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[personal profile] siderea
Canonical link: https://siderea.dreamwidth.org/1890011.html

This is part of Understanding Health Insurance





Health Insurance is a Contract



What we call health insurance is a contract. When you get health insurance, you (or somebody on your behalf) are agreeing to a contract with a health insurance company – a contract where they agree to do certain things for you in exchange for money. So a health insurance plan is a contract between the insurance company and the customer (you).

For simplicity, I will use the term health plan to mean the actual contract – the specific health insurance product – you get from a health insurance company. (It sounds less weird than saying "an insurance" and is shorter to type than "a health insurance plan".)

One of the things this clarifies is that one health insurance company can have a bunch of different contracts (health plans) to sell. This is the same as how you may have more than one internet company that could sell you an internet connection to your home, and each of those internet companies might have several different package deals they offer with different prices and terms. In exactly that way, there are multiple different health insurance companies, and they each can sell multiple different health plans with different prices and terms.

Read more... [7,130 words] )

This post brought to you by the 220 readers who funded my writing it – thank you all so much! You can see who they are at my Patreon page. If you're not one of them, and would be willing to chip in so I can write more things like this, please do so there.

Please leave comments on the Comment Catcher comment, instead of the main body of the post – unless you are commenting to get a copy of the post sent to you in email through the notification system, then go ahead and comment on it directly. Thanks!
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[personal profile] siderea
Canonical link: https://siderea.dreamwidth.org/1889543.html


Preface: I had hoped to get this out in a more timely manner, but was hindered by technical difficulties with my arms, which have now been resolved. This is a serial about health insurance in the US from the consumer's point of view, of potential use for people still dealing with open enrollment, which we are coming up on the end of imminently. For everyone else dealing with the US health insurance system, such as it is, perhaps it will be useful to you in the future.





Understanding Health Insurance:
Introduction



Health insurance in the US is hard to understand. It just is. If you find it confusing and bewildering, as well as infuriating, it's not just you.

I think that one of the reasons it's hard to understand has to do with how definitions work.

Part of the reason why health insurance is so confusing is all the insurance industry jargon that is used. Unfortunately, there's no way around that jargon. We all are stuck having to learn what all these strange terms mean. So helpful people try to explain that jargon. They try to help by giving definitions.

But definitions are like leaves: you need a trunk and some branches to hang them on, or they just swirl around in bewildering clouds and eventually settle in indecipherable piles.

There are several big ideas that provide the trunk and branches of understanding health insurance. If you have those ideas, the jargon becomes a lot easier to understand, and then insurance itself becomes a lot easier to understand.

So in this series, I am going to explain some of those big ideas, and then use them to explain how health insurance is organized.

This unorthodox introduction to health insurance is for beginners to health insurance in the US, and anyone who still feels like a beginner after bouncing off the bureaucratic nightmare that is our so-called health care system in the US. It's for anyone who is new to being an health insurance shopper in the US, or feels their understanding is uncertain. Maybe you just got your first job and are being asked to pick a health plan from several offered. Maybe you have always had insurance from an employer and are shopping on your state marketplace for the first time. Maybe you have always gotten insurance through your parents and spouse, and had no say in it, but do now. This introduction assumes you are coming in cold, a complete beginner knowing nothing about health insurance or what any of the health insurance industry jargon even is.

Please note! This series is mostly about commercial insurance products: the kinds that you buy with money. Included in that are the kind of health insurance people buy for themselves on the state ACA marketplaces and also the kind of health insurance people get from their employers as a "bene". It may (I am honestly not sure) also include Medicare Advantage plans.

The things this series explains do not necessarily also describe Medicaid or bare Medicare, or Tricare or any other government run insurance program, though if you are on such an insurance plan this may still be helpful to you. Typically government-run plans have fewer moving parts with fewer choices, so fewer jargon terms even matter to them. Similarly, this may be less useful for subsidized plans on the state ACA marketplaces. It depends on the state. Some states do things differently for differently subsidized plans.

But all these different kinds of government-provided health insurance still use some insurance industry jargon for commercial insurance, if only to tell you what they don't have or do. So this post may be useful to you because understanding how insurance typically works may still prove helpful in understanding what the government is up to. Understanding what the assumptions are of regular commercial insurance will hopefully clarify the terms even government plans use to describe themselves. Just realize that if you have a plan the government in some sense is running, things may be different – including maybe very different – for you.



On to the first important idea: Health Insurance is a Contract.



Understanding Health Insurance

Put your circuits in the sea

Dec. 8th, 2025 02:58 am
sovay: (Rotwang)
[personal profile] sovay
After years of not even being able to pirate it, [personal profile] spatch and I have finally just finished the first series of BBC Ghosts (2019–23), during which he pointed out to me the half of the cast that had been on Taskmaster. I recognized a guest-starring Sophie Thompson.

This article on the megaliths of Orkney got Dave Goulder stuck in my head, especially once one of the archaeologists interviewed compared the Ring of Brodgar to sandstone pages. "They may not have been intended to last millennia, but, now that they have, they are stone doors through which the living try to touch the dead."

I wish a cult image of fish-tailed Artemis had existed at Phigalia, hunting pack of seals and all.

Any year now some part of my health could just fix itself a little, as a treat.

decisions, decisions

Dec. 7th, 2025 11:59 pm
marycatelli: (Default)
[personal profile] marycatelli
In one story, all the threads have to be gathered up for the conclusion.

In the other story, the love interest has to reveal the horrible past to the heroine.

What fun.

Milk Run

Dec. 7th, 2025 11:59 pm
marycatelli: (Golden Hair)
[personal profile] marycatelli
Milk Run by Nathan Lowell

Adventures in space!

Read more... )
teaotter: a girl in a pink coat that reads "anti social social club" (Default)
[personal profile] teaotter posting in [community profile] fan_flashworks
Title: the ally of caution is boldness
Fandom: The Double (cdrama)
Content notes: none
Challenge: Boss
Length: 200 words

Summary: Jingrui always had a talent for chess. His mother wishes he didn't.


Read more... )

Well, this was weird

Dec. 7th, 2025 10:18 pm
james_davis_nicoll: (Default)
[personal profile] james_davis_nicoll
Another unconscious person on public transit. This guy just seemed to be terribly tired, but when he slumped over, he knocked his stuff on the floor. Several times. I kept putting his stuff back, and mentioned him to the drive on my way out.
[syndicated profile] languagelog_feed

Posted by Victor Mair

Yesterday I pointed out the trombonish glissando in Bobby Vinton's "Blue Velvet"; today, during my morning ablutions, on the radio I heard a jazz singer do a whole song sounding like a musical instrument.  I don't think there was any digital or electronic assistance, just his natually endowed voice.

One thing that always blows my mind is hearing Pink Floyd's guitar riffs that sound like a human voice, with the crowd going nuts in the background.  This is due to David Gilmour's masterful use of effects like the Talk Box, which channels guitar sound through his mouth to form vowel sounds (like on "Pigs (Three Different Ones)"), alongside techniques like thumb-picking for vocal-like pitch bends, heavy use of Leslie speakers for swirling textures, and "wet/dry signal" setups with Uni-Vibes and delays, creating expressive, singing tones that mimic vocal phrasing. (AIO)

When I was in high school and played in various bands, brass instrumentalists would skillfully use different types of mutes to manipulate the sound stream originating from the buzzing of their lips and the tubing of their horn.  In fact, before valves were added to the French horn, hornists had to fashion their melodies from a combination of embouchure control and literal manipulation of their hand inside the bell of the instrument.  There are many astonishingly good French hornists, but the only two modern exponents of the instrument I know who could play the "natural" (i.e., without valves) horn were Hermann Baumann and Anthony Halstead).

The French horn is directly descended from large, circular hunting horns (cor de chasse) used in France.  A French horn has a amazingly long length of coiled tubing, typically ranging from 12 to over 20 feet, depending on whether it's a single horn (around 12-13 ft for the F side) or a more common double horn, which combines both F and B♭ tubing for a total length that can reach 22 feet or more.  I played a double horn (you have to generate a lot of wind to push your lip buzz through all that tubing), but started out on a much simpler, cheaper single horn, and had to learn to do the transpositions mentally /automatically.  Not easy.

About thirty years ago, I went with my sister Heidi to visit a friend of hers in a Seattle suburb.  His whole living room was full of electronic keyboards, amplifiers, speakers, headsets, and what-not.  I'm sure that it all must have cost many thousands of dollars.  He was not a professional, but created his music for his own pleasure and the entertainment of his guests such as Heidi and me.

It was like an electronic version of a late medieval organ, which has a vast array of "voices" (sounds) mimicking orchestral instruments, human voices, or creating unique tones, achieved by different pipe shapes (flue/reed), materials, and meticulous adjustments for brightness, darkness, or specific timbres like flutes, strings, brass, and winds (trumpets, oboes), and even unique effects like celestial harps or vox humanas. These voices are selected via stops on the keyboards, allowing a single organ to sound like an entire orchestra or choir in a majestic setting. 

Last summer, I made a pilgrimage to Salt Lake City to hear the Mormon Tabernacle Choir, but also to attend a concert played on their magnificent pipe organ.  Even the building was constructed to optimize the acoustics of all the reeds, pipes, and pedals.

Let's see where we are now in voice-instrument interaction:

This plugin transforms your voice into ANY instrument

You will scarcely believe this dazzling demonstration, all done by one man with a plugin.

Add in some AI:

Turn Your Voice Into Any Instrument with AI (Tutorial)

Using your body to make a full range of musical effects.

—–

Imitating Musical Instruments with the Human Voice
if instruments were voices and voices were instruments …
How to use Vocals like Instruments
The Voice As A Music Instrument!
Talk Box (blasting sound into your mouth) — watch how they explain the production of consonants and vowels
Can a voice sound like a stringed instrument? String Voice …
Watch this band with only their vocals as musical instruments.

—–

There are countless other presentations online of what all the electronic, digital paraphernalia can do FOR YOU.  You control it.  It is à votre service.

Upon initial encounter with all this intelligent equipage, it starts to get depressing, at least for me.  I feel like the machines are starting to take over; what's left for me, the human?

In the end, though, I realize that I can tell the machine what to do.

The machine may be smart, but I can tell the machine what to do and what not to do.  Above all, I can turn the machine on and off.

 

Selected readings

(no subject)

Dec. 7th, 2025 07:44 pm
skygiants: Hohenheim from Fullmetal Alchemist with tears streaming down his cheeks; text 'I'm a monsteeeer' (man of constant sorrow)
[personal profile] skygiants
The other movie I saw recently -- not on a plane! but in a real theater! -- was Guillermo del Toro's Frankenstein (do I need to spoiler cut this? well, let's be safe) )
22degreehalo: (PWAA holy)
[personal profile] 22degreehalo posting in [community profile] fancake
Fandom: The Scum Villain's Self-Saving System
Pairings/Characters: Luo Binghe/Shen Qingqiu
Rating: Explicit
Length: 18,992
Creator Links: [archiveofourown.org profile] benwisehart
Theme: Amnesty, Book Fandoms, Domestic, Established Relationship, Humor, Trauma & Recovery

Summary: The System gives Shen Qingqiu the ability to exchange B-Points for items, and what better way to earn points than by raising the satisfaction level of Zhongdian's favourite protagonist?

OR: The one where Shen Qingqiu starts seducing the fuck out of Binghe in order to enable his caffeine addiction.

Reccer's Notes: This one seems like it'd be just a fun kinky romp (which it also is!), but it's also very thoughtful about why Shen Qingqiu was reluctant to indulge in some of these things to begin with. Sometimes it's just his self-conscious personality, and sometimes it's because he was too quick to judge, but he's also his own person with his own preferences and traumas and those deserve to be respected, too! Really, the ultimate benefit out of this whole sequence of events might just have been allowing these two a sliver of genuine open communication, even if that's sometimes a hard-won lesson.

Fanwork Links: The Scum Villain's Sex and Pleasure Catalogue

vital functions

Dec. 7th, 2025 10:45 pm
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[personal profile] kaberett

(Last week's also now exists and is no longer a placeholder!)

Reading. Pain, Abdul-Ghaaliq Lalkhen. I want to be very, very clear: unless you are specifically researching attitudes and beliefs in pain clinics in early 2020s England, or similar, do not read this book. There are bad history and no references, appalling opinions on patients (), quite possibly the worst hyphenation choice I have ever seen, stunning omissions and misrepresentations of pain science, and It's Weird That It Happened Twice soup metaphors. Fuller review (or at least annotated bibliography entry) to follow, maybe.

Some further progress on Florencia Clifford's Feeding Orchids to the Slugs ("Tales from a Zen kitchen"), which I acquired from Oxfam in a moment of weakness primarily for EYB purposes at a point when it was extremely discounted. It is primarily a somewhat disjointed memoir for which I am not the target audience, but hey, Books To Go Back In The Charity Shop Pile but that I wouldn't actually hate reading were exactly the goal, so that's a victory. Mostly. I'm a little over halfway through it, sticking book darts on pages that contain recipes for easier reference when I go back through on the actual indexing pass.

I absolutely needed something that was not going to make me furious and furthermore that was not going to be demanding, and there's a new one in the series, so I have now reread several Scalzi: Old Man's War and The Ghost Brigades completed, The Lost Colony in progress.

I've also had a very quick flick through the mentions of Descartes in Joanna Bourke's The Story of Pain, which is my next Pain Book. She does better than everyone else I've read, but I still think she's misinterpreting Treatise on Man. (Why do I have strongly-held opinions on Descartes now. CAN I NOT.)

Playing. Inkulinati, Monument Valley )

Cooking. SOUP.

smitten kitchen's braised chickpeas with zucchini and pesto, two batches thereof, because I had promised A burrata to go with and then (1) the supermarket was out of it and (2) the opened part-pack of feta wound up doing two days quite comfortably, so the second batch was required For Burrata Purposes.

I have also established that the pistachio croissant strata works very well in one of the loaf tins if you scale it down to 50% quantities because there were only 3 discount croissants at the supermarket (... because you had to wait and watch the person who got there JUST ahead of you taking Most Of Them...), which also conveniently used up the dregs of the cream that I had in the fridge.

Eating. Tagine out the freezer (thank you past Alex). Relatively fresh dried apple. A very plain lunch at Teras in Seydikemer, which was apparently the magic my digestive system needed to settle itself down! And I am very much enjoying my dark chocolate raspberry stars. :)

[ SECRET POST #6911 ]

Dec. 7th, 2025 03:15 pm
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[personal profile] case posting in [community profile] fandomsecrets

⌈ Secret Post #6911 ⌋

Warning: Some secrets are NOT worksafe and may contain SPOILERS.


01.


More! )


Notes:

Secrets Left to Post: 02 pages, 42 secrets from Secret Submission Post #987.
Secrets Not Posted: [ 0 - broken links ], [ 0 - not!secrets ], [ 0 - not!fandom ], [ 0 - too big ], [ 0 - repeat ].
Current Secret Submissions Post: here.
Suggestions, comments, and concerns should go here.
full_metal_ox: A gold Chinese Metal Ox zodiac charm. (Default)
[personal profile] full_metal_ox posting in [community profile] fancake
Fandom: Lord of the Rings; How the Grinch Stole Christmas
Pairings/Characters: Gen; Sauron, the Mouth of Sauron, Pippin, Sam Gamgee, the Hobbit community
Rating: General Audiences
Length: (Fic) 957 words; (Comic) 30 panels
Content Notes: No Archive Warnings Apply
Creator Tags:

Erisif | Valarhalla: #i could have done something useful today #instead i wrote this #i hate myself
english-history-trip: #lotr #nonsense #well that was my day how was yours #why is sauron in a cave and then a tower #go to hell that's why #why is frodo bartholomew cubbins instead of a who #the answer won't surprise you

Creator Links:
(Fic):
Elisif: (AO3) [archiveofourown.org profile] Elisif; (Tumblr) [tumblr.com profile] valarhalla
(Fancomic): english-history-trip: (Tumblr) [tumblr.com profile] english-history-trip

Theme: Amnesty, Crack, Crossovers/Fusions, Just Plain Fun, Non-Fic Recs: Fanart, Non-Fic Recs: Fancomic, Poetry, Tumblore

Summary: Every being in Eä liked peacetime a lot…
But Sauron, who was also in Eä, did NOT.


Reccer's Notes: Elisif’s retelling of The War of the Ring in Seussian rhyming verse, firmly informed by The Lore, maps the Shire onto Whoville without introducing an anachronistic Christmas (that’s for Narnia.)

And then, in proper cumulative Tumbloric fashion, english-history-trip proceeds to remix Seussian illustrations to match. (Spoiler: Sauron does not experience redemptive cardiac enlargement; another character gets to preside over the grand climactic celebration.)

Fanwork Links:

Fic: AO3: https://archiveofourown.org/works/26135110
Tumblr: https://valarhalla.tumblr.com/post/190955320437/every-being-in-eä-liked-peacetime-a-lot-but

Fancomic: https://english-history-trip.tumblr.com/post/636994579930939392/english-history-trip-english-history-trip-part

Culinary

Dec. 7th, 2025 06:31 pm
oursin: Frontispiece from C17th household manual (Accomplisht Lady)
[personal profile] oursin

This week's bread: Country Oatmeal aka Monastery Loaf from Eric Treuille and Ursula Ferrigno's Bread (2:1:1 wholemeal/strong white/pinhead oatmeal), a bit dense and rough-textured - the recipe says medium oatmeal, which has seemed hard to come by for months now (I actually physically popped into a Holland and Barrett when I was out and about the other day and boy, they are all about the Supplements these days and a lot less about the nice organic grains and pulses, sigh, no oatmeal, no cornmeal, etc etc wo wo deth of siv etc). Bread tasty though.

Friday night supper: groceries arrived sufficiently early in the pm for me to have time to make up the dough and put the filling to simmer for sardegnera with pepperoni.

Saturday breakfast rolls: adaptable soft rolls recipe, 4:1 strong white/buckwheat flour, dried blueberries, Rayner's Barley Malt Extracxt, turned out very nicely.

Today's lunch: savoury clafoutis with Exotic Mushroom Mix (shiitake + 3 sorts of oyster mushroom) and garlic, served with baby (adolescent) rainbow carrots roasted in sunflower and sesame oil, tossed with a little sugar and mirin at the end, and sweetstem cauliflower (some of which was PURPLE) roasted in pumpkin seed oil with cumin seeds.

Afternoon in Oxford on Friday

Dec. 7th, 2025 04:43 pm
queen_ypolita: Head of a statue of a woman (WomanHead)
[personal profile] queen_ypolita
I had Friday afternoon off to make sure I'll use up all of my holiday entitlement this year—we don't get carryover to next year. With the time off I have planned around Christmas and new year, my balance will be zero at the end of the year. But coming to the end of November I still had this half day and another pro-rata little bit from going from one level of entitlement to the next level in August. So I had the 2 hours 20 minutes last week by the virtual of finishing early on the Friday, and the half day this Friday.

So I went to Oxford and went to see This is what you get: Stanley Donwood, Thom Yorke exhibition at the Ashmolean. I didn't really know much about it before I went, but it was something to do, and talking to a colleague about my plans reminded me it was still on. So I went and did really enjoy it.

Afterwards, did some browsing in the bookshops. I hadn't been to Waterstones in its new location before, so it was good to have a chance to look around.

The forecast for Friday promised most rain for the late afternoon, early evening period, and so it did. I got pretty wet walking to the station.

Yesterday and today, browsed for and thought about Christmas presents I'll need to buy. Thinking is mostly done now but I'll do the remaining shopping next week.

vignettes

Dec. 7th, 2025 11:39 am
marycatelli: (Default)
[personal profile] marycatelli
This week's prompt is:
habitual 🚶‍♀️‍➡️

Anyone can join, with a 50-word creative fiction vignette in the comments. Your vignette does not have to include the prompt term. Any (G or PG) definition of the word can be used.

Rec [fic]: Junkyard by Melime

Dec. 7th, 2025 04:27 pm
paranoidangel: Pink Dalek (Pink Dalek)
[personal profile] paranoidangel posting in [community profile] tardis_library
Title: Junkyard
Creator: [archiveofourown.org profile] Melime
Rating: General
Word Count/Length/Size: 606 words
Creator's Summary: The Doctor lands just outside 76 Totter's Lane in 1963, but fortunately he's able to leave before he meets himself. Unfortunately he's not the only one to make it into his TARDIS.
Characters/Pairings: Sixth Doctor, Susan Foreman
Warnings/Notes: None

Reasons for reccing: It's such a sweet story.


Link: https://archiveofourown.org/works/74248856

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