Wanita hamil curah air panas ke muka bekas suami yang merogolnya
Seorang
wanita hamil bertindak mencurah air panas di muka bekas suaminya yang 'ganas'
selepas dia diculik dan dirogol.
Media
tempatan melaporkan mangsa, yang tidak dinamakan, berusia 20 tahun, diculik
dari rumahnya oleh suspek yang merupakan bekas suaminya, juga berusia 20 tahun
dengan bantuan abang mangsa dan seorang wanita.
Gambar-gambar
telah diambil oleh polis di bandar Eldorado di negeri selatan Brazil.
Ibu
mertua mangsa dan jiran-jiran dilaporkan melihat mangsa dibelasah di dalam
kereta yang kemudian dipandu laju meninggalkan tempat kejadian.
Wanita
itu, yang sedang hamil empat bulan dilaporkan hilang dan pihak polis
menjumpainya keesokan hari di sebuah rumah di mana dia dikurung oleh suspek
yang menyiksanya di dalam bilik dan berulang kali merogolnya, menurut polis.
Suspek
dikatakan mengaku melakukan jenayah kepada pihak polis dan memberitahu bahawa
mangsa, ketika dia sedang leka, telah mengambil peluang mencurah air mendidih
ke atas mukanya.
Source
: The reporter
Best
Health Insurance Company
There
are so many moving parts when it comes to picking the best health insurance
that it’s hard to know where to turn. However, one thing to keep in mind when
you’re building a list of health insurance companies is your desired level of
coverage: What do you need covered and what’s your budget? In order to help you
find the top health insurance companies in your area, we’ve put together this
tool.
Because
there is no “best” health insurance company for everyone, I’ll instead focus on
finding the best provider and plan for you. I’ll discuss how geography affects
your choice of health insurance and briefly mention companies that have a good
reputation for customer satisfaction.
I’ll
also cover how different types of health plans operate, what major medical
plans must include, and special considerations that may apply when you’re
shopping.
How
Geography Affects Your Health Insurance Choices
The
reality of the U.S. health insurance industry means you may not have much latitude
to choose your provider. How much choice you have almost entirely depends on
where you live.
Generally,
if you’re in a big city in a densely populated state, a good number of insurers
will be competing for your business. But in some rural areas, there may be a
single dominant insurer. In fact, in 2010, a single insurer had gobbled up more
than half the market for individual health care plans in 30 states, according
to the Kaiser Family Foundation.
For
example, if I lived in New York City and needed individual medical coverage, I
could choose from more than 150 plans from at least a dozen health insurance
companies on that state’s health insurance exchange. If I lived in Wheeling,
W.Va., I could choose from 14 plans on the federal health exchange (used by
many states, including West Virginia), all provided by a single insurer: Blue
Cross Blue Shield.
The
ACA aims to stimulate more competition across the country, and there are signs
that’s happening in some small measure. In 2015, 86% of eligible individuals
were able to choose from at least three insurers on the federal health
exchange, an increase from 70% in 2014.
Still,
that’s not the case in some parts of the country, where the best health
insurance company for you may be the only one that will take your business.
Aetna’s bid to acquire Humana and Anthem’s bid to buy Cigna could also
significantly shrink choices nationwide.
Can
health insurance ‘drop’ you?
This
is a commonly asked question and a contentious issue in our current political
climate. As it currently stands as of the updating of this article, the current
Health Care Reform guidelines prevent insurers from dropping clients who are
sick or seriously ill. They also stop health insurance providers from setting
lifetime financial limits on benefits.
Best
Health Insurance Companies for Customer Satisfaction
If
you’re lucky enough to live in an area with a lot of top health insurance
companies offering competitively priced plans, you may be able to factor in an
insurer’s reputation for providing satisfactory service. Be careful not to put
too much stock in individual reviews of health care companies, however. They
are highly dependent on very personal circumstances, and they are
overwhelmingly negative across the board.
There
are a few resources that allow you to get a wider, more reliable snapshot of
the top health insurance companies. J.D. Power’s 2015 Member Health Plan Study
ranks several providers by U.S. region. Insurers that come out at or near the
top in several states include the Kaiser Foundation Health Plan and Blue Cross
Blue Shield. (Be sure to check your specific region, as the same insurers that
are in the top in some states may rank at the bottom in other states.)
In
Insure.com’s 2014 customer satisfaction ratings, Kaiser Permanente (parent
company of Kaiser Foundation Health Plan) comes out on top, followed by Humana,
Blue Cross and Blue Shield of Florida, and UnitedHealthcare.
You
may also obtain rankings for certain plans via Consumer Reports, which obtains
data from the National Committee for Quality Assurance. You can search for
plans in your area by selecting plan type (HMO, PPO, Medicare, or Medicaid) and
your state.
Best
Health Insurance Companies by Region
The
following data come from J.D. Power’s 2015 Member Health Plan Study, which
examined more than 31,000 plan members’ satisfaction with coverage and
benefits; provider choice; information and communication; claims processing;
cost; and customer service.
Finding
the Best Health Insurance Plan for You
If
you’re in an area with limited choices or your preferred providers are too
expensive, it’s still possible to zero in on a plan that will work for you,
regardless of company. To do so, you’ll need to understand what types of plans
are out there, what kind of coverage is already included in major medical
health insurance plans, and whether you have special considerations that will
affect your decision.
If
your budget is the major driving force behind your decision, be sure to check
out How to Find Affordable Health Insurance in 2016.You’ll find a more detailed
discussion of the shopping process and how to find the most affordable plan you
can without skimping on coverage.
Selecting
the right plan type
One
major factor to consider is the type of health care plan that makes sense for
you. But keep in mind that your location will also affect how much choice you
have regarding plan types, just like it does with providers.
Whatever
plan type you choose, note that the ACA has made lifetime and annual benefit
caps illegal. That means that, with the exception of non-ACA-regulated
short-term health plans, you will no longer be on the hook for all of your
costs after going over a certain dollar amount during a certain time period — a
massive benefit for anyone with health conditions that require extensive,
high-dollar care.
All
plans will also include an out-of-pocket maximum that limits the amount you
have to pay each year before your insurance will cover 100% of your remaining
costs. The ACA requires all deductibles, coinsurance, copayments, or similar
charges to go toward this limit; however, your premiums and any spending on
non-essential health benefits are among charges that don’t count toward the
limit. For 2017, individuals’ out-of-pocket maximums are capped at $7,150 on
the federal marketplace, and family plan maximums are capped at $14,300.
HMO
HMOs
(health management organizations) may be the most infamous type of health
insurance plan. This is likely because they’re the most restrictive. With an
HMO, you must receive your care within your HMO’s provider network, and you
must go through your primary care physician for a referral if you need to see a
specialist. If you receive care out of your network, you could be on the hook
for the entire bill except in the case of an emergency.
Cost
management is the main goal, and advantage, of going with an HMO. HMOs are more
likely to charge flat copays instead of coinsurance. This means you could pay
anywhere from roughly $5 to $25 each time you need any kind of medical care or
prescription. However, you probably won’t have to pay a deductible before your
insurance kicks in every year — these can average $250 to $500 for individuals
or families, respectively, but may cost even $1,000 or more if you opt for a
plan with lower monthly premiums.
The
lack of deductible can make HMOs a good choice if you’re on a tight budget and
live in a city with abundant quality medical facilities, especially if you’re
relatively healthy and don’t need a lot of care from year to year. An HMO can also
be a good choice if you know you’ll need a greater degree of routine care (such
as for pregnancy) and all of your providers are available in network. However,
if you know you’ll need a lot of specialized care, you might find an HMO
frustratingly limiting — and very expensive if you suddenly need to go outside
of your network.
PPO
PPOs
(preferred provider organizations) give you much more latitude to choose your
health providers. You don’t need to go through a single primary-care physician
to receive a referral. Though you still pay less if you stay in your PPO
network, you probably won’t have to pay the whole bill if you decide to go out
of network. If you want to shop around for doctors or have a condition that
demands specialized care, a PPO could be your best bet.
While
lower costs are the main pro of an HMO, higher costs are the main con of a PPO.
You’ll need to pay your deductible before your insurance kicks in. As I
mentioned above, that can be as little as a couple hundred dollars a year, or
more than $1,000 if you opted for a plan with a lower monthly premium.
Your
out-of-pocket costs don’t stop there: You’ll pay coinsurance for certain
services instead of a flat copay. That could be roughly 10% for in-network
services and as much as 40% for out-of-network care. If you go out of network,
you may have to pay your bill upfront and then file for reimbursement, a
potentially lengthy and frustrating process.
Ultimately,
PPOs are usually the best choice for anyone who prizes flexibility over cost
savings. If you have a complicated medical history and may need to see
specialists, particularly out of network, a PPO can actually save you money
over a more restrictive HMO. In general, however, you’ll probably pay a bit
more out of pocket to have a greater degree of choice and control over your
care with a PPO.
Hybrid
plans: POS plans and EPOs
POS
(point of service) plans aim to blend the characteristics of HMOs and PPOs.
You’ll need to go through a primary-care physician for referrals, much like an
HMO. However, a POS plan also allows you to receive care outside your network
like a PPO.
A
POS plan could be right for you if you really like your primary physician and
don’t mind routing your care through him, but want to keep out-of-network
flexibility. Costs tend to fall in between those of HMOs, which are on the
cheaper end, and PPOs, which are more expensive.
EPOs
(exclusive provider organizations) are the least common plan type. They’re also
a blend of PPOs and HMOs. Like HMOs, you must receive care within your network.
But like PPOs, you won’t need to go through your primary care physician to get
a referral. However, you may need to get preauthorization for more expensive
services.
EPOs
may be a good choice if you expect to stay in network but don’t want to deal
with referral paperwork. Costs also tend to be in the middle between HMOs and
PPOs.
Short-term
health plans
Unlike
the other four plans on this list, short-term health plans are not major
medical plans. They are inexpensive, stopgap plans meant to hedge against
catastrophic health disasters, maybe while you’re between jobs or because you
are shopping outside of open enrollment. Your deductible will likely be very
high.
The
major pro here is that short-term plans are the cheapest plans you can get. But
ACA regulations don’t apply to short-term health plans, which are the only ones
for sale when it isn’t open enrollment.
Buyer
beware: These plans are not required to provide benefits such as preventive
care, and there will be a cap on benefits — this is no longer allowed for major
medical plans. You may not even qualify if you have pre-existing health
conditions, which other health plans must accommodate under the ACA.
Ultimately,
we don’t recommend short-term health plans unless you are young, healthy, and
need coverage to hedge against the high cost of emergency care simply because
you missed open enrollment. Otherwise, the fine print and exclusions on these
plans make them a very flimsy substitute for major medical insurance.
Essential
health benefits
One
of the major requirements of the ACA is that all major medical insurance plans
you can purchase as an individual (excluding short-term health insurance,
discussed above) must cover a set of 10 essential health benefits. These
benefits apply regardless of whether you buy your plan through a state or
federal health exchange, from an insurance broker, or directly from an
insurance company. They are as follows:
Ambulatory (outpatient) care: This is care
you receive on an outpatient basis — that is, without getting admitted to a
hospital. It includes standard doctor’s office appointments and in-home health
visits.
Emergency care: This includes any care you
receive for a potentially debilitating or fatal condition. Ambulance and
emergency-room treatment are common examples.
Hospital care: Any care you receive as a
patient at a hospital or skilled nursing facility is covered. This includes lab
work, surgery, medications, and any other treatment you receive as a patient.
Laboratory services: Tests necessary to
diagnose, monitor, or rule out certain conditions are covered.
Maternal health and newborn care: This
includes all prenatal care for expectant mothers, as well as labor, delivery,
postnatal care, and newborn care.
Mental health care and addiction treatment:
Whether inpatient or outpatient, this includes any care necessary to diagnose,
monitor, or treat mental illness or addiction. Some plans limit treatment to a
certain number of days.
Pediatric services: This includes all care
provided to children, including yearly checkups, vaccinations, dental care, and
vision care.
Prescriptions: Plans must cover at least
one medication in every federal category and class of prescription drugs.
Insurers still have preferred-drug lists and may require generics over
name-brand drugs, among other restrictions.
Preventive care: This includes physicals,
screenings, immunizations and other services meant to prevent or detect illness
or other conditions, as well as the management of chronic conditions.
Rehabilitative and habilitative care: These
services help you gain or regain abilities limited or lost to or limited by
injuries, illness, or other conditions. Examples might include physical
therapy, occupational therapy, and speech therapy. Some plans limit treatment
to a certain number of sessions a year.
Will
health insurance cover oral surgery?
Typically,
your health insurance policy may cover oral surgery if it is deemed medically
necessary. This could include dental care from a severe mouth injury or certain
diseases. If your needs are deemed more cosmetic in nature, then your health
insurance provider might not be able to help.
Special
considerations: Looking beyond essential benefits
While
the list of essential health benefits seems exhaustive, there are still a
number of factors that can affect your coverage depending on where you live and
which provider and plan you choose. For these issues, it’s especially important
to read the fine print to see what’s covered when you’re shopping for a plan.
Staying
in network
If
you have an existing relationship with a certain health care provider and want
to maintain it, never assume that provider will be in network on your new plan.
Likewise, if you don’t want to be restricted to a small number of providers or
certain hospitals, you’ll need to shop carefully. For instance, all doctors at
a certain hospital (or even within a certain practice) may not be members of
the same insurance networks.
Experts
say many insurers are cutting costs by narrowing their provider networks. While
this might be a good thing if you don’t need much care and want to save money,
it increases the chances that you’ll have to pay steep out-of-pocket costs for
out-of-network care.
Prescription
drugs
Yes,
prescription drugs must be covered under the ACA, as noted above. But there’s
no guarantee that the specific drugs you take will be covered, and what you’ll
pay still varies by plan.
If
you take certain medications, you’ll want to check a potential plan’s
preferred-drug list, or formulary, to see whether it’s covered. This
information is typically available on an insurer’s website. If your drug isn’t
covered, your doctor can help you request it by explaining how it’s necessary
for your treatment, but the process may not be a quick one, and there are no
guarantees.
If
you know you’ll need prescriptions filled regularly, you’ll also want to pay
attention to cost. Your plan will likely require either coinsurance or a copay
for prescriptions. Coinsurance means you pay a certain percentage of each
drug’s cost (around 30% is typical). If you have a copay, you’ll pay a certain
fixed amount (usually $10-$30) when you need a prescription, but it’s
independent of the drug’s price. That usually makes copays a better bet if you
know the drugs you take are expensive.
Mental
health coverage
Again,
some mental health care is required in every major medical plan. But beyond
that, what kind of services are covered can vary tremendously by state.
If
you have a specific need, you’ll need to wade into the fine print of a plan’s
benefits summary to determine whether you’ll be covered. And if you want to see
a specific provider, such as a certain therapist or psychiatrist, you’ll need
to make sure he or she is in your network. It’s not uncommon for psychiatrists
to refuse joining insurance networks to manage high demand and combat low
reimbursements compared with other services.
Rehabilitative
and habilitative care
Like
mental health care, rehabilitative and habilitative care is more of a gray area
for insurers. Even though some coverage is required, what’s covered and the
limits on that coverage will vary by state and by plan.
Experts
say those with chronic conditions need to pay especially close attention to the
fine print. Because treatment tends to be more expensive, insurers have greater
incentive to cap these benefits or skip them entirely. So while your physical
therapy for a back injury may be entirely covered, speech therapy for your
autistic child may not be.
The
bottom line
Shopping
through the best health insurance companies is a complex process, but well
worth it in the end. You might need to look into multiple providers and review
their policy prices before you find one that matches your needs. Another thing
to consider is the company’s online reputation as well as customer support.
This can be a huge indicator in how your experience might turn out.
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