Improving our health is always a topic for Texans and all Americans. Even if you are in “good shape” you have things you want to improve. The old Diet and Exercise combo is one of the most popular new year resolutions that a lot of people work on.   Most people could stand to “lose a few pounds”,  through  more exercise and  examining  our eating habits to find ways to live by doing what’s  right for ”our body”.

I do not work for the HEB Grocery Store  but I have noticed some ad’s they ran on diet and exercise.  The  web site to find some good information is  Healthy at HEB.  HEB has stores in most parts of Texas and I think the web site offers some good general info on the whole topic of diet and exercise.  They are not by a long shot the only resource, but they are a resource that most Texans can relate to.

I have enjoyed some 30 minute monthly health webinars presented by Kelsey Seybold.  Please note that they are hosted live, usually on the first Wednesday of each month, but there is also an archive of past webinars available on their website.

The other “Resolution”  topic I will touch on is financial.

That is to review  your bank accounts, investments  including  stocks and mutual funds (IRAs,  401Ks and other qualified accounts) and taxable investments.

Look at your home situation whether you own or rent and see what is best for you.

The topic that is relevant to this web site is to look at the insurance you now have  and determine whether or not you  have the right “risk protection”.

Start with a look at your health insurance.   I believe all prudent people should have health protection, and like all insurance,  you must have the right coverage before you need it.

Then move on to to the broad topic,  your personal  risk protection (this would be life insurance, disability, Long Term Care Insurance (LTCi) and other forms of risk protection.)

If you do not work with an insurance professional and would like to look at the options you have and talk about other possible options then please contact me.

All the best for 2012 and I hope it is a good year for Texans and all Americans in this national election year.

This is scheduled to go into effect on January 1 2012 and, for the most part will impact Medicare .  ACOs  from what I can see look like  HMOs but will be different.  HMOs, however, can be ACOs.

The Houston area  Kelsey’s Seybold Doctor Group and their association with St. Luke’s Hospital is a form of ACO.

ACOs are the latest model for delivering  medical services by offering doctors and hospitals financial incentives to provide quality care to Medicare beneficiaries while keeping down costs.

I have fielded questions on this acronym and wanted to put up some information on this on the website. I have also provided the following two links to what I think are reliable news sites with an explanation of ACOs.

See

NPR  from 01/18/2011 on ACOs
And
Kaiser Health News from 10/21/2011 on ACOs

The recent big news on brand-named drugs vs. generic’s is the story on Lipitor.
Lipitor, which became available in 1997 and generated annual sales of $13 billion at its peak, and did 10.7 billion in sales in 2010 from a wsj report, reduces “bad” LDL cholesterol and the risk of heart attack and stroke. It loses U.S. patent protection on 11-30-2011.

As cholesterol fighter Lipitor goes generic, its maker Pfizer Inc. is hoping to hold onto perhaps thirty percent of the 3 million Americans who take the biggest-selling drug of all time.

In health insurance coverage whether individual or group, the Rx or prescription drug part of the coverage is an important part of the insurance protection.  Drugs can be very expensive and very necessary for medical treatment given by a person’s doctor.

Drug coverage that has a copay for prescription drugs is usually tiered. Generic,  brand-name , and non preferred brand or formulary are the most common three tiers.

The lowest co-pay is for generic drugs and today most major drug retailers even have a loyalty card to give people  decent access to low cost generic drugs. This is a big help for people without insurance.  These programs are, OK in my opinion, but are actually a tool of the retailer and give  effective access  for generic drugs ONLY.

Consumer Driven Health Plans (CDHP) are in most cased also Qualified High Deductible Health Plans (QHDP) that are eligible for Health Savings Accounts (HSA).

These plans do not have the separate (embedded) individual deductible per person like conventional PPO plans. In most cases these high deductible plans have an aggregate deductible. This means that the deductible for all persons covered on the plan must be met before any other benefit is paid by the insurance.

To spell it out,  these plans have no co pay amounts for doctor visits or filling prescriptions. The insured pays the full negotiated rate the insurance company has set and this amount is counted towards your deductible for the year.

That is to say a preferred provider organization or PPO plan has co-pays for going to the doctor and using the pharmacy etc. verses high deductible plans that do not have these immediate benefits.

Plans that only cover one person are not affected by “aggregate” family deductibles.

When considering Health Insurance plans that cover more than one person, make sure to  take a close look whether their health plan will require their family to meet the full family deductible before benefits are payable.

When given a choice, “embedded” deductibles provide better coverage for those covering dependents assuming all other benefits are the same.

An important distinction needs to be made concerning how deductibles are computed for qualified high-deductible health plans, including Health Savings Account (HSA) type coverage.

The family deductible is an aggregate or combined deductible.  Each person’s covered medical expenses go toward meeting the family deductible.  Each insured person’s covered medical expenses go toward meeting this amount.

Once the family deductible is met, most plans will cover 100% of all allowable expenses for the entire family. Therefore, any other covered expense you have done that year, will be paid for by the insurance company.

Compare this to a traditional copay plan where three of the insured persons EACH have their own deductible that must be met.  It is much more difficult to have each person meet their deductible than it is to meet an aggregate deductible.

When I present Consumer Driven Health Plans, I prefer to first show the so-called deductible and then, 100% plans which offer great coverage and are easier to understand.

Let me say again that most Qualified High Deductible Health Plans (QHDP) eligible for Health Savings Accounts (HSA) do not have the separate (embedded) individual deductible per person like conventional PPO plans.  This is an important detail when covering more than one person on these types of plans. High deductible plans are gaining in popularity and will continue to do so if pricing for this coverage makes more economic sense.

The following is a list of other terms that come into play when writing on this subject:

Consumer Driven Health Plan (CDHP)
Qualified High Deductible Health Plan (QHDP)
Health Savings Accounts (HSA)
Flexible Spending Account (FSA)
Health Reimbursement Account (HRA)

Therefore, any other covered expense you have done that year, will be paid for by the insurance company.  Compare this to a traditional copay plan where three of the insured persons EACH have their own deductible that must be met.  It is much more difficult to have each person meet their deductible than it is to meet an aggregate deductible.

Saving money is the first lesson most people started out learning as a child and it continues on through a person’s entire life.  That is to say the learning and I hope the saving for tomorrow, planned and the unexpected, should be a ongoing process.

The simple lesson of savings is to live below your means vs. above.

I did see a good tool that illustrates savings in the NYTimes.com.  In short this tool shows the power of compounding and that saving more early in a time period or a live will pay off.

Life insurance should be part of a long term savings and accumulation plan for a person and especially their family.  Insurance in general and life insurance in particular should be thought of and used when you have a risk or a thing you want to protect.

This could be a business – corporation – partners, or more important the people you love like children and spouses.

I like to work with people to help them protect the gains from the  hard work they have done and will do. And so try to  help them work smart. People and  situations are unique so there are not  standard answers that will  work for all people.

You  might consider the need to find  professional’s ( Stock Market investments – Banking – Insurance – Real Estate and etc) to work with. Then you have a person to talk with who can help you make a plan.  Then review the plan every so often  so if needed you can change “your plan”.

If you would like to talk to someone about personal insurance protection and  see if one of the people in our office could be right to work with,  then give a call or send a email so we can start a conversation and then, create a plan.

NPR radio:

Saving for retirement: how much do you need?

Plans may have both per individual and family deductibles.

Some plans may have separate deductibles for specific services. For example, a plan may have a prescription drug plan that has a deductible for all Rx except for generic drug prescriptions, or a hospitalization deductible per admission.

Deductibles may differ if services are received from an approved provider as opposed to a provider not on the approved list.

The most common type of deductible for basic medical expense and major medical contracts is the calendar-year deductible, which is the amount that must be paid by the insured in a calendar year before the insurance company pays anything. This scenario is for what is termed a 100% plan. After the insured has paid the deductible for the year, then the insurance company pays everything for the rest of year. This is basically the same as the aggregate deductible in commercial insurance policies.

In a plan with a deductible amount and co-insurance the covered person must pay the deductible amount then the covered party and the insurance company are in the “co-insurance” part where they share the cost. A typical plan has co-insurance 80% -20% for a fixed dollar amount. I have created an Excel spread sheet to help people see the numbers that make up deductible and co-insurance for a health insurance plan.

For more information on health insurance deductibles, copays, co-insurance and maximums, check out this video on YouTube.

So far I have only seen one family that I thought was over insured or, in other words, had  too much life insurance. That, however, is very very rare.  And yes I did indicate that I thought they had more than enough life insurance and alas I did not sell them any more.

Surveys point out that there is a growing number of families in the United States that are under insured or do not have any life insurance.  In just the last 6 years the survey points out that there are over 10 Million more households that do not have any life insurance.

Take some time to think about you and your loved ones and contact your insurance professional if you know and or work with one. If you do not work with an Insurance professional and would like to talk,  please contact me and my office.

The following video illustrates a real life situation from Texas and shows that there are ways to get life insurance at work as well as going it alone by working with a life insurance professional. This story shows the twist of life and the importance of “planning.”

In addition see great pics of the most important people in my life, and then create your own slideshow in 3 easy steps.

On the above web page you will find tools to help you think about life insurance that are not from any one life insurance company. Give it some thought and feel free to call  me for further discussion or call the insurance professional you work with to make sure all your bases are covered.

In closing I will say that a majority of families either have no life insurance or not enough, leaving them one accident or terminal illness away from a financial catastrophe for their loved ones.

They are responsible for calculating premiums, developing plans and defining underwriting risk.

A person who is an actuary by training or collage degree can work as an insurance company “underwriter”. This is the person that evaluates the risk in taking on a new policy for the insurance company. This person also sets the rate of the premium to be paid for the risk class that the applicant is eligible for.

The premium will be set for the specific duration period the policy is set to have.

For  most health insurance policies the premium is set for 12 months and then re-evaluated and priced out.

For life insurance: Term the premium is usually set for the “term” of the policy (10-20-30 year term policy).

For permanent life insurance ((WL) Whole or (UL) Universal Life) the premium is set for the life of the policy or for a set payment period.

Contact your insurance professional if you have more questions and if you do not have and insurance person you work with then give us a call or email and we would be happy to help you.

How is it calculated and what use is it to me and Insurance companies?

BMI is a number based on a person’s weight and height that provides a way to estimate the effect of weight on health. The higher the BMI, the greater the risk of diseases such as high blood pressure, coronary artery disease, stroke, osteoarthritis, some cancers, and type 2 diabetes.

Body Mass Index is a number from 10-50 and is calculated by dividing a person’s height in inches by 703 by weight in lbs. squared.   This is rated on  an  age with gender (Male / Female) scale.

This is the most basic thing that insurance companies use to grade or underwrite a person or applicant. BMI not only comes into play when insuring a person, but for your own self preservation and the ones you love you should look at this and work to keep oneself in a good range.

Each person “lifestyle” can influence your personal health and well being. That is how we live. To be more precise what we eat, how much exercise we do or do-not get and how much proper rest we get. Also all other things we put into our body can and do have an effect

If you work with a doctor or physician, then ask about  this topic and your weight in particular. If you do not see a medical professional on a regular basis, I encourage you to do so. With early detection of any problem, you may be able to make an easy choice verses late detection where your choices may be limited.  I am all for giving you and me choice.

The first goal, as I see it, is to keep your weight in a stable range. Then if like me you are a little over weight, set a goal with the help of a Doctor, your local gym or a friend to make a change for yourself and the ones you love.

BMI Calculators

I like this BMI Calculator created by   Steven B. Halls, MD (in Canada) and you can use  English or metric measurements.  He gives you two reference scales to  grade your BMI on.

WebMD’s BMI-plus Calc is a nice tool as well.