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Glossary of Insurance Terms
Glossary of Insurance Terms
Access: Right to enter or use health care services.
Acquisition Cost: The cost to an insurer to acquire new business. It includes costs such as underwriting the risk, issuing a new policy, paying commissions and overhead or office expenses.
Activities of Daily Living (ADLs): Everyday activities which are used to measure an individual's ability to function independently. ADLs define the disability in long term care insurance. The loss of some number of ADLs is an insuring or triggering event in all long term care policies. In California, Senate Bill 1943 established seven standard activities of daily living (eating, bathing, dressing, toileting, continence, transferring, ambulating) for any LTC policy that purports to cover home care in it's provisions. A loss of 2 to 7 of the ADLs will qualify an insured for benefits. There are LTC programs in California that do not comply with S.B.1943 (California Partnership and CALPERS). These programs have more stringent insuring clauses. ADLs and the loss necessary to trigger benefits may vary from state to state. Additionally, despite standardization, companies choose to define the inability to perform an ADL differently. The NAIC is working to set national standards for ADL definitions.
Actual Charge: The amount a physician or supplier actually bills for a particular medical services or supply.
Actuary: A professional who mathematically analyzes and determines the price of the risk associated with providing insurance coverage. An actuary may also determine the anticipated cost of providing future benefits. Factors considered in the study include the projection of future claims experience, administrative expenses and anticipated investment return.
Acute Care: Care for illness or injury that develops rapidly, has pronounced symptoms ad is finite in length. Traditional medical insurance, Medicare and Medicare supplements are designed to provide coverage for acute illness.
Adjusted Average Per Capita Cost (AAPCC): Health Care Financing Administration (HCFA) basis of payment to HMOs and CMPs.
Adjusted Community Rate (ACR): Uniform capitation rate that is charged to all enrollees in a plan based on adjustments for risk factors such as age and sex.
Administrative Services Only (ASO): A type of contract with an insurance company or a third-party administrator that provides an employer with administrative services. It does not provide coverage for risk of insurance protection. The usual expenses covered include claims processing, plan design advice and printing benefit booklets. These contracts are usually entered into by large employers who can afford the risk of providing insurance protection with their own money.
Administrator: A person who is designated to be responsible for the proper operation and administration of a plan. When the plan sponsor does not designate a person for this duty, the ERISA considers the pan sponsor to be the plan administrator.
Adult Day Care: Social, recreational and/or rehabilitative services provided for persons who benefit from daytime supervision. An alternative between care in the home or in a institution.
Adverse Selection: A tendency which occurs when a person makes a decision based on his/her diminished health condition or frequency of needed treatment and is, therefore considered a poorer claims risk than most others in the group.
Aid to Families with Dependent Children (AFDC): Public assistance program that provides payment to families with children 18 years of age and under who have an income below a defined poverty line.
Agent: Licensed by the state, performs the functions for sole proprietors and small businesses that Human Resource Departments do for larger businesses, gathers census data, prepares proposals, makes presentations to businesses, explains benefits to employers, and employees, does field underwriting when required, delivers policies and certificates, assists in handling claims, performs other related tasks required by the employer or sole proprietor.
Aggregate Amount (limit): Maximum amount of total losses for which a plan sponsor (employer) is liable for any one-plan year.
Ageism: Prejudice against people because of their age.
Alternate Care Benefit: Payment for a special arrangement of services specifically designed to allow the person to reside in a setting other than a nursing facility (i.e. services to provide assistance, capital improvements such as a ramp, and/or durable medical support.
Alternative Care Benefit: payment for a special arrangement of services specifically designed to allow the person to reside in a setting other than a nursing facility (i.e. services to provide assistance, capital improvements such as a ramp, and/or durable medical equipment.
Alternate Care Facility: (1) A hospice; or (2) a place that provides ongoing care to inpatients in one location and which (a) provides 24-hour care and services sufficient to support needs resulting from inability to perform activities of daily living or cognitive impairment; (b) has a trained and ready-to-respond employee to provide such care; (c) provides three meals a day and accommodates special dietary needs; (d) is appropriately licensed or accredited; (e) has formal arrangements for the services of a physician or nurse to provide emergency medical care; and (f) has appropriate procedures for handling administering drugs.
Alzheimer's Disease: A form of organic dementia resulting in premature mental deterioration, first described in 1906 by German neurologist, Alois Alzheimer. In California, as well as most of the rest of the United States, Alzheimer's Disease is considered a cognitive impairment, thus triggering benefits under long term care insurance policy.
Ambulatory Care: Medical services provided on an outpatient (non-hospitalized) basis. Services may include diagnosis, treatment, surgery, and rehabilitation.
Ancillary Services: Health care services conducted by providers other than physicians and surgeons. These will usually include such services as physical therapy and home health care.
Annual Benefit Cap: Maximum amount paid for specific medical services or total medical services.
Approved Amount: The amount Medicare determines is reasonable for a service covered under Medicare Part B. It may be less than the actual charge. For many services, including physician services, the approved amount is taken from a fee schedule that assigns a dollar value to all Medicare-covered services that are paid under that fee schedule.
Assessment: A determination of physical and/or medical status by a health professional based on established medical guidelines. The assessment is a central component in home care coverage's and the payment of home care claims. Upon the triggering of benefits, due either to the loss of some number or activities of daily living or a cognitive impairment, an assessment is performed by a multidisciplinary team. This "team" usually spearheaded by the insured's physician, determines the level of functional incapacity and develops a plan of care that will be followed in assisting the insured in the performing the ADLs and IADLs (instrumental activities of daily living).
Assignment: An arrangement whereby a physician or medical supplier agrees to accept the amount approved by Medicare as full payment for services and supplies under Part B. Medicare usually pays 80% of the approved amount directly to the physician or supplier after the beneficiary meets the annual Part B deductible of $100. The beneficiary pays the other 20 percent.
Assignment of Benefits: When the insured authorizes the insurer or claims payer to pay benefits directly to the medical care provider.
Assisted Living: A non-medical institution providing room, board, laundry, some form of personal care and usually recreational and social services. Licensed by state departments of social services, these facilities exist under several names including domiciliary care facility,, sheltered house, board and care, community based residential care facilities and alternate care facilities.
ASO: A type of contract with an insurance company or a third party administrator that provides an employer with administrative service. It can include coverage for a certain amount of claims risk. The usual administrative expenses include claims processing, plan design advice and printing benefit booklets. Large employers who can afford the risk of providing insurance protection with their own money usually enter into these contracts.
Attachment Point: For aggregate stop-loss insurance, it is the point at which the stop-loss insurance carriers begin to reimburse the employer based upon the cumulative total of claims paid within a policy year.
Authorizations: Consent or endorsement by a primary care physician for patient referral to ancillary services and specialists.
Average Length of Stay: One measure of use of health facilities, reported as an average number of inpatient days spent in a hospital or other health care facility per admission or discharge. It is calculated as follows: total number of days in the facility for all admissions during a particular period divided by the number of admissions during the same period. Average lengths of stay vary and are measured by age, specific diagnosis, or sources of payment.
Balance Billing: Specific deductible is the point at which the stop-loss insurance carrier begins to reimburse the employer based upon the individual's total of claims paid within a policy year. Also, the practice of medical care providers (such as doctors, hospital, or other medical practitioner) billing the insurer for full costs, then billing the insured for the portion of the bill which was not paid. Many Managed Care plans prohibit the use of balanced billing and may use sanctions against providers who balance the bill.
Benchmark: Point of comparison between desired clinical outcome and actual practice.
Beneficiary: The person entitled to receive benefits under a plan, including the covered employee and his or her dependents.
Benefit: Amount an insurance company pays to a claimant, assignee, or beneficiary when the insured suffers a loss covered by the policy.
Benefit Increase Options: Also known as automatic benefit increase option, automatic increase benefit, and cost of living adjustment benefit. These are optional benefits that provide for annual increases in the benefit amount to offset the effects of inflation. Benefit increase options are paid for at the time of issue and either increases the daily policy benefits by a 5% compounded or simple interest factor. A key element to remember is that the increases begin at the second policy anniversary and continue for the duration of the policy, except where the insurance carrier "caps" the increase at some predetermined amount. These increase options are not to be mistaken with future insurability options.
Benefit Period: A benefit period is a way of measuring a beneficiary's use of hospital and skilled nursing facility services covered by Medicare. A benefit period begins the day the beneficiary is hospitalized. It ends after the beneficiary has been out of the hospital or other facility that primarily provides skilled nursing for rehabilitation services (or, if in the latter type of facility, has not received skilled care there) for 60 days in a row. If the beneficiary is hospitalized after 60 days, a new benefit begins period begins, most Medicare Part A benefits are renewed, and the beneficiary must pay a new impatient hospital deductible. There is no limit to the number of benefit periods a beneficiary can have.
Cafeteria Plan: A plan which offers a choice between two or more benefits, or a choice between cash and one or more qualified benefits, and which complies with Section 125 of the Internal Revenue Code. (Also known as flexible benefit plans or "flex" plans).
Capitation: Method of compensation, used primarily by HMOs, to pay providers a fixed amount for each enrollee regardless of the actual number or nature of services provided to each person.
Carve-Out: Term used to describe certain services not included in capitated benefits that are paid for separately on a predetermined fee-for-service basis.
Case Management: Planned approach to manage service or treatment to an individual with a serious medical problem. Its dual goal is to contain costs and promote more effective intervention to meet patient needs. Often referred to as large case management.
Centers of Excellence: Providers who are selected to perform certain specialized procedures because of their expertise and willingness to provide discounts.
Chronic Care: Care for illness continuing over a long period of time or recurring frequently. Chronic conditions often begin inconspicuously and symptoms are less pronounced than acute conditions. Long term care insurance is designed to assist people who have a loss of capacity due to chronic illnesses.
Civilian Health and Medical Program of the Uniformed Services (CHAMPUS): Federal program providing cost-sharing health benefits for dependents and survivors of active duty personnel and for retirees and their dependents and survivors.
Claim: Demand to the insurer by an insured person for the payment of benefits under a policy.
Closed Panel: Managed care plan that contracts with physicians on an exclusive basis that requires the insured to use a list of certain providers. The primary provider is responsible for all health care needs and refers to a specialty physician or hospitalization only when medically needed.
Coalitions: An association of health care plan sponsors who pool their resources to negotiate with insurers or other health care payers and providers.
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985): A federal law that requires most employers to allow eligible employees and their beneficiaries to continue to self-pay for their coverage after it normally terminates for up to 18, 24, 29 or 36 months.
Cognitive Impairment: Deterioration in intellectual capacity which (1) requires regular supervision to protect patients and others; (2) must be determined by clinical diagnosis or test; and (3) may be the result of Alzheimer's disease, senile dementia, or other nervous or mental disorders of organic origin.
Co-insurance: An agreement between the insured and the insurance company where payment is shared for all claims by the policy. A typical arrangement is 80%/20% up to $5,000. The insurance company pays 80% of the first $5,000 and the insured pays 20%. Usually after 80% of $5,000, the insurance company then pays 100% of covered expenses during the remainder of the calendar year up to any limits of the policy. This is also referred to as co-payment.
Commission: Part of an insurance premium, which is paid by an insurance company to an agent or broker for procuring and servicing the business for the insurance company/client. Depending upon the size of the group being insured, these commissions average between three and ten percent of the premium paid by the employer.
Community-Rated: Method of developing group-specific capitation rates by a health plan that generally does not account for unique characteristics of the group. The rate is based on the total experience of a given geographic area or "community."
Community-Rating: A rating method that determines a single average premium based on the characteristics and claims experience of an entire membership such as an HMO or an insurance pool. Age, lifestyle, industry, health factors and gender are not used to determine rates (See Adverse Selection).
Competitive Medical Plans (CMPS): Health care organization that meets specific government criteria for Medicare risks contracting but is not necessarily a HMO.
Concurrent Review: Method of utilization review that takes place on-site when a patient is confined to a hospital.
Congregate Housing: Apartment houses or group accommodations that provide health care and other support services to functionally impaired older persons who do not need routine nursing care.
Conversion Privilege: A contractual right given to an insured person whose group coverage terminates so that person is able to convert to an individual policy without providing evidence of insurability.
Coordination of Benefits (COB): A contractual provision to prevent an insured from receiving benefits under more than one health insurance plan so that the insured's benefits from all sources do not exceed allowable medical expenses or eliminate appropriate patient incentives to contain cost.
Co-payment: A small charge paid at the time a medical service is received. It does not accumulate towards a plan's deductible or out-of-pocket maximum and is designed to discharge utilization. (See Co-insurance)
Cost Containment: Efforts or activities designed to reduce or slow down the cost increases of medical care services.
Cost Sharing: The sharing of costs between the payment of premium cost and medical expenses by the health care plan and its insured through employee contributions, deductibles, co-insurance and co-payments.
Cost Shifting: The increased cost of medical care to other patients that makes up for losses incurred in providing care to patients who are under-insured or who have no coverage.
Coverage: The different types of options selected and the benefits paid under a plan or insurance contract.
Covered Expense(s): An expense that will be reimbursed according to the terms of the plan or insurance contract. Credentialing Review and documentation of professional providers including licensure, malpractice history, analysis of practice patterns, and certification.
Current Procedural Terminology (CPT): Set of five-digit codes describing medical services that are used for billing by professional providers.
Custodial Care Facilities: A licensed facility that provides personal assistance to persons who are unable to care for themselves due to age, illness, physical or mental infirmity, but who do not require daily nursing care.
Customer: User of health care services, such as patients getting care or providers getting support services from laboratories; payer of service, such as individuals, employers, or the government; or the general public.
Deductible: The amount of covered expenses that the insured must pay before a plan or insurance contract starts to reimburse for eligible expenses.
Defense Medicine: Extensive use of laboratory testing, treatment, increased hospital admissions, and extended hospital stays that are not medically necessary for the treatment of the patient; the sole purpose of reducing the possibility of malpractice suits by the patient or providing a good legal defense in the event of such lawsuits.
Dementia: The severe impairment of cognitive functions (thinking, memory and personality). Of our elderly population, 5 to 6 percent have dementia. Alzheimer's Disease causes approximately one-half of these causes, vascular disorders (multiple strokes) case one-fourth and the other dementia's are caused by alcoholism, heart disease, infections, toxic reaction to medication and other rarer conditions. While impairment from Alzheimer's Disease and vascular disorders is permanent, dementia caused by other conditions can usually be corrected.
Diagnosis-Related Groups (DRGs): System of determining specific reimbursement fees based on the medical diagnosis of a patient.
Discharge Planning: Assessment of an inpatient's medical condition for the purpose of arranging for appropriate continuing care upon leaving the facility. This planning includes how long the patient will be in the hospital, the expected outcome, and whether there are special needs or requirements on discharge.
Divestment: In reference to eligibility for Medicaid, the disposal of resources at less than fair market value in order to qualify for benefits.
Dual Choice: An arrangement where an employer will offer an alternative in addition to its original health plan.
Durable Power of Attorney: An individual's appointment of a representative to act on his or her behalf via a legal document that remains in effect of incapacity of the grantor.
Eligible Expense(s): The portion of the medical care provider's services that are covered for payment under the terms of the health plan or insurance contract.
Elimination Period: The number of days in which you receive covered care or services before benefits are payable.
Employee Retirement Income Security Act of 1974 (ERISA): A federal law that originally set minimum standards for funding, vesting and termination of employer-sponsored pension plans. ERISA also contains provisions to protect the interests of participants and beneficiaries in welfare plans. Welfare plans must be in written form, describe the benefits and name the persons responsible for the operation of the plan.
Enrollee: health plan participant, member, or eligible individual in a managed Care program.
Evidence of Insurability: A procedure used to review factors concerning a person's physical condition and medical history. From this information, the plan or insurance company evaluates whether the risk of the individual will be accepted and if they will offer coverage.
Exclusion: Specific conditions or services that are not covered by the terms of the plan or insurance contract.
Exclusive Provider Organization (EPO): Arrangement consisting of a group of providers who have a contract with an insurer, employer, third-party administrator, or other sponsoring group. Criteria for provider participation may be the same as those in PPOs but have more restrictive provider selection and credentialing process or otherwise forfeit reimbursement altogether.
Expected Claims: A dollar amount, which represents the expected claims, which will be paid during any plan or contract period.
Experience: Refers to the history of actual claims paid for the contract period (see Paid Claims) or can refer to the history of claims incurred during a contract period.
Experience-Rated: Determination of premium or capitation rates for a group risk based wholly or partly on that group's previous cost and utilization experience.
Explanation of Benefits (EOB): A document sent to an insured when the plan or insurance company handles a claim. The document explains how reimbursement was made, or why the claim was not paid, and if any additional information is needed. The appeals procedure should be outlined to advise the insured of his/her rights if there is dissatisfaction with the decision.
Extended Benefits: Benefits which continue, or become payable, after the termination of coverage from a plan or insurance contract, for example a hospitalization which continues after coverage would normally cease.
Federally Qualified: Voluntary federal certification for HMOs.
Federally Qualified Health Center: Another way to limit your health care costs is to go to a federally qualified health center (FQHC) for the type of care generally provided in a doctor's office.
Fee-for-Service Reimbursement: Payment for services based on each visit or service rendered. Under this arrangement Plans or Insurers have not established contracted or capitated rates of payments with providers prior to the insured claim occurrence.
Fee Schedule: Maximum dollar or unit allowances for health services that apply under a specific contract.
Fiduciary: Under ERISA, any person who exercises discretionary authority or control over a plan or plan assets.
Fixed Costs: Refers to those costs which are payable monthly and which do not relate to actual claims paid or incurred, for example, premium and administration costs.
Flexible Spending Accounts: Special accounts typically funded by an employee's salary reduction to help pay certain expenses not covered by the employer's plan or insurance contract. The advantage of these accounts is that after-tax dollars are converted to before-tax dollars, thereby reducing the actual cost of expenses.
Formulary: List of preferred pharmaceutical products to be used by a managed care plan's network physicians. Formularies are based on evaluations of the efficacy, safety, and cost effectiveness.
Fraud: Fraud in the health care system may include areas such as offering free tests or services and billing the insurer or plan, or for charging for services no rendered.
Freestanding Plan: Unbundled or separate health care benefits apart from the basic health care plan, usually dental or vision care. Employees are allowed either to select the separate benefit or decline it for other alternatives. This choice of freestanding plans is often referred to as "cafeteria-type" benefits.
Fully Insured Plan: The employer pays the entire premium and, in return, transfers all of the risk and responsibility for claims payments to the insurance company.
Gatekeeper: (Primary Care Physician) A health professional within a managed-care environment who determines the patient's access to treatment. The primary care physician treats the patient and determines necessity of access to further treatment and specialists.
Gatekeeper Question: A qualifying question asked by an insurance company at the time of application to help identify risk(s). Example: "Have you ever been treated for a heart attack or heart condition?"
Geriatrics: The study of physical and mental changes in persons as they age - including the diagnostic, treatment and prevention of disorders.
Grace Period: Time period that follows the premium due date when the coverage and policy remain in force.
Global Fees: Negotiated fees that are all-inclusive (one fee is paid for the entire range of services provided for a specific episode or episode of care.)
Group-Model HMO: HMO staffing that occurs by contracting with multi-speiciality medical groups to care for plan members. Physicians are not employees of the HMO but are considered as a closed panel.
Guaranteed Issue Underwriting: The applicant is guaranteed coverage up to an agreed amount or level without evidence of insurability (see Evidence of Insurability).
Guaranteed Renewable: The insured's right to continue an in-force policy by the timely payment of premiums. The insurance company cannot change the coverage or refuse to renew the coverage for other than non-payment of premiums (includes health conditions and/or marital or employment status).
Health Alliances: Health Alliances or Health Insurance Purchasing Cooperatives (HIPCs) are groups or entities whose primary purpose is to negotiate with health plans to provide coverage at competitive prices to members of the alliance.
Health Insurance Purchasing Cooperatives (HIPCS): See Health Alliances
Health Care Financing Administration (HCFA): Branch of the U.S Department of Health and Human Services charged with oversight and financial management of government-related health care programs such as Medicare and Medicaid.
Health Care Prepayment Plan (HCPP): HCFA program allowing managed care groups that organize, finance, and deliver Medicare Part B services be reimbursed for such services on a reasonable cost basis.
Health Insurance Purchasing Cooperatives (HIPCS): See Health Alliances
Health Maintenance Organization (HMO): An organization that provides a wide range of comprehensive health care services for a specified group of enrollees for a fixed, pre-paid premium. There are several models of HMOs: Group Model, Individual Practice Association (IPA), Staff Model and Network Model.
Home and Community-Based Care Benefits: To be eligible for Home and Community-Based Care Benefits, you must require covered services while your policy is in force that are due to (1) medical necessity, or (2) your inability to perform two or more activities of daily living, or (3) cognitive impairment.
Home Health Services: Comprehensive medically necessary services provided by a recognized provider to a patient in the home.
Hospice: Care provided to terminally ill patients and their families that emphasize emotional needs and coping with pain and death.
Hospital Bill Audit: Independent examination of hospital bills by a third party to determine if services and supplies charged to the patient were actually delivered, and if the price charged was correct.
Hospital Indemnity Insurance: Hospital indemnity coverage is insurance that pays a fixed cash amount for each day you are hospitalized up to a designated number of days. Some coverage may have added benefits such as surgical benefits or skilled nursing home confinement benefits. Some policies have a maximum number of days or a maximum payment amount.
Inability to Perform Activities of Daily Living: Dependence on someone else because of need, due to injury, sickness, or frailty of age, for regular human assistance or supervision in performing normal activities of daily living.
Incontestability: Provision in a policy which allows an insurance company to contest the validity of a claim after the policy has been in force for a certain period, usually two or three years.
Incurred But Not Reported (IBNR): Claims which have been incurred by the insured but have not been submitted to the plan or insurance company for reimbursement (also known as lagged claims).
Indemnity Insurance: Health care insurance plan providing benefits in a predetermined amount for covered services. Traditionally, the insurer pays on a fee-for-service basis with no involvement in the actual delivery of health care services.
Individual or Independent Practice Association (IPA): Association of individual physicians that provides services on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis. It is one model of HMO managed care. IPAs may also serve non-HMO patients.
Institutionalization: Admission of an individual to an institution, such as a nursing home.
Instrumental Activities of Daily Living (IADLs): The more complex tasks associated with independent living. California State Bill 1943 stipulates that any long term care insurance policy that purports to cover home care, must provide benefits for the IADLs. The IADLs include lighthouse keeping, taking medications, using the telephone, meal preparation, moving about outside, and shopping for essentials. IADLs define the services covered by policies covering home care.
Insurability: The health status of an insurance applicant, which makes him/her acceptable to an insurance company, i.e. health, financial condition, occupation.
Integrated Coverage: Combinations of HMOs, indemnity plans, or PPO's into one health care plan.
Intermediate Care: Care that may, but does not necessarily need to be delivered by a skilled professional.
Lagged Claims: The time between when service is incurred and when it is submitted and processed for payment.
Lapse: Termination of insurance coverage for failure to pay premiums.
Lifetime Aggregate or Maximum: The maximum benefit payment provided under a plan or insurance contract.
Long-term Care (LTC): Continuum of maintenance, custodial, and health services to the chronically ill, disabled, or mentally impaired over a lengthy period of time. Services may be provided in long-term care or on an outpatient basis (subacute care, rehabilitation facility, nursing home, mental hospital, outpatient, or at-home basis).
Long-Term Care Facility: A place which is (1) licensed by the state; (2) provides skilled, intermediate, or custodial nursing care on an inpatient basis under the supervision of a physician; (3) keeps a daily medical record of each patient.
Malpractice: Unprofessional, incompetent, or inappropriate medical care.
Malpractice Reform: Proposed changes may include required arbitration and limits to the amount of attorney's fees.
Managed Care: Term used to describe the coordination of financing and provision of health care to produce high-quality health care for the lowest possible cost. A system that imposes control on the utilization of medical services and on the providers who renders the care. Managed care is provided through managed indemnity plans; Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), Health Maintenance Organizations (HMOs), or any other cost management environment.
Managed Competition: Proposed system in which the government restricts the consumer to purchasing insurance from government-approved carriers.
Managed Indemnity: Use of utilization controls in traditional fee-for-service health insurance plans in order to reduce cost and inappropriate care.
Mandate: A specific procedure or coverage that a plan or insurance contract must offer dictated by state or federal law.
Mandated Benefits: Health care coverage required by state and federal law to be included in health insurance contracts.
Medicaid: State programs with federal matching funds for public health assistance to persons, regardless of age, whose income and resources are insufficient to pay for health care.
Medical Necessity: Term used by insurers to describe medical treatment that is appropriate and in accordance with generally accepted standards of medical practice.
Medicare: Federally sponsored program under the Social Security Act that provides hospital benefits, supplementary medical care, and catastrophic coverage to persons 65 years of age and older and to some younger persons who are covered under Social Security benefits.
Medicare-Approved Amount: Medicare has a fee schedule that list the dollar amount that Medicare considers to be the reasonable charge for the services provided by a doctor that Medicare approves for a covered service provided by a doctor is the lesser of the Medicare fee schedule amount for a particular service or the amount charged by the doctor.
Medicare Part A (Hospital Insurance): Helps pay for medically necessary inpatient care in a hospital, skilled nursing facility or psychiatric hospital, and for hospice and home health care.
Medicare Part B (Medical Insurance): Helps pay for medically necessary physician services and many other medical services and supplies not covered by Part A.
Medicare-Qualified Providers: Providers who have been approved by Medicare.
Medicare Risk Plan: A type of Medicare supplement coverage where the Medicare recipient "assigns" his/her benefits to an HMO. The HMO contracts with the Federal Government to provide medical services to the Medicare recipient at a discounted rate to the government.
Medicare Select: Federal programs designed to introduce Medicare beneficiaries to managed care plans through Preferred Provider Organization supplemental (MedSup) health insurance.
Medigap-Medicare Supplement Insurance: Medigap insurance is specifically designed to supplement Medicare's benefits and is regulated by federal and state law. It must be clearly identified as Medicare supplemental insurance and it must provide specific benefits that help fill the gaps in your Medicare coverage. Other kinds of insurance may help you with out-of- pocket health care costs but they do not qualify as Medigap plans.
Mental Health Services: Behavioral health care services that may be provided on an inpatient, outpatient, or partial hospitalization basis.
Military Health Services System (MHSS): Federal health benefits program for active duty military personnel, retirees, their dependents, and survivors.
Multiple Employer Trust (MET): A trust established by a sponsor that allows small employers in the same or related industries to provide medical insurance under a trust arrangement.
Multiple Employer Welfare Arrangement (MEWA): An employee welfare arrangement designed to provide benefits to employees of two or more employers.
Multiple Provider Arrangement: Managed care plan consisting of group, staff, or IPA structures in combination.
Multi-specialty Group Practice: Independent physicians' group that is organized to contract with a managed care plan to provide medical services to enrollees. The physicians are not employees of the HMO, but are employed by the group practice.
National Association of Health Underwriters (NAHU): A professional organization founded in 1929, of more than 14,800 men and women in the health insurance industry representing more than 119 million consumers. NAHU promotes excellence in the insurance industry through legislative advocacy, education, participation and quality leadership.
National Association of Insurance Commissioners (NAIC): An organization that assists state insurance departments and helps draft models laws.
National Committee on Quality Assurance (NCQA): Private, voluntary organization for accrediting managed care. It assesses quality, credentialing utilization management, customer rights, preventive health services, and medical records. Developed the Health Plan Employer Data Set.
Negotiated Fees: Managed care plans and providers mutually agree on set fees for each service. This negotiated rate is usually based on services defined by the Current Procedural Terminology (CPT) codes, generally at a discount from what the provider would usually charge. Providers cannot charge more than this fee.
Network or Mixed-Model HMO: Provider arrangements that contract with a number of Independent Practice Associations or group practices to provide physician services to HMO enrollees in return for higher patient volume. This model is a multiple provider arrangement that can be either an open or closed panel.
Network Providers: Limited grouping or panels of providers in a managed care arrangement with several delivery points. Enrollees may be required to use only network providers or may have financing liability for using non-network providers for medical services.
Non-Forfeiture Benefits: A guarantee for a refund of all of the premiums paid in one of two way; (1) to a named beneficiary at the death of the insured, or, (2) as an "extended term" type benefit for as long as all premiums accrued will last with the balance (if any) left to a named beneficiary. See Return of Premium
Non-Network Providers: Non-contracted or unapproved health providers who are outside a managed care arrangement.
Omnibus Budget Reconciliation Act (OBRA): Term given by Congress to many of its annual tax and budget reconciliation acts. Most of these tax and budget acts have language or provisions related to health care and managed care, particularly in relation to Medicare.
Open-Ended HMO: Hybrid HMO product that allows members to use physicians outside the plan in exchange for additional financial liability in the form of a deductible, coinsurance, or co-payment.
Open Panel: A right included in an HMO which allows the covered person to obtain non-emergency covered services from a specialist without a referral from the primary care physician or gatekeeper.
Out-of-Network Care: Medical services obtained by managed care plan members from unaffiliated or non-contracted health care providers. In many plans, such care will not be reimbursed unless previous authorization is obtained.
Out-of-Pocket Expenses: Those health care costs that must be borne by the insured.
Out-of-Pocket Maximum: The maximum amount that an insured is required to pay under a plan or insurance contract.
Outcome Measurement: A document program that tracks a physician's treatment patterns for the purposes of evaluating efficiency.
Overutilization: Inappropriate or excessive use of medical services that add to health care costs.
Paid Claims: The total claims payment made by the plan or insurance company. It does not include any employee cost sharing or provider discounts.
Partial Capitation Risk Contracts: State Medicaid contracts with HMOs or similar managed care organizations that accept risk for a defined set of services (for example, physician services and laboratory, x-ray, or clinic services). Other services are reimbursed on a fee-for-services basis.
Participating Provider: A provider who has agreed to contract with a managed care program to provide eligible services to covered persons.
Per Review: Traditional quality assurance program to monitor standard processes of care or adverse outcomes of provider practice by other professional peers. The goal of peer review is to find and correct medical practices that do not conform to the standard processes of care.
Per Diem: Literally, per day. Term that is applied to determining costs for one day of care. It is an average cost and does not reflect true cost for each patient.
Per Member Per Month (PMPM): Computational designation for each enrollee in a managed care program.
Personal Care Advocate: A representative of the nursing facility resident who reviews care, address concerns, and provides advocacy support for a patient and his or her family.
Physician-Hospital Organization (PHO): Group practice arrangement that occurs when hospitals and physicians organize for purposes of contracting with managed care organizations. These relationships are formally organized, contractual, or corporate in character and include physicians outside the boundaries of a hospital's medical staff.
Plan of Care: Also known as Home Care Plan. It is the result of an assessment; a program for providing home care services. In most policies, a physician and the multi-disciplinary team will prepare such a program. It will be appropriate for the level of care needed for the physician's diagnosis. All long term care policies qualifying under California Senate Bill 1943 require plans of care.
Play or Pay: A concept that would require employers to provide health insurance to their employees and dependents (play) or pay a tax or premium toward a publicly provided system that covers people without private insurance (pay).
Point of Service Plans (POS): Combination of HMO and PPO features. They provide a comprehensive set of health benefits and offer a full range of health services much the same as the HMO. However, the member does not have to choose how to receive services until they need them. The member can then opt to use the defined managed care program, or can go out-of-plan for services but pay the difference for non-plan benefits (e.g. 100 percent coverage for managed care Vs. 80 percent coverage out-of-plan).
Pool (ing): Used by insurance companies to combine all premiums, claims and expenses in order to spread the risk of insurance coverage. This process ensures that small employers will not be singled out and unfairly assessed with a large rate increase due to unanticipated medical catastrophic claims of insured employee(s).
Portability: Provides access to continuous health insurance coverage so the insured does not lose coverage due to any change in health or personal status (such as employment, marriage, or divorce).
Practice Guidelines: Specific, professionally agreed upon recommendation for medical practice used within health care organizations to standardize the practice to achieve consistent quality outcomes. Practice guidelines may be instituted when triggered by specific clinical indicators.
Pre-authorization: Previous approval required for referral to a specialist or non-emergency health care services.
Pre-certification: Utilization management program that requires the individual or provider to notify the insurer before hospitalization or surgical procedure. Notification allows the insurer to authorize payment and to recommend alternate courses of action.
Pre-existing Condition: A condition or diagnosis which existed (or for which treatment was received) before coverage began under a current plan or insurance contract, and for which benefits are not available or are limited.
Pre-existing Condition Clause: A clause in an insurance contract or plan that specifies if benefits will or will not be paid for a pre-existing condition. (Example: "the insured must be covered by the plan for a certain period of time or have gone a certain amount of time without any treatment.") Additionally, the clause may limit the benefit payable for treatment of pre existing conditions until a certain time period of coverage has elapsed, usually six months to a year.
Preferred Provider Organization (PPO): Managed care arrangement consisting of a group of hospitals, physicians, and other providers who have contracts with an insurer, employer, third-party administrator, or other sponsoring group to provide health care services to covered persons in exchange for prompt payment and increased patient volume.
Premiums: Periodic payment to keep an insurance policy in force.
Premium Tax: A state tax on insurance premiums.
Prepaid Group Practice: A type of HMO plan where participating providers render specific services to the insured in exchange for an advance fixed patient.
Prevailing Charges: Amounts charged by health care providers that are consistent with charges from similar providers for identical or similar services in a given locale.
Preventive Medicine: Wellness and health promotion services that are part of the basic benefits package of a managed health care plan.
Primary Care: Non-specialist, basic routine medical care provided by family physician.
Primary Care Case Management: Single provider is responsible for coordinating, arranging, and monitoring all patient care, even for those patients with no serious medical conditions.
Primary Care Physician (PCP): Primary deliverers and managers of health care, central to controlling costs and utilization. The PCP provides basic care to the enrollee, initiates referrals to a specialist, and provides follow-up care. Refers exclusively to other contracted providers and admits patients only to contracted hospitals. Usually defined as a physician practicing in such areas as internal medicine, family practice, and pediatrics.
Profiling: Systematic method of collecting, collating, and analyzing patient data to develop provider-specific information about medical practice.
Prospective Review: Data-gathering technique that uses projected figures or current data to determine future costs or services.
Protocol: Tool for enhancing quality in a health care organization by developing customary methods for medical interventions. Treatment protocols are developed for clinical areas of medicine where diagnostic or therapeutic approaches are defined. Technology assessment and quality studies are used to establish decision protocols for particular diseases or treatments.
Providers: Term used to describe medical professionals and services organizations that provide health care services.
Readmission: Patient admission to a hospital for the same or similar diagnosis as a previous, recent admission. Often used as a measure of inappropriate discharge or treatment from the first admission.
Reasonable and Customary: The maximum amount a plan or insurance contract will consider eligible for reimbursement, based upon prevailing fees in a geographic area.
Rebating: The practice (illegal in most states) of giving an insurance applicant anything of value as an inducement to purchase or renew an insurance policy.
Referral: Primary care physician-directed transfer of a patient to a specialty physician or specialty care.
Referral Pool: Capitation set-aside for referrals or inpatient medical services. If utilization targets are met at the end of the year, primary care physicians may share what is left in the pool.
Rehabilitation: Process and goal of restoring a disabled insured person to maximum physical, mental, and vocational independence and productivity commensurate with their limitations.
Reinsurance: The transfer of part of the insurance risk to another insurer or insurers--self-funded plans generally buy specific and/or aggregate stop-loss coverage to cover losses in excess of certain limits (also known as excess loss coverage). (See Attachment Point)
Reserves: A specific amount of money pre-funded and set aside to assure adequate funds to cover future claims. Both insurance companies and self-insured employers must "reserve" in order to preserve cash flow and protect solvency.
Resource-Based Relative Value Scale (RBRVS): Developed by the Health Care Financing Administration (HCFA) of the federal government to redistribute physician payments more adequately to encourage the use of PCP services. The amount of resources devoted to produce a health care service serve as the basis for the fee that is paid.
Retention: The portion of the insurance premium which is allocated for expenses, administration, commissions, risk charges and profit.
Retrospective Claim Review: Examination of claim data after completion of medical services to assess appropriateness of care or reimbursement for services.
Rider (Exclusion): An amendment to insurance contracts limiting, or excluding an existing coverage for certain conditions. For example, a rider to a policy may exclude coverage for treatment to an applicant's knee.
Risk: Chance of incurring financial loss by an insurer or provider.
Risk Adjustment: Correction of capitation or fee rates based upon factors that can cause an increase in medical costs such as age or sex.
Risk Contract: See Medicare Risk Contact.
Risk Sharing: Apportionment of chance of incurring financial loss by insurers, managed care organization, and health care providers.
Second Surgical Opinions: Utilization control to determine appropriateness of surgery by a second provider source.
Self-Insurers: Employers, businesses, and other entities that chose to assume the responsibilities of an insurance company to insure their beneficiaries.
Self-Funding: An arrangement under which all or some of the risk associated with providing coverage is not covered by an insurance contract.
Self-Referral: Choice by the insured or patient of medical specialists or specialty services without need for primary care physician or health plan controls.
Service Area: A geographic area of operation for a managed care entity.
Set Aside: See Withdrawal Arrangements
Seventy-five/twenty-five (75/25) Rule: HMOs participating in the Medicaid program are required to limit Medicaid and Medicare recipients to no more that 75 percent of enrollees and to draw at least 25 percent of their enrollees from the private sector. This "75/25" is imposed to ensure that care provided to Medicaid enrollees is comparable to that provided to enrollees with private insurance.
Skilled Nursing Facilities: Institution providing the degree of medical care required from, or under the supervision of, a registered nurse or a physician.
Social Security Act: Law under which the federal government operates the Old Age, Survivors, Disability, and Health Insurance Program (OASDHI).
Specialty Managed Care Arrangements: Those group practices and organizations of providers who contract with managed care organizations to provide non primary-care medical services.
Specialty Physicians: Those physicians practicing in areas other than internal medicine, family practice, or pediatrics.
Specified Disease Insurance: Specified disease insurance, which is not available in some states, provides benefits for only a single disease, such as cancer, or for a group of specified diseases. The value of such coverage depends on the chance you will get the specific disease or diseases covered. Benefits are usually limited to payment of a fixed amount for each type of treatment.
Specified Low-Income Medicare Beneficiary (SLMB): Persons entitled to Medicare Part A whose incomes are slightly higher than the National Poverty Level. Your income cannot exceed the National Poverty Level by more than 20 percent.
Spend Down: See Divestment
Staff Model HMO: HMO that owns the clinical facilities used by patients enrolled in the HMO. The HMO directly employs the physicians providing service and they provide service only to patients enrolled in the HMO plan.
Stakeholders: Those with a stake in the cost and quality of health care services, including patients, employers, providers, and government.
Stop-Loss Insurance: Protection purchased by self-insured and some managed care arrangements against the risk of large losses or severe adverse claim experience.
Subacute Care: Health care services that are less intense than hospital care but more intense than skilled nursing home services.
Supplementary Coverage: Insurance to help cover those parts of Medicare Part B that are non-reimbursable.
Third-Party Administrator (TPA): Method by which an outside person or firm, not a party to a contract, provides specific administrative duties (including premium accounting, claims review and payment, arranges for utilization review and stop-loss coverage) for a self- funded plan. Entity may also handle payment of claims.
Tort Reform: The purpose of reform is to eliminate unnecessary practices and testing which are performed defensively by a physician with little or no value to the person seeking treatment. It may also include reasonable limits placed on non-economic damages paid to a patient or beneficiary.
Total Disability: Generally, a disability that prevents insureds from performing all occupational duties.
Trend Factor: The percentage of increase used by an insurance company or plan to reflect the projected rise in health care costs. Calculation factors also include inflation, utilization, technology and geographic area.
Triggers: Data point or indicator that suggests further study or review. Also refers to the assessments conducted by a licensed health care practitioner to determine eligibility for private long term care insurance benefits.
Triple Option Plan: An employer plan that usually offers an insured an opportunity to choose between an indemnity HMO or PPO level of benefits at time of claim.
Twenty-four (24-hour) Coverage: Any combination of traditional health insurance and workers' compensation insurance that attempts to dissolve the occupational and non-occupational boundaries between the two coverages.
Unbundled: Health services or benefits that are a stand-alone or carved-out benefit under a separate contract or bill.
Unbundling: To increase the reimbursement paid by a plan or insurance contract, each medical procedure is billed under a separate code as a separate item, instead of part of one overall procedure.
Underwriters: Insurance professionals who determine if and on what basis an insurer will accept an application for insurance.
Usual, Customary, and Reasonable (UCR) Fees: Charges of health care providers that are consistent with charges from similar providers for identical or similar services in a given locale.
Utilization: Patterns of usage for single medical service or type of service (hospital care, prescription drugs, physician visits). Measurement of utilization of all medical services in combination usually is done in terms of dollar expenditures. Use is expressed in rates per unit of population at risk for a given period, such as number of annual admissions to a hospital per 1,000 persons over age 65.
Utilization Review (UR): Programs designed to reduce unnecessary medical services, both inpatient and outpatient. Utilization reviews may be prospective, retrospective, concurrent, or in relation to discharge planning.
Waiting Period: Date of hire and the employees eligibility to qualify for a plan of insurance or if already insured that time period before one is eligible for benefits (i.e. elimination period).
Waivers: Term usually associated with the Medicare or Medicaid programs by which the government waives certain regulations or rules for a managed care or insurance program to operate in a certain geographic area. Can also relate to exclusions in life and disability insurance (reference "Rider").
Waiver of Premium: A provision in a plan or insurance contract, which relieves the insured of paying premiums while totally disabled or also when receiving care for nursing home benefit and sometimes HHC.
Withhold Arrangements: Portion of a provider's salary, fees, or capitation that is held back until performance in relation to quality and utilization are examined at the end of each year. If performance was at least satisfactory, withholds are released to the provider.
Workers Compensation Insurance: Programs mandated by the states, which requires employers to provide liability insurance coverage and pay benefits to dependents of employees killed to compensate for work related injuries or disabilities.
Wrap-Around Coverage: Programs of HMOs that, in some states, were prevented by state law from taking on financial risk for out-of-plan care and joined with insurers to cover the out-of-plan portion of care. Such programs led to the development of point-of-service (POS) plans.


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This is part of my series of interesting newspaper articles and snippets that I find in the old Latvian newspapers available through Periodika. Most of the articles I post are in some way related to migration, wars or other events that are of particular genealogical note.
Source: StrÄdnieku AvÄ«ze (Workers' Newspaper), April 7, 1923
Escaped from a ship's command. The following ship workers deserted from the steamship "Estonia" when it was in a New York port: JÄnis Strazdiņš, Adolfs Freimanis, Augusts RudzÄ«tis, Bruno Freimanis, Staņislavs VodeiÅ¡o, Staņislavs Papirtis, Aleksandrs Dovkants, Ludwigs Zvagulis, Ernests KreiÅ¡manis, Adolfs Eilenbergs, Adolfs Kleins and Reinholds Baburs. By order of the captain, if the deserters return to Latvia, they will be held to account for their actions.
One has to wonder – why did these ship workers desert the Estonia, a ship that travelled from LiepÄja to New York during the 1920s? I am particularly interested in finding answers, since the last man mentioned, Reinholds Baburs, is very likely to be my great-great-grandmother Karline Matilde Baburs' cousin. Baburs is an extremely uncommon name in Latvia, and the ages fit with a Reinholds Baburs I have a record of.
I looked up the ship manifest on Ellis Island, and this is what I found about the twelve men, in the same order as mentioned in the article – their jobs, their ages, and their years of service at sea.
- JÄnis Strazdiņš – Cooks' mate, 27, 7 years service
- Adolfs Freimanis – Mess boy, 30, 1/2 year service
- Augusts RudzÄ«tis – Mess boy, 42, 9 years service
- Bruno Freimanis – Mess boy, 33, no years of service
- Staņislavs VodeiÅ¡o – Waiter, 45, 2 years service
- Staņislavs Papirtis – Waiter, 25, 4 years service
- Aleksanders Dovkants – Musician, 33, 1 year service
- Ludwigs Zvagulis – Musiker, 37, 1/2 year service
- Ernest KreiÅ¡manis – Electrical Assistant, 39, 12 years service
- Adolfs Eilenbergs – Kitchen boy, 24, 8 years service
- Adolfs Kleins – Waiter, 41, 1/2 year service
- Reinholds Baburs – Music Conductor, 41, 2 1/2 years service
The manifest mentions four other deserters as well, but those four were not Latvian citizens, so hence why they probably weren't mentioned in a Latvian newspaper.
Looking at their ages, and the average time at sea – one really has to wonder why they left the ship. The conditions must have been extremely harsh to get people who have had as many years of service as some of them have to desert – I'm sure that could affect future job prospects. And why would two musicians and a conductor desert a ship if there were bad conditions? Could they have not pursued a career on land? I'm very curious.
Then the next question – did they leave as a group, or individually? Did they know that the others were planning it too? How common was desertion from ships in this era? That is a question I want to answer.
Furthermore – did any of these men ever return to Latvia? I found a newspaper article that mentions a Reinholds Baburs selling land in Preiļi parish in 1935, but that doesn't say anything about his age, so I don't know if he is the same Reinholds Baburs. Not to mention such a sale could potentially take place without him being there. So did he ever return? If so, what was his punishment? Or do I have some unknown distant relatives somewhere in the United States? I'm curious to know! So if you happen to be descended from Reinholds Baburs – or any of these crewmen, for that matter – do let me know what happened to them!

subset: commoncrawl


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Although The Poi Company, Inc. closed its doors in May of 2002, I still get frequent e-mail messages: "Where can I buy poi? I live near Wilmington, Delaware."
We didn't succeed in bringing Poi to the World. I personally maintain this website to at least bring the poi message to the world. The various Google ads you see on the right of this page (and others) just about pay for the cost of hosting the website. If any of the Google links are of interest to you, please click on them. In doing so, you will help to keep this website going.
There is always dehydrated poi, made by Taro Brand. It can be ordered on their website, and can be stored for ultimate use. Personally, I never liked the stuff. I thought it tasted like they'd dried out sour poi: but I don't know how they make the stuff. If you're having a luau for mainland guests, and they probably won't like poi anyway, the dehydrated stuff is fine. It will look the part, your guests can try a little bit and go "yuck," and all will be well.
If you want poi that really tastes like poi, or if your guests know what poi should taste like, you'll probably need to get fresh poi. You can order this online from Hanalei Poi on Kauai.
If you live near San Mateo, California, you should be able to get poi on certain days of the week from Takahashi Market. (If you speak with Gene Takahashi, tell him Craig said "aloha.")
We have recently heard that Haleiwa Poi apparenlty now makes a powdered poi that reconstitutes well. Please see the separate article.
If you have any poi recipes you'd like to share, please e-mail me and I'll post them on the website. And if you have updated knowledge about how to get poi, please let me know and I will also post this.
And if you want to decorate your Christmas tree with poi bags stuffed with shredded purple cellophane (with credit to our friend, Saundra Smith) here's what you do:
Copyright 1998-2009 by Craig W Walsh Top of Page


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Experience improved vitality, physical and mental strength & flexibility, and greater self awareness with Power Yoga.
Power Yoga, aka Power Vinyasa or Vinyasa Flow, is an invigorating, dynamic style of modern yoga practice.
Practiced in a warm room, this well balanced class starts at a moderate-fast pace and flows through a succession of warming and strengthening poses, before slowing down to move through a range of floor-based postures, always finishing in savasana (relaxation). Taught with an emphasis on safe anatomical alignment (including optional modifications), effective breathing, and personal empowerment, this is an accessible and stimulating class for both new and experienced students.
So bring your mat*, towel and water bottle and get ready to move, sweat and reconnect through an energising 60 minute flow.
What Are the Benefits of Power Yoga?
- Increases flexibility, strength, and stamina
- Power yoga is low impact, but highly effective
- Improves posture and reduces back pain
- Provides an alternative method for strengthening your bones
- Power yoga promotes weight loss
- Improves your mood
- Improves self-image and helps confidence
- Helps you de-stress
- Can improve your quality of sleep
- Improves concentration and memory


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Another jump in prices tightens the squeeze on US consumers
Published 11:13 am Thursday, June 10, 2021
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WASHINGTON — American consumers absorbed another surge in prices in May — a 0.6% increase over April and 5% over the past year, the biggest 12-month inflation spike since 2008.
The May rise in consumer prices that the Labor Department reported Thursday reflected a range of goods and services now in growing demand as people increasingly shop, travel, dine out and attend entertainment events in a rapidly reopening economy.
The increased consumer appetite is bumping up against a shortage of components, from lumber and steel to chemicals and semiconductors, that supply such key products as autos and computer equipment, all of which has forced up prices. And as consumers increasingly venture away from home, demand has spread from manufactured goods to services — airline fares, for example, along with restaurant meals and hotel prices — raising inflation in those areas, too.
In its report Thursday, the government said that core inflation, which excludes volatile energy and food costs, rose 0.7% in May after an even bigger 0.9% increase in April, and has risen 3.8% over the past year. That is the sharpest 12-month jump in core inflation since 1992. And it is far above the Federal Reserve's 2% target for annual price increases.
Among specific items in May, prices for used vehicles, which had surged by a record 10% in April, shot up an additional 7.3% and accounted for one-third of May's overall price jump. The price of new cars, too, rose 1.6% — the largest one-month increase since 2009.
The jump in new and used vehicle prices reflects supply chain problems that have caused a shortage of semiconductors. The lack of computer chips has limited production of new cars, which, in turn, has reduced the supply of used cars. As demand for vehicles has risen, prices have followed.
But higher prices were evident in a wide variety of categories in May, including household furnishings, which rose 0.9%, driven by a record jump in the price of floor coverings. Airline fares rose 7% after having increased 10.2% in April. Food prices rose 0.4%, with beef prices jumping 2.3%. Energy costs, though unchanged in May, are still up 56.2% in the past year.
From the cereal maker General Mills to Chipotle Mexican Grill to the paint maker Sherwin-Williams, a range of companies have been raising prices or plan to do so, in some cases to make up for higher wages they're now paying to keep or attract workers. This week, for example, Chipotle Mexican Grill announced it was boosting menu prices by roughly 4% to cover the cost of raising its workers' wages. In May, Chipotle had said that it would raise wages for its restaurant workers to reach an average of $15 an hour by the end of June.
Andrew Hunter, a senior U.S. economist at Capital Economics, noted that the price category that covers restaurant meals jumped 0.6% last month. He took that as evidence that labor shortages at restaurants, hotels and other service sector companies are beginning to fuel wage and price increases.
The inflation pressures are not only squeezing consumers but also posing a risk to the economy's recovery from the pandemic recession. One risk is that the Fed will eventually respond to intensifying inflation by raising interest rates too aggressively and derail the economic recovery.
The central bank, led by Chair Jerome Powell, has repeatedly expressed its belief that inflation will prove temporary as supply bottlenecks are unclogged and parts and goods flow normally again. But some economists have expressed concern that as the economic recovery accelerates, fueled by rising demand from consumers spending freely again, so will inflation.
The question is, for how long?
"The price spikes could be bigger and more prolonged because the pandemic has been so disruptive to supply chains," said Mark Zandi, chief economist at Moody's Analytics. But "by the fall or end of the year," Zandi suggested, "prices will be coming back to earth."
That would be none too soon for consumers like Carmela Romanello Schaden, a real estate agent in Rockville Centre, New York. Schaden said she's having to pay more for a range of items at her hair salon. But she is feeling the most pain in the food aisle. Her monthly food bill, she said, is now $200 to $250 for herself and her 25-year-old son — up from $175 earlier in the year.
A package of strip steak that Schaden had normally bought for $28 to $32 jumped to $45. She noticed the increase right before Memorial Day but bought it anyway because it was for a family picnic. But she won't buy it again at that price, she said, and is trading down to pork and chicken.
"I've always been selective," Schaden said. "When something goes up, I will switch into something else."
So far, Fed officials haven't deviated from their view that higher inflation is a temporary consequence of the economy's rapid reopening, with its accelerating consumer demand, and the lack of enough supplies and workers to keep pace with it. Eventually, they say, supply will rise to match demand.
Officials also note that year-over-year gauges of inflation now look especially large because they are being measured against the early months of the pandemic, when inflation tumbled as the economy all but shut down. In coming months, the year-over-year inflation figures will likely look smaller.
Kathy Bostjancic, an economist at Oxford Economics, a consulting firm, suggested that that the effect of these so-called "base effects" will start to recede next month and that year-over-year measures of inflation should, too.
"This will be the peak in the annual rate of inflation," Bostjancic said in a research note. "While we share the Fed's view that this isn't the start of an upward inflationary spiral, we look for inflation to remain persistently above 2% through 2022."
Indeed, the government's month-to-month readings of inflation, which aren't subject to distortions from the pandemic, have also been rising since the year began. Some economists say they fear that if prices accelerate too much and stay high too long, expectations of further price increases will take hold.
That, in turn, could intensify demands for higher pay, potentially triggering the kind of wage-price spiral that bedeviled the economy in the 1970s.
Investors so far appear unfazed by the risks of higher inflation. On Thursday, yields in the bond market declined in the hours after the government reported the surge in consumer prices. And stock prices rose.
For now, though, rising commodity costs are forcing Americans to pay more for items from meat to gasoline. Prices for corn, grain and soybeans are at their highest levels since 2012. The price of lumber to build homes is at an all-time high. More expensive commodities, such as polyethylene and wood pulp, have translated into higher consumer prices for toilet paper, diapers and most products sold in plastic containers.
General Mills has said it's considering raises prices on its products because grain, sugar and other ingredients have become costlier. Hormel Foods has already increased prices for Skippy peanut butter. Coca-Cola has said it expects to raise prices to offset higher costs.
Kimberly-Clark, which makes Kleenex and Scott toilet paper, said it will be raising prices on about 60% of its products. Proctor & Gamble has said it will raise prices for its baby, feminine and adult care products.
"There is stronger demand for hotel rooms, air travel, restaurant dining," said Gus Faucher, chief economist at PNC Financial. "Many businesses are also facing upward pressure on their costs such as higher wages."


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This is the Dutch edition of the diary. Other languages are available under "Diary".
Anne Frank keeps her diary from 12 June 1942 to 1 August 1944. In the over two years of her being in hiding, she fills a number of notebooks. In 1947 her father Otto Frank publishes the diaries. It would become one of the best-read books in the world.
Anne Frank's reports of her personal thoughts and the ups and downs of those in hiding are honest and at times amusing. In the eyes of Otto Frank some of the passages were too candid. Therefore, he left them out of his version of the diaries.
In this version, Anne Frank's writing style has been largely left unaltered. Besides this, a long passage dated 8 February 1944 has been added to the end of the already existing entry of that date. Furthermore, in line with recent findings, the entry of 7 November 1942 has been moved to 30 October 1943.


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- Kenneth M. Franasiak, chairman and CEO, Calamar, Wheatfield, New York
- Gale Epstein, president and creative director, Hanky Panky, New York City
- Rick Lewandowski, founder and board member, Prism Solar Technologies, Highland, New York
The Council, composed of executives and presidents from small businesses, including those which are agricultural-based, meets three times a year to advise the New York Fed president and first vice president on economic and financial conditions in the Second District.
"Members of the Advisory Council on Small Business and Agriculture provide us with valuable real time information on the current conditions faced by small businesses in our community," said William C. Dudley, president and chief executive officer of the Federal Reserve Bank of New York. "Understanding the business environment helps inform the formulation of effective central bank policy. We are very thankful for the members' participation."
Council members serve three-year terms and meet with the Bank's senior leadership three times per year. The Council last met on November 15, 2010, and is scheduled to meet next in March .
Media Relations


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Advanced Search
Microsoft's court loss to i4i LP has spawned a make-shift tool to check for patent-infringing technology in Word files.
The free tool can be used to scan .DOCX and .DOCM Word files. It generates a log file that lists "custom XML" code references in the Word files. The unsupported tool is described by Gray Knowlton, a Microsoft product management team leader for Office developers, and it can be downloaded at his blog page here.
Custom XML is a term used by Microsoft to describe user-defined schemas in XML, according to the inventor of the technology, Michel Vulpe, founder and CTO of i4i. Microsoft was enjoined from selling copies of Office 2007 and Office 2003 that use this technology after Jan. 10, according to a court decision, which was upheld on appeal.
The scanning tool may be just for the morbidly curious. Existing users of Office 2007 and Office 2003 do not have to stop using those products, nor do they even have to care that custom XML code is used in those products. Those who buy Office products today however will use updated technology, or they will be prompted by Microsoft to apply a patch that avoids the infringing technology.
"The documents identified by the tool as containing custom XML markup are themselves not affected by the ruling, and require no action on your part," Knowlton explained in the blog. "What positive scan results will indicate are documents that will behave differently when opened in patched and unpatched versions of Office."
Knowlton added that the tool can be used to help determine "possible areas of impact for your specific IT environment."
In other posts in his blog, Knowlton explained that the custom XML technology can also be identified by "pink tags" that show up around the tagged content. The court's judgment against Microsoft doesn't apply to ECMA and ISO/IEC standards for Office Open XML, according to Knowlton.
"Even if Word's specific implementation of custom XML support does infringe the i4i patent (which Microsoft does not believe to be the case), i4i has never claimed that its patent is essential to the OXML standard," Knowlton wrote in his blog. Microsoft is currently seeking a rehearing of the i4i case.
Some news accounts reported that copies of Office 2007 and Office 2003 were removed from store shelves after the Jan. 10 injunction date. However, the Microsoft Store in Mission Viejo, Calif. currently stocks all editions of the products, according to a "store associate" via telephone. Possibly, there's disruption in ordering the products online. An attempt to order full editions of Office 2007 from Microsoft's online store produced a "temporarily out of stock" message. However, a check at Amazon.com showed the products to be in stock.
About the Author
Kurt Mackie is senior news producer for 1105 Media's Converge360 group.
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What did forecasters learn during the European sovereign debt crisis about the impact of fiscal policies on economic growth?
5 September 2018
By Lucyna Górnicka, Christophe Kamps, Gerrit Koester and Nadine Leiner-Killinger[1]
Economists often try to forecast whether the economy as a whole will grow or contract. When measuring the effects of fiscal policy measures on economic activity, such forecasts are based on so-called multipliers. Using a new dataset compiled from economic forecasts and recommendations by the European Commission under the excessive deficit procedure of the Stability and Growth Pact, we derive the multipliers that were assumed by forecasters during the European sovereign debt crisis to project the effects of fiscal consolidation on economic growth. Our results confirm that forecasters adapted their assumptions on multipliers as the crisis progressed and accounted for larger effects of consolidation on growth later on in the crisis. Another finding is that the actual fiscal multipliers were not exceptionally large during the crisis.
As is well known, from 2008 the euro area was faced with a financial crisis, and national government debts increased to often unprecedented levels. In order to deal with this crisis-induced increase in debt, as of 2010 many euro area countries embarked on a process known as fiscal retrenchment, i.e. raising taxes and/or cutting public services. The crisis reignited a controversial debate on the impact of fiscal policies – the use of taxes and government spending to influence the overall economy – on economic growth. The fact that the impact of fiscal policies on growth is not directly observable but has to be estimated lies at the heart of this debate. Forecasters usually try to estimate the effects of fiscal measures on growth using the so-called fiscal multiplier. This measures the effect of a €1 change in government spending or a €1 change in taxes on economic activity as measured by GDP.
At the height of the sovereign debt crisis in 2011 and 2012, GDP growth was much lower than forecasters had expected – especially in the countries worst hit by the crisis. In an influential contribution to the policy debate at the time, two economists, Olivier Blanchard and Daniel Leigh, argued that the forecast errors came about largely because forecasters had underestimated the feedback effects of fiscal consolidation on economic growth – in other words, forecasters underestimated fiscal multipliers.[2] At the same time, Blanchard and Leigh (2013, 2014) found that the underestimation of these negative feedback effects declined in the later years of the crisis. They conjectured that this reflected at least in part the lessons learned by forecasters in the course of the crisis about the size of fiscal multipliers.
In a recent paper of our own, we test this hypothesis. We identify the fiscal multipliers used by forecasters at the European Commission during the sovereign debt crisis between 2009 and 2015 and investigate their role in explaining forecast errors during consolidation episodes. We find that the forecasters did indeed adjust their assumptions about the impact of fiscal retrenchment on growth to incorporate a larger negative impact as the crisis progressed.
A new dataset
One of the strengths of our paper — and one of its advantages over the papers by Blanchard and Leigh — is its use of a new dataset. Our dataset is new in that it combines the two forecast scenarios published by the European Commission when conducting its surveillance of fiscal policies in the European Union (EU): the regular forecasts and the forecasts made under the excessive deficit procedure (EDP). In the regular Commission forecasts, the economic outlook is based on the assumption that no fiscal consolidation measures will be undertaken beyond those already legislated for. In the forecasts under the EDP, the Commission specifies the size of the additional fiscal consolidation that would be recommended to reduce an excessive deficit to below the 3% of GDP threshold by a certain year.[3] We then compare the two forecasts. With a limited number of assumptions, it is possible to calculate the fiscal multipliers for individual countries and years as applied by the forecasters at the European Commission. It transpires that all EU Member States except Estonia, Luxembourg and Sweden were under the EDP at the height of the sovereign debt crisis. For this reason, we could derive the fiscal multipliers as actually applied by the European Commission for almost all EU Member States in the period 2009-15.
Learning effects
What do our results show? They show that forecasters definitely learned from the crisis. This can be seen from the increases they made to the fiscal multipliers used in the European Commission's recommendations. By how much did their multipliers increase? In the early years of the crisis, between 2009 and 2011, the recommendations were based on assumptions of a fiscal multiplier of around 1/4 on average, that is, below what forecasters often consider to be the "standard" value of 1/2. By contrast, later on in the crisis, between 2012 and 2015, most forecasts under the EDP were based on fiscal multiplier assumptions that were much higher than this level at around 2/3. As shown in Chart 1, 18 EDP forecasts issued in the second half of 2009 are based on an ex ante implicit fiscal multiplier of around 0.1. The five EDP forecasts issued in the first half of 2010 are based, on average, on an even lower implicit fiscal multiplier of close to 0. These low implicit fiscal multipliers reflect the implicit assumption at the beginning of the crisis that fiscal retrenchment would have only very limited negative effects on growth – if any. In fact, given that the private sector was concerned about the state of public finances in the light of soaring deficit and debt levels, fiscal tightening was expected by some to raise confidence and ultimately growth.[4] As the crisis continued, however, it became obvious that fiscal adjustment had had a more negative impact on growth in the early years of the crisis than anticipated. Therefore, it is likely that the broad-based rise in implicit fiscal multipliers during the later years of the crisis reflects the fact that, as previously posited by Blanchard and Leigh, forecasters did indeed learn as the crisis progressed.
Chart 1: Ex ante fiscal multipliers in EDP recommendations issued by the ECOFIN Council between 2009 and 2015 (number of EDP recommendations indicated above columns)
Note: EDP recommendations issued by the ECOFIN Council. The y-axis reflects the average size of the fiscal multiplier across all the EDP recommendations issued. For the second half of 2010, the average multiplier excludes the outlier, Finland, for which the EDP is based on an implicit multiplier of close to 2. No new EDP recommendations were issued in 2011. The data is depicted on a half-yearly basis for the early years of the crisis (from the first half of 2009 to the second half of 2011) to reflect the fact that recommendations under the EDP were issued throughout the year, which was not always the case in the later years under consideration.
Source: European Commission, own calculations.
Implications for the estimation of "true" ex post fiscal multipliers
What can these findings tell us about the – unobservable – "true" ex post fiscal multipliers, that is, the actual impact that fiscal retrenchment had on growth during the sovereign debt crisis? To infer something about the "true" ex post fiscal multipliers, Blanchard and Leigh start from two hypotheses: first, fiscal forecasters applied a "standard" fiscal multiplier of 0.5 in their projections; and, second, lower than initially projected growth indicates the extent to which this "standard" fiscal multiplier underestimated the actual impact of governments' fiscal consolidation plans on growth. They conclude for a country sample broadly comparable to ours and across forecasts by different international institutions that multipliers were markedly above 1, implying that each euro of fiscal consolidation reduced output by more than this amount.
Does our analysis of information contained in the EDP recommendations support these findings that the "true" ex post fiscal multipliers are higher than expected? Not quite. We find that the "true" ex post multiplier remained below 1 at the height of the crisis. As argued by Blanchard and Leigh, our analysis shows that the impact of fiscal retrenchment on growth was indeed larger than initially assumed by forecasters. But we show that their initial assumption at the time was not what experts consider "standard", but markedly below that. These very optimistic beliefs regarding the limited impact of consolidation on growth indeed imply that their "true" impact was larger, but not by as much as Blanchard and Leigh posit.
Our analysis benefited from the European Commission's increased transparency regarding the fiscal policy recommendations that are issued to EU Member States under the EDP. More transparency regarding the applied fiscal multipliers would generally enhance the impact of forecasting by international institutions and thus, ultimately, improve policy-making.
Alesina, A. and Ardagna, S. (2010), "Large Changes in Fiscal Policy: Taxes versus Spending", Tax Policy and the Economy, Vol. 24(1), pp. 35-68.
Blanchard, O. and Leigh, D. (2013), "Growth Forecast Errors and Fiscal Multipliers", American Economic Review Papers and Proceedings, Vol. 103(3), pp. 117-120.
Blanchard, O. and Leigh, D. (2014) "Learning about Fiscal Multipliers from Growth Forecast Errors", IMF Economic Review, Vol. 62 (2), pp. 179-212.
Gornicka, L., Kamps, C., Koester, G. and Leiner-Killinger, N. (2018) "Learning about fiscal multipliers during the European sovereign debt crisis: evidence from a quasi-natural experiment", ECB Working Paper Series, No. 2154, Frankfurt am Main.
- Disclaimer: This article was written by Lucyna Gόrnicka (Economist, International Monetary Fund), Christophe Kamps (Head of Division, Directorate General Economic Developments, European Central Bank), Gerrit Koester (Principal Economist, Directorate General Economic Developments, European Central Bank) and Nadine Leiner-Killinger (Principal Economist, Directorate General Economic Developments, European Central Bank). It is based on a paper entitled "Learning about fiscal multipliers during the European sovereign debt crisis – evidence from a quasi-natural experiment" by L. Gόrnicka, C. Kamps, G. Koester and N. Leiner-Killinger. The authors gratefully acknowledge the comments of Jacopo Cimadomo, Paul Dudenhefer, Geoff Kenny, Sander Tordoir and Leopold von Thadden. The views expressed here are those of the authors and do not necessarily represent the views of the European Central Bank and the Eurosystem.
- Blanchard and Leigh's findings first appeared in 2013 in a short paper in the American Economic Review, one of the top journals in the field of economics. An expanded version of the paper was published in the IMF Economic Review in 2014. In the short paper, Blanchard and Leigh conducted their analysis primarily for the IMF forecasts. They also reported results for other forecasters, including the European Commission.
- The EDP scenario does not prescribe to what extent the recommended consolidation effort is to be distributed across government expenditure and revenue measures.
- This was the conclusion of a study published in 2010 by Alberto Alesina and Silvia Ardagna.
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Mishawaka Channel Letters
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Great read from anabolic minds
The Press from thread 'What Causes Shin Splints?':
By Jeremey DuVall, M.S., CPT Men's Fitness
Dedicated runners and weekend warriors alike can attest to the annoyance of shin splints. After a few weeks of pounding the pavement, a small pain may develop in the front side of the shin. In a few short runs, that tiny pain may turn into a larger injury, eventually putting a halt to your training. With shin splints being such a common injury, its important to know the cause and methods for recovery and prevention to keep you healthy and on the roads.
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To stay healthy and on the roads, its important to approach your training program with a cautious mindset. Joe advises, Runners should be keeping a training log to stay in tune with how far they are running and how often. Otherwise, it's easy to log too many miles too quickly or ignore recovery. Other than simply monitoring mileage, proper footwear and strength are also crucial to staving off shin pain. Choose a pair of running shoes that combines the proper amount of cushioning and support. In most cases, its best to head to your local running store for a gait analysis to determine the best shoe for you. Outside of gearing up, it pays to help strengthen the muscles in your feet and surrounding your ankle to handle the pounding of running. Joe suggests jumping rope, especially single leg skips, to strengthen the ankle and foot. Running on softer surfaces like grass or trails can also help to soften the blow on each footfall as opposed to concrete. When all else fails, rest and ice are your primary resources for healing quickly and getting back to your normal training schedule.


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On May 19, 2005, NASA's Mars Exploration Rover Spirit captured this stunning view as the Sun sank below the rim of Gusev crater on Mars. This Panoramic Camera mosaic was taken around 6:07 in the evening of the rover's 489th Martian day, or sol.
Sunset and twilight images are occasionally acquired by the science team to determine how high into the atmosphere the Martian dust extends, and to look for dust or ice clouds. Other images have shown that the twilight glow remains visible, but increasingly fainter, for up to two hours before sunrise or after sunset. The long Martian twilight (compared to Earth's) is caused by sunlight scattered around to the night side of the planet by abundant high altitude dust. Similar long twilights or extra-colorful sunrises and sunsets sometimes occur on Earth when tiny dust grains that are erupted from powerful volcanoes scatter light high in the atmosphere.
Image Credit: NASA/JPL/Texas A&M/Cornell


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