing memos and newsletters regarding HIPAA info can help enforce the info, too.

• Adapt with today's modern technology.

Nowadays, files or records with health care providers and insurance companies are kept confidential in computer systems at the various businesses. Hence, the institutions are obliged to insure the safety of the information stored in the computers.

Passwords need to be established and changed on a regular basis, according to HIPAA policy. In addition, archived records and those in data backup and other storage, even offline, need to be secure. Security is very important because medical information may leaked to the wrong people. The health information of every patient must be kept private to avoid penalties due to violating HIPAA policy.

Staying Healthy: HIPAA Rules

The Department of Health and Human Sciences first issued the Health Insurance Portability and Accountability Act of 1996 or HIPAA to set national standards for the protection of patient health information. This law was designed to protect and control how private health information is used. The Office for Civil Rights has the responsibility to implement and enforce privacy rules that will include voluntary compliance with financial penalties.

Goals of HIPAA

An individuals' health information is highly private. There should be no dissemination of information to outside parties unless written permission is expressively given by the patient. This rule strives to provide a balance that permits information to be sent to necessary parties while at the same time promoting protection and security of the public's health and safety. The rule is flexible yet comprehensive and gives specific details as to what information can be sent to third parties.

HIPAA requires that entities (those who use health information) comply with the applicable requirements and rules. The summary of the HIPAA law is not a source of legal information, but the entire law or act needs to be read and studies to ensure that specific laws are followed.

HIPAA Coverage

HIPAA rules cover health plans or insurance companies and clearinghouses that move heath information to different third party providers. HIPAA definitely applies to the health care provider and other providers to meet the information needed treat a patient. Take note that HIPAA privacy coverage also covers health plans that are implemented by employment, government and church sponsored plans.

All individual and group plans that pay the cost of medical care are regulated by HIPAA rules and procedures. These include health and dental as well as vision and prescription drugs. Those organizations that are HMO, Medicare and Medicaid are also liable. In other words, every entity that handles private medical information is subject to HIPAA.

HIPAA is designed to protect individual medical records when entities use electronic technology to transmit medical records. Healthcare clearinghouses are those businesses that process nonstandard information and they are highly regulated under HIPAA rules. Clearinghouses are billing services, community health management systems and value-added systems that provide services to hospitals and clinics.

One very important medical entity is psychotherapy. The notes taken by a health care provider in regards to mental health are highly regulated. All professional documenting or analyzing during conversations with patients, family or groups are private and not to be disseminated unless specific permission is granted. All medications and monitoring plus counseling sessions and their start and stop times, the modalities of treatments that are furnished plus the results of clinical tests and the summary are not to be given to third parties. The only exception to this rule may be in the case of court ordered release to substantial a legal matter.

HIPAA does retain the right to modify the existing rules and procedures at any given time. There are updates issued on a regular basis. Currently there are a number of provisions of the HITECH Act that are designed to strengthen security issues for health information that are established in HIPAA.

For more information, please visit our hipaa training website.

Georgia Health Insurance - How to Select a Health Insurance Provider in Georgia

If you live in Georgia, and are looking for a new health insurance provider, there are some things that you should know, that will make your search easier. You need to think about your budget, and the types of health insurance coverage you need, in order to find the perfect provider and the best policy for you.

Of course, no one wants to choose a health insurance policy with a Georgia provider that has outrageous prices and a reputation for bad service. On the other hand, you don’t want to take the absolute cheapest policy you can find, as it may not provide you with the benefits that you need.

For example, not all health insurance policies offer prescription drug coverage, meaning that if you or someone in your family gets sick, you will have to either purchase your medications out of pocket, or use your health savings account, if you have one. Oftentimes, your medications are much more expensive than the actual doctor’s visit, so you need to keep this in mind. If you take daily prescription medications, you should really make certain that your health insurance policy has prescription coverage, or you could end up spending a bundle on your medications.

You also need to think about your deductible and your co-pays as well. As with most insurance policies, the higher the deductible you choose, typically the lower your premiums are, but you have to make certain you don’t cut yourself short here. For example, if you have children, they probably visit the doctor often, and if you choose a health insurance policy with a $750 deductible, you will either have to pay for all of their visits out of your pocket, or out of your health savings account, until that deductible has been met each year. If you can’t afford to do that, then you will be better off with a lower deductible. Likewise, you need to look for a health insurance provider that offers policies with low co-pays, as these can add up quickly as well. If you or someone in your family happens to need chiropractic care, typically you will go to the chiropractor three times a week, for at least the first month, and if you have a $20 co-pay or more, this can add up. You could be spending $240 in that first month just on co-pays, and the typical family today cannot afford to pay out that kind of money.

You also need to familiarize yourself with lifetime limits on the health insurance plans you are looking at, hospital and emergency coverage options, referrals, network providers, and the overall history and strength of the Georgia health insurance provider and health insurance policies you are considering. You could be risking your health, your family’s health, and your financial future here, so it is important to take your time, and choose the best Georgia health insurance provider for your needs.

Do you want to learn more about how to choose health insurance that is right for you? I have just completed my brand new guide titled ‘Don't Buy Insurance in Georgia Until You Read This. What the Insurance Industry Doesn't Want You to Know‘

5 Important Guidelines in Finding Affordable Health Insurance for the Self-Employed

The biggest problem of being self-employed is that you won't be able to get health insurance benefits unlike people who are employed in a big company. However, you can still find affordable ones online and enjoy the same benefits.

If you're working for yourself, it doesn't mean that you won't be able to enjoy the same benefits that go with working in a certain company and it doesn't also mean that you won't be able to find affordable health insurance. The coverage for these independent individuals may be quite costly but when you're equipped with a little knowledge, you can find the best and yet affordable ones online.

Listed below are effective ways on how to look for affordable health insurance if you are self-employed:

1. When shopping around for this particular type of insurance, always look for coverage with higher deductibles. These high deductible insurance plans are also called drastic or major medical plans and they usually have very low premiums.

2. If you visit a doctor regularly because of a chronic illness, then you might want to consider getting a full coverage insurance plan. This is a good option for independent workers. Full or regular coverage plan can be expensive, however, there are a lot of companies online that offer this type of coverage at inexpensive rates.

3. One good option is forming a small group of individuals. This group may be your business partner, members of your family, relatives, or your own employees, making the costs lower. Get some quotes online from reliable insurance companies.

4. Paying your premium yearly is another way for you to save money since companies give out big discounts when you pay all at once.

5. Get quotes and compare them to obtain affordable policies for unaffiliated individuals. The easiest way is still to look online. When doing so, always ask for quotes and take time to compare them with the quotes you get from other companies and see which company offers the best ones at cheaper rates.

For many people, finding the best and most affordable health insurance for a self-employed person is really a very difficult task since most policies are becoming too expensive. But with a lot of options available out there and a lot of companies offering the best deals, many unaffiliated persons or small business owners will enjoy the same health benefits as that of a regular company employee.

All About Affordable Health Insurance Plans

While consumers search for affordable health insurance, they have price in their mind as the top priority. A general conception among the consumers is that cheap health plans should not be costly-the cheapest health plan available in the market is their target. However, this approach is not good. Sometimes, paying for a cheap health insurance plan but still not getting the required level of coverage results only in wastage of money.

With the implementation of the affordable care act, the reach of affordable health plans is set to increase. Or at least, this is what is believed to be the objective of healthcare reforms. However, lots of consumers are still in confusion about how things would work. In this article, we will discuss some detailed options that consumers can try while looking to buy affordable health plans.

To get a hand on affordable health insurance plans, consumers need to take of certain things. First among them is about knowing the options in the particular state of the residence. There are lots of state and federal government-run programs that could be suitable for consumers. Knowing the options is pretty important. Next would be to understand the terms and conditions of all the programs and check the eligibility criteria for each one of them. Further, consumers should know their rights after the implementation of healthcare reforms, and something within a few days, they may qualify for a particular program or could be allowed to avail a particular health insurance plan. If consumers take care of these steps, there is no reason why consumers can't land on an affordable health plan that could cater to the medical care needs.

Let's discuss some options related to affordable health insurance plans state-wise:

State-run affordable health insurance programs in California

While considering California, there are three affordable health insurance plans that are run by the state government. Consumers can surely get benefitted by these if they are eligible for the benefits.

• Major Risk Medical Insurance Program (MRMIP)

This program is a very handy one offering limited health benefits to California residents. If consumers are unable to purchase health plans due to a preexisting medical condition, they can see if they qualify for this program and get benefits.

• Healthy Families Program

Healthy Families Program offers Californians with low cost health, dental, and vision coverage. This is mainly geared to children whose parents earn too much to qualify for public assistance. This program is administered by MRMIP.

• Access for Infants and Mothers Program (AIM)

Access for Infants and Mothers Program provides prenatal and preventive care for pregnant women having low income in California. It is administered by a five-person board that has established a comprehensive benefits package that includes both inpatient and outpatient care for program enrollees.

Some facts about affordable health insurance in Florida

While talking about affordable health insurance options in Florida, consumers can think about below mentioned options:

• Floridians who lost employer's group health insurance may qualify for COBRA continuation coverage in Florida. At the same time, Floridians, who lost group health insurance due to involuntary termination of employment occurring between September 1, 2008 and December 31, 2009 may qualify for a federal tax credit. This credit helps in paying COBRA or state continuation coverage premiums for up to nine months.

• Floridians who had been uninsured for 6 months may be eligible to buy a limited health benefit plan through Cover Florida.

• Florida Medicaid program can be tried by Floridians having low or modest household income. Through this program, pregnant women, families with children, medically needy, elderly, and disabled individuals may get help.

• Florida KidCare program can help the Floridian children under the age of 19 years and not eligible for Medicaid and currently uninsured or underinsured.

• A federal tax credit to help pay for new health coverage to Floridians who lost their health coverage but are receiving benefits from the Trade Adjustment Assistance (TAA) Program. This credit is called the Health Coverage Tax Credit (HCTC). At the same time, Floridians who are retirees and are aged 55-65 and are receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), may qualify for the HCTC.

Some facts about affordable health insurance in Virginia

While talking about affordable health insurance options in Virginia, consumers need to consider their rights:

• Virginians who lost their employer's group health insurance may apply for COBRA or state continuation coverage in Virginia.

• Virginians must note that they have the right to buy individual health plans from either Anthem Blue Cross Blue Shield or CareFirst Blue Cross Blue Shield.

• Virginia Medicaid program helps Virginians having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, and elderly and disabled individuals are helped.

• Family Access to Medical Insurance Security (FAMIS) helps Virginian children under the age of 18 years having no health insurance.

• In Virginia, the Every Woman's Life Program offers free breast and cervical cancer screening. Through this program, if women are diagnosed with cancer, they may be eligible for treatment through the Virginia Medicaid Program.

Some facts about affordable health insurance in Texas

While talking about affordable health insurance options in Texas, consumers need to consider their rights:

• Texans who have group insurance in Texas cannot be denied or limited in terms of coverage, nor can be required to pay more, because of the health status. Further, Texans having group health insurance can't have exclusion of pre-existing conditions.

• In Texas, insurers cannot drop Texans off coverage when they get sick. At the same time, Texans who lost their group health insurance but are HIPAA eligible may apply for COBRA or state continuation coverage in Texas.

• Texas Medicaid program helps Texans having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, elderly and disabled individuals are helped. At the same time, if a woman is diagnosed with breast or cervical cancer, she may be eligible for medical care through Medicaid.

• The Texas Children's Health Insurance Program (CHIP) offers subsidized health coverage for certain uninsured children. Further children in Texas can stay in their parent's health insurance policy as dependents till the age of 26 years. This clause has been implemented by the healthcare reforms.

• The Texas Breast and Cervical Cancer Control program offers free cancer screening for qualified residents. If a woman is diagnosed with breast or cervical cancer through this program, she may qualify for medical care through Medicaid.

Like this, consumers need to consider state-wise options when they search for affordable health coverage. It goes without saying that shopping around and getting oneself well-equipped with necessary information is pretty much important to make sure consumers have the right kind of health plans.

A New Efficient and Cost-Effective "Gatekeeper" Model For Containing Health Insurance and Care Costs

With Health Insurance and Healthcare costs continuing to skyrocket and access to trained Doctors decreasing, something needs to change. The current system is expensive, wasteful, and inefficient. We are proposing a new Gatekeeper Model that will provide Employees greater access to Doctors at a fraction of the cost with far better outcomes.

The Traditional Gatekeeper Model for Healthcare?

What was the traditional Healthcare Gatekeeper Model? The Alliance for Health Reform guidebook defines the gatekeeper/care manager as a "Health Care professional, usually a primary care physician, who coordinates, manages, and authorizes all health services provided to a person covered by certain types of health plans. Unless an emergency exists, the gatekeeper generally must pre-authorize referrals to specialists, hospitalizations and lab and radiology tests."

Unfortunately this system was often plagued by redundancies inefficiencies, and added - not reduced - costs. It has become more and more difficult to gain a Doctor appointment and the emergency rooms are overrun. Under this system - and the other traditional norms for bringing those in actual need of care together with physicians - there is a tremendous waste of time and money!

A few vital statistics!

70% of Doctor's Office Visits are Unnecessary

55% of ER Visits are Unnecessary

41% of ER visits are unnecessary because the Patient could not Get a Doctor's Appointment

51% of Ambulance utilizations are unnecessary

The existing norms obviously have problems. The difficulties in gaining an appointment with a Doctor are growing. PPACA/Obamacare will make this a bigger problem. Millions of people will have new found access to health insurance and will expect access to Doctors. The old system was already dysfunctional and now will be more stained.

The new Gatekeeper Model!

Utilizing Telemedicine as the Gatekeeper to bring people quickly and efficiently together with Doctors. This will remove the Barriers between Employees and Doctors for determining the best course of medical action. Telemedicine is not new! There are a number of Vendor/Providers. Each provides a different level of service and different cost structure. Most would not qualify as a Gatekeeper! I'll qualify the requirements below.

The Telemedicine/Gatekeeper Model is new! When the Employee or Family Member Calls the Doctor First - utilizing the Telemedicine Plan - they immediately access an emergency trained doctor who assists them with their medical need, coordinates, manages, and authorizes all health services required as part of their Employer's Health Plan. The Gatekeeper Doctor authorizes the referral to a specialist, hospital, urgent care facility or lab for tests if needed.

Let's look at how Telemedicine could be utilized as the Gatekeeper.

What must the Telemedicine Plan Provider/Gatekeeper be capable of providing based on the Plan Providers history and their Telemedicine Plan Design?

• A case specific ROI Calculator to show the Employer, CFO, TPA, etc. the value of implementing and supporting the model.
• Immediate access to emergency room trained US doctors - no messaging or call backs.
• Accepts emergency and non-emergency calls.
• The ability to direct the caller to Emergency Rooms or Specialists care if medically required.
• The ability to prescribe needed pharmaceuticals as required based on a health history when the person joined the plan.
• A doctor's prescription medical kit - in the possession of the member - providing the proper tools to administer what the doctor directs over the phone while the member is heading to their doctor's office, urgent care center, or resting where they are.
• Follow-up with the member after diagnosis and treatment to ascertain if there are additional needs.
• A focus on lowering health Plan utilization costs while encouraging the use of the Telemedicine System and their trained Doctors.
• A flat, affordable monthly fee for the Telemedicine Plan that includes the cost of the doctor's medical kit.
• The Telemedicine Plan must be affordable and yet have a depth of services required to encourage Employees to Call the Gatekeeper Doctor First reducing unnecessary utilization of the core healthcare plan.
• No extra fees or charges for usage by the participants or their family members.
• The Telemedicine Plan must be: (1) a qualified health deduction for the Employer, (2) qualified under Section 125 for the Employees to pre-tax a contribution to the Plan, and (3) HRA/HSA qualified.
• The Telemedicine Plan must provide assistance to the Broker and Employer for implementing the Plan and Educating the Employees about Calling the Doctor First and utilizing the Plan as the Gatekeeper.

The above merely describes what features the Telemedicine Gatekeeper must provide the Employer and Employees to reduce costs while increasing Doctor access.

Now let's look at what the Employer, Broker, and Telemedicine Provider (and possibly the TPA) need to accomplish when establishing the Telemedicine Plan as a Gatekeeper:

1. Determine the Employer's specific ROI for implementing the Telemedicine/Gatekeeper Plan.
2. Determine who will pay for the cost for the Telemedicine Plan - optimal ROI will be achieved if the Employer pays for the plan and all Employees and their Families are on the Plan.
3. Create an Employee Benefit Plan Design that requires the Employees and their Family Members to Call the Doctor First (unless there is an absolute emergency) to begin the process of diagnosis and how to proceed with medical care.
4. Include in the Employee Benefit Plan Design an added cost for Doctor visits if the Employee or Family Member does not Call the Doctor First - much like going out-of-network charges. This will help Encourage Plan and Gatekeeper Utilization, Provide Better Employee Care, and Increase ROI.
5. Create a systematic program - including Owners, Executives, the CFO, etc. - for Educating Managers and Employees about the Plan, Timelines for Implementation, Effective Dates for Coverage, and Proper Utilization of the Telemedicine/Gatekeeper Plan.
6. The Owners, Managers, and CFO must be involved in monitoring the Gatekeeper Plan to encourage Plan Utilization by Employees and in reducing unnecessary Core Benefit Plan Utilization.

Five steps to implementing a Telemedicine/Gatekeeper Plan!

• Work through an ROI Calculator to establish the Potential Savings
• Carefully Select a Qualified Telemedicine/Gatekeeper Provider
• Make Simple Changes to the Employee Benefit Plan Design
• Put the Plan in place now for the Fall Enrollment and the 2014 Effective Date
• Educate the Employees and their Families about the Value of the Plan; and explain the "Gatekeeper" function
• As an Employer or Broker/Trusted Advisor, the Employer, and the Employees/Families will experience an enhanced, cost-saving, Plan with Greater access to trained physicians

What's Next - (1) As an Employer (2) as a Broker

1) Employers -- Use the ROI Calculator! Whether you are Self-Funded or Fully Insured, contact us to utilize the ROI Calculator - there's No Cost. You can see the value of moving forward with a Telemedicine Plan and even better - utilizing the Plan as a Gatekeeper. You can: (a) Substantially Reduce Health Plan Costs, (b) Reduce Unnecessary Doctor and Emergency Room Visits, (c) Dramatically Improve Employee Access to Healthcare Professionals, (d) Reduce Lost Employee Work Time and Absenteeism. Employers have realized triple digit returns on their investment during the first 12 months.

2) Brokers - Use the ROI Calculator and see what it would do for your Clients. (a) You can save your Current and Potential Clients substantial Dollars (b) Improve the Employees and their Families Health Care, (c) Gain Employees and their Families immediate access to Emergency Trained Professionals, (d) Retain and Attract Employer and Individual Clients. Employers have realized triple digit returns on their investment during the first 12 months.