Monday, November 12, 2012

What is Yoga?

The word yoga is often interpreted as "union" or a method of discipline from the Sanskrit word "yuj" (to yoke or bind). A male practitioner is called a yogi, a female practitioner, a yogini. The Postures ....

The contemporary western approach to yoga is not based on any particular belief or religion, however Yoga does has its roots in Hinduism and Brahmanism. Yoga was developed by seers or ascetics living primarily in the southern parts of India. The seers observed nature and lived as close as they could to the earth, studying the many aspects of nature, the animals and themselves. By observing and emulating the different postures and habits of the animal kingdom they were able to develop grace, strength and wisdom.

It was through these very disciplined lives that the practice of the yoga postures were developed. It was necessary to develop a series of postures to keep the body lithe and able to endure long periods of stillness when in meditation. The Writings ....

Brahmanism dates back to containing sacred scriptures called "the Vedas". These scriptures contained instructions and incantations. It was in the oldest text "Rg-Veda" from the scriptures that the word Yoga first appeared, this was nearly 5000 years ago. The fourth text called "Atharva-Veda" contains mainly spells for magical rites and health cures many of which use medicinal plants. This text provided the average person with the spells and incantations to use in their everyday life and this practice of "Veda" can still be seen in the streets of India today. The Bhagavad-Gita, another ancient work on spiritual life describes itself as a yoga treatise, although it uses the word Yoga as a spiritual means. It was from this literature that Patanjali's "eight limbs of yoga" were developed. Yoga Sutra's are primarily concerned with developing the "nature of the mind" and I will explain more of this in the next section.

The Breadth ....

The vratyas, a group of fertility priests who worshipped Rudra, god of the wind would attempt to imitate the sound of the wind through their singing. They found that they could produce the sound through the control of their breath and through this practice of breath control was formed "Pranayama". Pranayama is the practice of breath control in yoga.

The Paths ....

The Upanishads, which are the sacred revelations of ancient Hinduism developed the two disciplines of karma yoga, the path of action and jnana yoga, the path of knowledge. The paths were developed to help the student liberate from suffering and eventually gain enlightenment. The teaching from the Upanishads differed from that of the Vedas. The Vedas demanded external offerings to the gods in order to have an abundant, happy life. The Upanishads through the practice of Karma yoga focused on the internal sacrifice of the ego in order to liberate from suffering. Instead of the sacrifice of crops and animals (external) it was the sacrifice of the inner ego that would become the basic philosophy, thus yoga became known as the path of renunciation.

Yoga shares some characteristics also with Buddhism that can be traced back through history. During the sixth century B.C., Buddhism also stresses the importance of Meditation and the practice of physical postures. Siddharta Gautama was the first Buddhist to actually study Yoga.

What is Yoga Sutra and how did the Philosophy of Yoga develop?

Yoga Sutra is a compilation of 195 statements which essentially provide an ethical guide for living a moral life and incorporating the science of yoga into it. An Indian sage called Patanjali was believed to have collated this over 2000 years ago and it has become the cornerstone for classical yoga philosophy.

The word sutra means literally "a thread" and is used to denote a particular form of written and oral communication. Because of the brusque style the sutras are written in the student must rely on a guru to interpret the philosophy contained within each one. The meaning within each of the sutras can be tailored to the student's particular needs.

The Yoga Sutra is a system of yoga however there is not a single description of a posture or asana in it! Patanjali developed a guide for living the right life. The core of his teachings is the "eightfold path of yoga" or "the eight limbs of Patanjali" . These are Patanjali's suggestions for living a better life through yoga.

Posture and breath control, the two fundamental practices of yoga are described as the third and fourth limbs in Patanjali's eight-limbed path to self-realisation. The third practice of the postures make up today's modern yoga. When you join a yoga class you may find that is all you need to suit your lifestyle.

The eight limbs of yoga

1. The yamas (restraints),

These are like "Morals" you live your life by: Your social conduct:

o Nonviolence (ahimsa) - To not hurt a living creature

o Truth and honesty (satya) - To not lie

o Nonstealing (asteya) - To not steal

o Nonlust (brahmacharya) - avoid meaningless sexual encounters - moderation in sex and all things.

o Nonpossessiveness or non-greed (aparigraha) - don't hoard, free yourself from greed and material desires

2. niyamas (observances),

These are how we treat ourselves, our inner discipline:

o Purity (shauca). Achieving purity through the practice of the five Yamas. Treating your body as a temple and looking after it.

o Contentment (santosha). Find happiness in what you have and what you do. Take responsibility for where you are, seek happiness in the moment and choose to grow.

o Austerity (tapas): Develop self discipline. Show discipline in body, speech, and mind to aim for a higher spiritual purpose.

o Study of the sacred text (svadhyaya). Education. Study books relevant to you which inspire and teach you.

o Living with an awareness of the Divine (ishvara-pranidhana). Be devoted to whatever is your god or whatever you see as the divine.

3. asana (postures) -

These are the postures of yoga:

o To create a supple body in order to sit for a lengthy time and still the mind. If you can control the body you can also control the mind. Patanjali and other ancient yogis used asana to prepare the body for meditation.

Just the practice of the yoga postures can benefit one's health. It can be started at any time and any age. As we grow older we stiffen, do you remember the last time you may have squatted down to pick something up and how you felt? Imagine as you age into your fifties, sixties, seventies and on being able to still touch your toes or balance on one leg. Did you know that the majority of injuries sustained by the elderly are from falls? We tend to lose our balance as we grow older and to practice something that will help this is surely a benefit.

The fourth limb, breath control is a good vehicle to use if you are interested in learning meditation and relaxation.......

4. pranayama (breathing) - the control of breath:

inhalation, retention of breath, and exhalation

o The practice of breathing makes it easier to concentrate and meditate. Prana is the energy that exists everywhere, it is the life force that flows through each of us through our breath.

5. pratyahara (withdrawal of senses),

o Pratyahara is a withdrawal of the senses. It occurs during meditation, breathing exercises, or the practice of yoga postures. When you master Pratyahara you will be able to focus and concentrate and not be distracted by outward sensory.

6. dharana (concentration), - teaching the mind to focus.

o When concentrating there is no sense of time. The aim is to still the mind e.g. fixing the mind on one object and pushing any thoughts. True dharana is when the mind can concentrate effortlessly.

7. Dhyani (meditation), - the state of meditation

o Concentration (dharana) leads to the state of meditation. In meditation, one has a heightened sense of awareness and is one with the universe. It is being unaware of any distractions.

8. samadhi (absorption), - absolute bliss

o Absolute bliss is the ultimate goal of meditation. This is a state of union with yourself and your god or the devine, this is when you and the universe are one.

All eight limbs work together: The first five are about the body and brain- yama, niyama asana, pranayama, and pratyahara - these are the foundations of yoga and provide a platform for a spiritual life. The last three are about reconditioning the mind. They were developed to help the practitioner to attain enlightenment or oneness with Spirit.

How do you choose the type of yoga right for you?

The type of yoga you choose to practice is entirely an individual preference and thus why we are looking into here to help you start. Some types hold the postures longer, some move through them quicker. Some styles focus on body alignment, others differ in the rhythm and selection of postures, meditation and spiritual realization. All are adaptable to the student's physical situation. You therefore need to determine what Yoga style by your individual psychological and physical needs. You may just want a vigorous workout, want to focus on developing your flexibility or balance. Do you want more focus on meditation or just the health aspects? Some schools teach relaxation, some focus on strength and agility, and others are more aerobic.

I suggest you try a few different classes in your area. I have noticed that even between teachers within a certain style, there can be differences in how the student enjoys the class. It is important to find a teacher that you feel comfortable with to truly enjoy and therefore create longevity in what you practice.

Once you start learning the postures and adapting them for your body you may feel comfortable to do practice at home as well! All yoga types have sequences that can be practiced to work different parts of your body. To A fifteen minute practice in the morning may be your start to the day. Your body will feel strong and lithe within no time and with knowledge, the choice is there for you to develop your own routines.

The Major Systems of Yoga

The two major systems of yoga are Hatha and Yoga Raja Yoga. Raja yoga is based on the "Eight Limbs of Yoga" developed by Pananjali in the Yoga Sutras. Raja is part of the classical Indian System of Hindu Philosophy.

Hatha yoga, also Hatha vidya is a particular system of Yoga founded by Swatmarama, a yogic sage of the 15th centry in India. Swatmarama compiled the "Hatha Yoga Pradipika", which introduced the system of Hatha Yoga. Hatha yoga is derived from a number of different traditions. It comes from the traditions of Buddhism which include the Hinayana (narrow path) and Mahayana (great path). It also comes from the traditions of Tantra which include Sahajayana (spontaneous path) and Vajrayana (concerning matters of sexuality). Within Hatha yoga there are various branches or styles of yoga. This form of yoga works through the physical medium of the body using postures, breathing exercises and cleansing practices.

The Hatha Yoga of Swatmarama differs from the Raja Yoga of Patanjali in that it focuses on Shatkarma, "the purification of the physical" as a path leading to "purification of the mind" and "vital energy". Patanjali begins with "purification of the mind and spirit" and then "the body" through postures and breath.

The Major Schools of Yoga

There are approximately forty-four major schools of Yoga and many others which also lay claim to being Yogic. Some of the major schools are Raja Yoga and Hatha Yoga (as mentioned above). There are also Pranayama Yoga and Kundalini Yoga which stem from Hatha. Jnana, Karma, Bhakti, Astanga and Iyengar stem from Raja.

The Yoga Styles that stem from Hatha include:

Pranayama Yoga

The word pranayama means prana, energy and ayama, stretch. Breath regulation, prolongation, expansion, length, stretch and control describes the action of pranayama yoga. Some Pranayama breath controls are included in the Hatha Yoga practices of a general nature (to correct breathing difficulties).

This school of yoga is entirely built around the concept of Prana (life's energy). There are about 99 different postures of which a lot of these are based around or similar to physical breathing exercises.

Pranayama also denotes cosmic power, or the power of the entire universe which manifests itself as conscious living being in us through the phenomenon of breathing.

Kundalini Yoga

Kundalini yoga is in the tradition of Yogi Bhajan who brought the style to the west in 1969. It is a highly spiritual approach to hatha yoga involving chanting, meditation, breathing techniques all used to raise the kundalini energy which is located at the base of the spine.

The Yoga Styles that stem from Raja include:

Raja Yoga/Ashtanga Yoga

Raja means royal or kingly. It is based on directing one's life force to bring the mind and emotions into balance. By doing so the attention can then be focused on the object of the meditation, namely the Devine. Raja Yoga or Ashtanga Yoga is one of the four major Yogic paths of Hinduism. The others are Karma Yoga, Jnana Yoga and Bhakti Yoga. Raja or Ashtanga are derived from the "eight limbs of Yoga" philosophy composed by Patanjali.

Power Yoga

Power Yoga has been devised through the teachings of Sri K. Pattabhi Jois, a renowned Sanskrit scholar who inspired Western Yogis with his Ashtanga Yoga Style and philosophies. It is therefore often referred to as the western version of India's Ashtanga yoga. Power yoga is vigorous and athletic and is therefore very popular with men. It works with the student's mental attitude and perspective and incorporates the eight limbs of yoga into practice.

Jnana Yoga

Jnana (sometimes spelled "Gnana") means wisdom and a Jnani is a wise man. Sometimes referred to as the" yogi of discernment".

This form of yoga focuses on studying inner life and adhyatmic subjects, the practice of certain relaxations and contemplative, meditative kriyas. The main purpose of jnana meditation is to withdraw the mind and emotions from perceiving life and oneself in a deluded way so that one may behold and live in attunement with reality or spirit. This form of yoga focuses on meditation to work towards transformation and enlightenment.

Karma Yoga

Karma means "action". Karma yoga is based around the discipline of action based on the teachings of Bhagavad Gita, a holy scripture of Hinduism. This yoga of selfless service focuses on the adherence to duty (dharma) while remaining detached from the reward. Karma is the sum total of our acts, both in the present life and in the preceding births.

Bhakti Yoga

Bhaki yoga has many phases to it's practice. Bhaki means "devotion" and Guna Bhaki is to worship according to your nature. A practitioner of Bhakta Yoga is not limited to any one culture or religious denomination, the approach is more to the inner life rather than the wholly devotional. The self within worships the self of the universal nature.

Bhaki yoga is the state of being in contact with our existence and being and the existence and being of all things. It doesn't matter if you believe in something or you don't the only quality is the openness to the mind and heart, unexpected and unknown.

Those who have read about Quantum physics where each and every atom in the universe is connected to the underlying reality will be able to liken this to the philosophy behind Bhaki yoga.

Iyengar Yoga

Iyengar Yoga was developed in India by B.K.S Iyengar, born 14th December, 1918. At the age of 16, he was introduced to yoga by his Guru Sri T. Krishnamacharya. Iyengar Yoga is now one of the most popular styles practiced in the west.

Instructors are very knowledgeable about the anatomy and precise body place for each posture. There is less focus on pranayama or breathing techniques and mediation and thus why the practice is popular in the west.

Iyengar Yoga emphasizes more on the correct placement of the feet to ensure the spine and the hips are in alignment. Iyengar has developed many different props and techniques to cater for individuals in their practice.

Other Styles

Integral Yoga or Purna Yoga Integral yoga is a yoga of synthesis, harmonizing the paths of karma, jnana and bhakti yogas. It was developed by Swami Satchidananda.

It is also considered a synthesis between Vedanta (Indian system of philosophy) and Tantra (Asian beliefs and practices using the principle that the divine energy creates and maintains the universe, channelling the energy within the human microcosm). It also been explained as a synthesis between Eastern and Western approaches to spirituality.

Postures are gentler than other forms of yoga and classes normally end with extended periods of deep relaxation, breathing and meditation. Integral Yoga is an all round approach to hatha yoga.

Sivananda Yoga

Sivananda yoga offers a gentle approach. It includes meditation, chanting and deep relaxation in each session. Students are encouraged to be healthy which includes being vegetarian.

Bikrams Yoga

Bikrams yoga was founded by Bikram Choudhury who was taught by Bishni Ghosh the brother of Paramahansa Yogananda. Bikrams Yoga is taught generally in a room the temperature set between 95 and 105 degrees.

The heat helps soften the muscles and ligaments. There are approximately 26 postures and this yoga produces a real workout because of the heat is quite intense. This yoga therefore places more emphasis on the physical performance of the postures, not the sides of relaxation and meditation.

Some of the Great Teachers...

All styles share a common lineage. The founders of two of the major styles of yoga Raja/Ashtanga and Avenger were all students of the same great teacher named Krishnamacharya. Shri T. Krishnamacharya,was born in the village of Muchukunte, Karnataka State, in 1888. His formal Education, largely in Sanskrit, included Degrees from several universities in North India. He studied for seven years under a distinguished yogi in western Tibet: Rama Mohana Brahmachari who instructed him the therapeutic use of asanas & pranayama. Then he returned to South India and established a school of yoga in the palace of the Maharajah of Mysore. He passed away at the age of 101 years in 1988.

Integral Yoga and Sivananda Yoga were also founded by students of another great teacher named Sivananda. Swami Sivananda Saraswati was born Kuppuswamy in Pattamadai, Tamil Nadu, India. A Hindu by birth, he is a well-known proponent of yoga and vedanta (a principal branch of Hindu philosophy).

He is reputed to have written over 300 books, on these and related subjects, during his life. In 1936 he founded the new religious movement "The Divine Life Society" on the bank of the holy Ganges River. He died on the 14th July, 1963.

So which type is right for you?

These are not all the types of yoga available, however you can see from the short explanations of each that Yoga practice can differ dramatically. Each one makes use of the physical postures and breathing to strengthen the body for meditation, an inherent part of yoga practice. This is where it is important for the student to understand what they want out of their yoga practice and choose a style which will cater for this. If you try one and don't think it is physical enough, try another as it will be totally different. If you start one that is too demanding than again switch around until you find the practice for you.

Some of us want to just work on body and some want more focus on a method of searching for self realisation, whatever the reason I am sure there are enough styles out their and more developing each day to cater for our needs.

You are never too old to start yoga, I have met people in their seventies starting for the first time and experiencing life changing affects. If you've ever sat and watched your cat or dog awake in the morning what is the first thing they do? stretch. If we stop for just a moment and watch what we can learn from nature and the animal kingdom we will realize that just the simple act of stretching has been lost somewhere through our evolution.

The table below shows the rating between 1 and 10 I have given to explain the degree of Physical and degree of Meditation/Relaxation in each Yoga practice (10 being the highest)

Name of Yoga Physical Rating Meditation & Relaxation Rating

Pranayama Yoga 4 8 Kundalini Yoga 6 8 Raja Yoga/Ashtanga Yoga 10 6 Power Yoga 10 2 Jnana Yoga 6 8 Karma Yoga 6 8 Bhakti Yoga 6 8 Iyengar Yoga 8 4 Integral Yoga or Purna Yoga 6 8 Sivananda Yoga 6 8 Bikrams Yoga 10 (due to the heat) 2

Health Savings Accounts - An American Innovation in Health Insurance

INTRODUCTON - The term "health insurance" is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a non-insurance social welfare program funded by the government. Synonyms for this usage include "health coverage," "health care coverage" and "health benefits" and "medical insurance." In a more technical sense, the term is used to describe any form of insurance that provides protection against injury or illness.

In America, the health insurance industry has changed rapidly during the last few decades. In the 1970's most people who had health insurance had indemnity insurance. Indemnity insurance is often called fee-forservice. It is the traditional health insurance in which the medical provider (usually a doctor or hospital) is paid a fee for each service provided to the patient covered under the policy. An important category associated with the indemnity plans is that of consumer driven health care (CDHC). Consumer-directed health plans allow individuals and families to have greater control over their health care, including when and how they access care, what types of care they receive and how much they spend on health care services.

These plans are however associated with higher deductibles that the insured have to pay from their pocket before they can claim insurance money. Consumer driven health care plans include Health Reimbursement Plans (HRAs), Flexible Spending Accounts (FSAs), high deductible health plans (HDHps), Archer Medical Savings Accounts (MSAs) and Health Savings Accounts (HSAs). Of these, the Health Savings Accounts are the most recent and they have witnessed rapid growth during the last decade.

WHAT IS A HEALTH SAVINGS ACCOUNT?

A Health Savings Account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States. The funds contributed to the account are not subject to federal income tax at the time of deposit. These may be used to pay for qualified medical expenses at any time without federal tax liability.

Another feature is that the funds contributed to Health Savings Account roll over and accumulate year over year if not spent. These can be withdrawn by the employees at the time of retirement without any tax liabilities. Withdrawals for qualified expenses and interest earned are also not subject to federal income taxes. According to the U.S. Treasury Office, 'A Health Savings Account is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care.

HSA's enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.' Thus the Health Savings Account is an effort to increase the efficiency of the American health care system and to encourage people to be more responsible and prudent towards their health care needs. It falls in the category of consumer driven health care plans.

Origin of Health Savings Account

The Health Savings Account was established under the Medicare Prescription Drug, Improvement, and Modernization Act passed by the U.S. Congress in June 2003, by the Senate in July 2003 and signed by President Bush on December 8, 2003.

Eligibility -

The following individuals are eligible to open a Health Savings Account -

- Those who are covered by a High Deductible Health Plan (HDHP). - Those not covered by other health insurance plans. - Those not enrolled in Medicare4.

Also there are no income limits on who may contribute to an HAS and there is no requirement of having earned income to contribute to an HAS. However HAS's can't be set up by those who are dependent on someone else's tax return. Also HSA's cannot be set up independently by children.

What is a High Deductible Health plan (HDHP)?

Enrollment in a High Deductible Health Plan (HDHP) is a necessary qualification for anyone wishing to open a Health Savings Account. In fact the HDHPs got a boost by the Medicare Modernization Act which introduced the HSAs. A High Deductible Health Plan is a health insurance plan which has a certain deductible threshold. This limit must be crossed before the insured person can claim insurance money. It does not cover first dollar medical expenses. So an individual has to himself pay the initial expenses that are called out-of-pocket costs.

In a number of HDHPs costs of immunization and preventive health care are excluded from the deductible which means that the individual is reimbursed for them. HDHPs can be taken both by individuals (self employed as well as employed) and employers. In 2008, HDHPs are being offered by insurance companies in America with deductibles ranging from a minimum of $1,100 for Self and $2,200 for Self and Family coverage. The maximum amount out-of-pocket limits for HDHPs is $5,600 for self and $11,200 for Self and Family enrollment. These deductible limits are called IRS limits as they are set by the Internal Revenue Service (IRS). In HDHPs the relation between the deductibles and the premium paid by the insured is inversely propotional i.e. higher the deductible, lower the premium and vice versa. The major purported advantages of HDHPs are that they will a) lower health care costs by causing patients to be more cost-conscious, and b) make insurance premiums more affordable for the uninsured. The logic is that when the patients are fully covered (i.e. have health plans with low deductibles), they tend to be less health conscious and also less cost conscious when going for treatment.

Opening a Health Savings Account

An individual can sign up for HSAs with banks, credit unions, insurance companies and other approved companies. However not all insurance companies offer HSAqualified health insurance plans so it is important to use an insurance company that offers this type of qualified insurance plan. The employer may also set up a plan for the employees. However, the account is always owned by the individual. Direct online enrollment in HSA-qualified health insurance is available in all states except Hawaii, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, Vermont and Washington.

Contributions to the Health Savings Account

Contributions to HSAs can be made by an individual who owns the account, by an employer or by any other person. When made by the employer, the contribution is not included in the income of the employee. When made by an employee, it is treated as exempted from federal tax. For 2008, the maximum amount that can be contributed (and deducted) to an HSA from all sources is: $2,900 (self-only coverage) $5,800 (family coverage)

These limits are set by the U.S. Congress through statutes and they are indexed annually for inflation. For individuals above 55 years of age, there is a special catch up provision that allows them to deposit additional $800 for 2008 and $900 for 2009. The actual maximum amount an individual can contribute also depends on the number of months he is covered by an HDHP (pro-rated basis) as of the first day of a month. For eg If you have family HDHP coverage from January 1,2008 until June 30, 2008, then cease having HDHP coverage, you are allowed an HSA contribution of 6/12 of $5,800, or $2,900 for 2008. If you have family HDHP coverage from January 1,2008 until June 30, 2008, and have self-only HDHP coverage from July 1, 2008 to December 31, 2008, you are allowed an HSA contribution of 6/12 x $5,800 plus 6/12 of $2,900, or $4,350 for 2008. If an individual opens an HDHP on the first day of a month, then he can contribute to HSA on the first day itself. However, if he/she opens an account on any other day than the first, then he can contribute to the HSA from the next month onwards. Contributions can be made as late as April 15 of the following year. Contributions to the HSA in excess of the contribution limits must be withdrawn by the individual or be subject to an excise tax. The individual must pay income tax on the excess withdrawn amount.

Contributions by the Employer

The employer can make contributions to the employee's HAS account under a salary reduction plan known as Section 125 plan. It is also called a cafeteria plan. The contributions made under the cafeteria plan are made on a pre-tax basis i.e. they are excluded from the employee's income. The employer must make the contribution on a comparable basis. Comparable contributions are contributions to all HSAs of an employer which are 1) the same amount or 2) the same percentage of the annual deductible. However, part time employees who work for less than 30 hours a week can be treated separately. The employer can also categorize employees into those who opt for self coverage only and those who opt for a family coverage. The employer can automatically make contributions to the HSAs on the behalf of the employee unless the employee specifically chooses not to have such contributions by the employer.

Withdrawals from the HSAs

The HSA is owned by the employee and he/she can make qualified expenses from it whenever required. He/She also decides how much to contribute to it, how much to withdraw for qualified expenses, which company will hold the account and what type of investments will be made to grow the account. Another feature is that the funds remain in the account and role over from year to year. There are no use it or lose it rules. The HSA participants do not have to obtain advance approval from their HSA trustee or their medical insurer to withdraw funds, and the funds are not subject to income taxation if made for 'qualified medical expenses'. Qualified medical expenses include costs for services and items covered by the health plan but subject to cost sharing such as a deductible and coinsurance, or co-payments, as well as many other expenses not covered under medical plans, such as dental, vision and chiropractic care; durable medical equipment such as eyeglasses and hearing aids; and transportation expenses related to medical care. Nonprescription, over-the-counter medications are also eligible. However, qualified medical expense must be incurred on or after the HSA was established.

Tax free distributions can be taken from the HSA for the qualified medical expenses of the person covered by the HDHP, the spouse (even if not covered) of the individual and any dependent (even if not covered) of the individual.12 The HSA account can also be used to pay previous year's qualified expenses subject to the condition that those expenses were incurred after the HSA was set up. The individual must preserve the receipts for expenses met from the HSA as they may be needed to prove that the withdrawals from the HSA were made for qualified medical expenses and not otherwise used. Also the individual may have to produce the receipts before the insurance company to prove that the deductible limit was met. If a withdrawal is made for unqualified medical expenses, then the amount withdrawn is considered taxable (it is added to the individuals income) and is also subject to an additional 10 percent penalty. Normally the money also cannot be used for paying medical insurance premiums. However, in certain circumstances, exceptions are allowed.

These are -

1) to pay for any health plan coverage while receiving federal or state unemployment benefits. 2) COBRA continuation coverage after leaving employment with a company that offers health insurance coverage. 3) Qualified long-term care insurance. 4) Medicare premiums and out-of-pocket expenses, including deductibles, co-pays, and coinsurance for: Part A (hospital and inpatient services), Part B (physician and outpatient services), Part C (Medicare HMO and PPO plans) and Part D (prescription drugs).

However, if an individual dies, becomes disabled or reaches the age of 65, then withdrawals from the Health Savings Account are considered exempted from income tax and additional 10 percent penalty irrespective of the purpose for which those withdrawals are made. There are different methods through which funds can be withdrawn from the HSAs. Some HSAs provide account holders with debit cards, some with cheques and some have options for a reimbursement process similar to medical insurance.

Growth of HSAs

Ever since the Health Savings Accounts came into being in January 2004, there has been a phenomenal growth in their numbers. From around 1 million enrollees in March 2005, the number has grown to 6.1 million enrollees in January 2008.14 This represents an increase of 1.6 million since January 2007, 2.9 million since January 2006 and 5.1 million since March 2005. This growth has been visible across all segments. However, the growth in large groups and small groups has been much higher than in the individual category. According to the projections made by the U.S. Treasury Department, the number of HSA policy holders will increase to 14 million by 2010. These 14 million policies will provide cover to 25 to 30 million U.S. citizens.

In the Individual Market, 1.5 million people were covered by HSA/HDHPs purchased as on January 2008. Based on the number of covered lives, 27 percent of newly purchased individual policies (defined as those purchased during the most recent full month or quarter) were enrolled in HSA/HDHP coverage. In the small group market, enrollment stood at 1.8 million as of January 2008. In this group 31 percent of all new enrollments were in the HSA/HDHP category. The large group category had the largest enrollment with 2.8 million enrollees as of January 2008. In this category, six percent of all new enrollments were in the HSA/HDHP category.

Benefits of HSAs

The proponents of HSAs envisage a number of benefits from them. First and foremost it is believed that as they have a high deductible threshold, the insured will be more health conscious. Also they will be more cost conscious. The high deductibles will encourage people to be more careful about their health and health care expenses and will make them shop for bargains and be more vigilant against excesses in the health care industry. This, it is believed, will reduce the growing cost of health care and increase the efficiency of the health care system in the United States. HSA-eligible plans typically provide enrollee decision support tools that include, to some extent, information on the cost of health care services and the quality of health care providers. Experts suggest that reliable information about the cost of particular health care services and the quality of specific health care providers would help enrollees become more actively engaged in making health care purchasing decisions. These tools may be provided by health insurance carriers to all health insurance plan enrollees, but are likely to be more important to enrollees of HSA-eligible plans who have a greater financial incentive to make informed decisions about the quality and costs of health care providers and services.

It is believed that lower premiums associated with HSAs/HDHPs will enable more people to enroll for medical insurance. This will mean that lower income groups who do not have access to medicare will be able to open HSAs. No doubt higher deductibles are associated with HSA eligible HDHPs, but it is estimated that tax savings under HSAs and lower premiums will make them less expensive than other insurance plans. The funds put in the HSA can be rolled over from year to year. There are no use it or lose it rules. This leads to a growth in savings of the account holder. The funds can be accumulated tax free for future medical expenses if the holder so desires. Also the savings in the HSA can be grown through investments.

The nature of such investments is decided by the insured. The earnings on savings in the HSA are also exempt from income tax. The holder can withdraw his savings in the HSA after turning 65 years old without paying any taxes or penalties. The account holder has complete control over his/her account. He/She is the owner of the account right from its inception. A person can withdraw money as and when required without any gatekeeper. Also the owner decides how much to put in his/her account, how much to spend and how much to save for the future. The HSAs are portable in nature. This means that if the holder changes his/her job, becomes unemployed or moves to another location, he/she can still retain the account.

Also if the account holder so desires he can transfer his Health Saving Account from one managing agency to another. Thus portability is an advantage of HSAs. Another advantage is that most HSA plans provide first-dollar coverage for preventive care. This is true of virtually all HSA plans offered by large employers and over 95% of the plans offered by small employers. It was also true of over half (59%) of the plans which were purchased by individuals.

All of the plans offering first-dollar preventive care benefits included annual physicals, immunizations, well-baby and wellchild care, mammograms and Pap tests; 90% included prostate cancer screenings and 80% included colon cancer screenings. Some analysts believe that HSAs are more beneficial for the young and healthy as they do not have to pay frequent out of pocket costs. On the other hand, they have to pay lower premiums for HDHPs which help them meet unforeseen contingencies.

Health Savings Accounts are also advantageous for the employers. The benefits of choosing a health Savings Account over a traditional health insurance plan can directly affect the bottom line of an employer's benefit budget. For instance Health Savings Accounts are dependent on a high deductible insurance policy, which lowers the premiums of the employee's plan. Also all contributions to the Health Savings Account are pre-tax, thus lowering the gross payroll and reducing the amount of taxes the employer must pay.

Criticism of HSAs

The opponents of Health Savings Accounts contend that they would do more harm than good to America's health insurance system. Some consumer organizations, such as Consumers Union, and many medical organizations, such as the American Public Health Association, have rejected HSAs because, in their opinion, they benefit only healthy, younger people and make the health care system more expensive for everyone else. According to Stanford economist Victor Fuchs, "The main effect of putting more of it on the consumer is to reduce the social redistributive element of insurance.

Some others believe that HSAs remove healthy people from the insurance pool and it makes premiums rise for everyone left. HSAs encourage people to look out for themselves more and spread the risk around less. Another concern is that the money people save in HSAs will be inadequate. Some people believe that HSAs do not allow for enough savings to cover costs. Even the person who contributes the maximum and never takes any money out would not be able to cover health care costs in retirement if inflation continues in the health care industry.

Opponents of HSAs, also include distinguished figures like state Insurance Commissioner John Garamendi, who called them a "dangerous prescription" that will destabilize the health insurance marketplace and make things even worse for the uninsured. Another criticism is that they benefit the rich more than the poor. Those who earn more will be able to get bigger tax breaks than those who earn less. Critics point out that higher deductibles along with insurance premiums will take away a large share of the earnings of the low income groups. Also lower income groups will not benefit substantially from tax breaks as they are already paying little or no taxes. On the other hand tax breaks on savings in HSAs and on further income from those HSA savings will cost billions of dollars of tax money to the exchequer.

The Treasury Department has estimated HSAs would cost the government $156 billion over a decade. Critics say that this could rise substantially. Several surveys have been conducted regarding the efficacy of the HSAs and some have found that the account holders are not particularly satisfied with the HSA scheme and many are even ignorant about the working of the HSAs. One such survey conducted in 2007 of American employees by the human resources consulting firm Towers Perrin showed satisfaction with account based health plans (ABHPs) was low. People were not happy with them in general compared with people with more traditional health care. Respondants said they were not comfortable with the risk and did not understand how it works.

According to the Commonwealth Fund, early experience with HAS eligible high-deductible health plans reveals low satisfaction, high out of- pocket costs, and cost-related access problems. Another survey conducted with the Employee Benefits Research Institute found that people enrolled in HSA-eligible high-deductible health plans were much less satisfied with many aspects of their health care than adults in more comprehensive plans People in these plans allocate substantial amounts of income to their health care, especially those who have poorer health or lower incomes. The survey also found that adults in high-deductible health plans are far more likely to delay or avoid getting needed care, or to skip medications, because of the cost. Problems are particularly pronounced among those with poorer health or lower incomes.

Political leaders have also been vocal about their criticism of the HSAs. Congressman John Conyers, Jr. issued the following statement criticizing the HSAs "The President's health care plan is not about covering the uninsured, making health insurance affordable, or even driving down the cost of health care. Its real purpose is to make it easier for businesses to dump their health insurance burden onto workers, give tax breaks to the wealthy, and boost the profits of banks and financial brokers. The health care policies concocted at the behest of special interests do nothing to help the average American. In many cases, they can make health care even more inaccessible." In fact a report of the U.S. governments Accountability office, published on April 1, 2008 says that the rate of enrollment in the HSAs is greater for higher income individuals than for lower income ones.

A study titled "Health Savings Accounts and High Deductible Health Plans: Are They an Option for Low-Income Families? By Catherine Hoffman and Jennifer Tolbert which was sponsored by the Kaiser Family Foundation reported the following key findings regarding the HSAs:

a) Premiums for HSA-qualified health plans may be lower than for traditional insurance, but these plans shift more of the financial risk to individuals and families through higher deductibles. b) Premiums and out-of-pocket costs for HSA-qualified health plans would consume a substantial portion of a low-income family's budget. c) Most low-income individuals and families do not face high enough tax liability to benefit in a significant way from tax deductions associated with HSAs. d) People with chronic conditions, disabilities, and others with high cost medical needs may face even greater out-of-pocket costs under HSA-qualified health plans. e) Cost-sharing reduces the use of health care, especially primary and preventive services, and low-income individuals and those who are sicker are particularly sensitive to cost-sharing increases. f) Health savings accounts and high deductible plans are unlikely to substantially increase health insurance coverage among the uninsured.

Choosing a Health Plan

Despite the advantages offered by the HSA, it may not be suitable for everyone. While choosing an insurance plan, an individual must consider the following factors:

1. The premiums to be paid. 2. Coverage/benefits available under the scheme. 3. Various exclusions and limitations. 4. Portability. 5. Out-of-pocket costs like coinsurance, co-pays, and deductibles. 6. Access to doctors, hospitals, and other providers. 7. How much and sometimes how one pays for care. 8. Any existing health issue or physical disability. 9. Type of tax savings available.

The plan you choose should according to your requirements and financial ability.

BIBLIOGRAPHY

1 Questions and Answers about Health Insurance- A Consumer Guide' published jointly by the Agency for Healthcare Research and Quality (AHRQ)and America's Health Insurance Plans (AHIP) 2 http://www.en.wikipedia.org/wiki/Health_savings_account 3 2002 AHIP Survey of Health Insurance Plans 4 "How High Is Too High? Implications of High-Deductible Health Plans" Davis, Karen; Michelle Doty and Alice Ho. The Commonwealth Fund, April 2005 5 http://www.fdhc.state.fl.us/schs/pdf/hsa_tri-fold_brochure.pdf 6 HSA/HDHP CENSUS 2008 by Hannah Yoo, Center for Policy and Research, America's Health Insurance Plans 7"HEALTH SAVINGS ACCOUNTS Early Enrollee Experiences with Accounts and Eligible Health Plans" John E. Dicken Director, Health Care. 8 Thomas Wilder and Hannah Yoo, "A Survey of Preventive Benefits in Health Savings Account (HSA)Plans, July 2007," America's Health Insurance Plans, November 2007 9 Gladwell, Malcolm, "The Moral Hazard Myth", The New Yorker (29-08-2005) 10 2008 Benchmark Survey HAS Bank 11. Employer Health Benefits 2007 Annual Survey, Kaiser Family Foundation 12. Health Savings Accounts and High Deductible Health Plans: Are They An Option for Low-Income Families?Catherine Hoffman and Jennifer Tolbert for Kaiser Family Foundation, October 2006 13. Medicare Prescription Drug, Improvement, and Modernization Act of 2003

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