Health Insurance Policy

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

Law School

In the United States, a law school is an institution where students obtain a professional education in law after first obtaining an undergraduate degree.

Law schools in the U.S. issue the Juris Doctor degree J.D., which is a professional doctorate, and for most practitioners a terminal degree.

Other degrees that are awarded include the Master of Laws LL.M. and the Doctor of Juridical Science J.S.D. or S.J.D. degrees, which can be more international in scope. Most law schools are colleges, schools, or other units within a larger post-secondary institution, such as a university. Legal education is very different in the United States from that in many other parts of the world.

These basic courses are intended to provide an overview of the broad study of law. Not all ABA-approved law schools offer all of these courses in the 1L year; for example, many schools do not offer constitutional law and/or criminal law until the second and third years. Most schools also require Evidence but rarely offer the course to first year students. Some schools combine legal research and legal writing into a single year-long "lawyering skills" course, which may also include a small oral argument component.

Because the first year curriculum is always fixed, most schools do not allow 1L students to select their own course schedules, and instead hand them their schedules at new student orientation.

At most schools, the grade for an entire course depends upon the outcome of only one or two examinations, usually in essay form, which are administered via students' laptop computers in the classroom with the assistance of specialized software. Some professors may use multiple choice exams in part or in full if the course material is suitable for it e.g., professional responsibility. Legal research and writing courses tend to have several major projects some graded, some not and a final exam in essay form.

After the first year, law students are generally free to pursue different fields of legal study, such as administrative law, corporate law, international law, admiralty law, intellectual property law, and tax law.

Graduation is the assured outcome for the majority of students who pay their tuition, behave honorably and responsibly, maintain a minimum per-semester unit count and grade point average, take required upper-division courses, and successfully complete a certain number of units by the end of their sixth semester. Students unable to meet these requirements are ejected and forced to pursue other career options; very few law schools will admit a candidate involuntarily dismissed from another school.

The ABA also requires that all students at ABA-approved schools take an ethics course in professional responsibility. Typically, this is an upper-level course; most students take it in the 2L year. This requirement was added after the Watergate scandal, which seriously damaged the public image of the profession because President Richard Nixon and most of his alleged cohorts were lawyers. The ABA desired to demonstrate that the legal profession could regulate itself and hoped to prevent direct federal regulation of the profession.

As of 2004, to ensure that students' research and writing skills do not deteriorate, the ABA has added an upper division writing requirement. Law students must take at least one course, or complete an independent study project, as a 2L or 3L that requires the writing of a paper for credit.

Most law courses are less about doctrine and more about learning how to analyze legal problems, read cases, distill facts and apply law to facts. Legal education focuses on skill-learning, not law-learning.

Many of the top schools in the United States are much more interested in teaching students legal theory and analysis than they are in the specific doctrines or "black letter law". Top schools emphasize theory over practice for several reasons. First, these schools often train legal academics, who will be teaching future lawyers. Second, professors at these schools are often interested in questions of legal theory and legal reform, as they themselves are, and were, often not practitioners. Third, these schools often have the most prestigious journals, and students are encouraged to engage in scholarship to publish in these journals.

However, clinical education is very important, and many schools, such as Wisconsin Law School and University of Maryland School of Law, differentiate themselves with excellent clinical programs. Moreover, students often seek out clinical programs because doctrinal courses offer little in the way of practical training. On the other hand, clinical programs may be emphasized to the detriment of opportunities for more lucrative tracts such as corporate law.

In 1968, the Ford Foundation began disbursing $12 million to persuade law schools to make "law school clinics" part of their curriculum. Clinics were intended to give practical experience in law practice while providing pro bono representation to the poor. However, conservative critics charge that the clinics have been used instead as an avenue for the professors to engage in left-wing political activism. Critics cite the financial involvement of the Ford Foundation as the turning point when such clinics began to change from giving practical experience to engaging in advocacy.

Many law students participate in internship programs during their course of study. In some schools, such as Northeastern University School of Law and the Earle Mack School of Law at Drexel University, students have the opportunity to pursue co-operative education programs during their legal education careers.

Finally, it should be noted that the emphasis in law schools is rarely on the law of the particular state in which the law school sits, but on the law generally throughout the country. Although this makes studying for the bar exam more difficult since one must learn state-specific law, the emphasis on legal skills over legal knowledge can benefit law students not intending to practice in the same state they attend law school.

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