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Citi reserves the right to terminate your coverage retroactively if you are determined to be ineligible under the terms of the Health Plans capillaries in fingers trusted procardia 30mg. You must pay the entire contribution (employee plus employer cost) plus a 2% administration fee for your continuation coverage capillaries uk discount 30 mg procardia fast delivery. A grace period of at least 30 days applies to the payment of the regularly scheduled contribution cardiovascular disease games procardia 30 mg line. For example arteries in the arm generic 30 mg procardia mastercard, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. The day after your employment terminates and you are ineligible for coverage under the Citi health plan, there is a sixty (60) day special enrollment period during which you can enroll for coverage in the Health Insurance Marketplace. If you are considering enrolling for coverage under the Exchange, be mindful of this enrollment deadline. Divorce or legal separation from your spouse or the termination of your civil union partnership/domestic partnership; or 4. If the covered employee elects continuation coverage and then has a child (either by birth, adoption, or placement for adoption) during that period of continuation coverage the new child is also eligible to become a qualified beneficiary. For example, if there is a choice among types of coverage, each qualified beneficiary who is eligible for continuation coverage is entitled to make a separate election among the types of coverage. Thus, a spouse/partner or dependent child is entitled to elect continuation coverage even if the covered employee does not make that election. A spouse/partner or dependent child may elect different coverage from that chosen by the employee. Citi considers the date of the qualifying event as the day your employment terminated or another qualifying event occurred. Under the law, you must elect continuation coverage within 60 days from the date you lost coverage as a result of one of the events described above, or, if later, 60 days after Citi provides notice of your right to elect continuation coverage. An employee or family member who does not choose continuation coverage within the time period described above will lose the right to elect continuation coverage. If you elect continuation coverage, Citi is required to give you coverage that, as of the time coverage is being provided, is identical to the coverage provided under the Health Plans to similarly situated employees or family members. If the coverage for similarly situated employees or family members is modified, your coverage will be modified, too. Additional qualifying events may occur while the continuation coverage is in effect after an initial qualifying event, such as loss of employment. If you lose coverage because of a termination of employment or a reduction in hours, these events can, but do not always, result in an extension of an 18-month continuation period to 36 months for your spouse/partner and dependent children. You must notify the Citi Benefits Center if a second qualifying event occurs during your continuation coverage period. This 11-month extension is available to all family members who are qualified beneficiaries due to termination of employment or reduction in hours of employment, even those who are not disabled. If you or a covered family member is disabled and another qualifying event occurs within the 29-month continuation period, then the continuation coverage period for your qualified beneficiaries is 36 months after your termination of employment or reduction in hours. The premium for continuation coverage is not paid on time (within the applicable grace period); 3. Your continuation coverage will begin on the earliest of the following: > > When you definitively inform Citi that you are not returning to work at the end of the leave; or the end of the leave, and you do not return to work. If the employee or a family member fails to provide this notice to Citi during this notice period, any individual(s) who loses coverage will not be offered the option to elect continuation coverage. Mail this information to the address below if the covered person is an active employee of Citi: Citi Benefits Center 2300 Discovery Drive P. If your coverage is extended from 18 to 29 months for disability, you will be required to pay 150% of the premium beginning with the 19th month of continuation coverage. If you elect continuation coverage, Citi will notify you of any changes in the cost. You and your family members will be subject to these changes in the cost of coverage.
The body may attempt to compensate for some increased blood volume by excreting more sodium and water through the urine cardiovascular system homeostasis buy generic procardia 30 mg on-line. An increase in blood volume leads to increased renal perfusion and an increase in the glomerular filtration rate; in turn cardiovascular outcomes research fellowship buy 30 mg procardia overnight delivery, this affects the amounts of sodium and water that enter the renal tubules and a greater rate of excretion of sodium and water from the body through the urine cardiovascular disease drugs buy discount procardia 30mg on-line. Additionally capillaries refill discount procardia 30mg visa, activation of the reninangiotensin-aldosterone system also contributes to decreased fluid loss through the urine and an increase in the amount of blood flow in the intravascular space. Elevated blood volume contributes to high blood pressure and increased stress on the heart because it ultimately increases ventricular preload, stroke volume, and cardiac output. Because levels of blood volume are typically controlled by hormones within the renal system, drugs that are administered to control blood volume are therefore designed to control some of these hormones that aim at regulating sodium and fluid reabsorption. Diuretics are some of the more commonly prescribed drugs that can reduce blood volume in the cardiovascular system. Diuretic medications affect sodium and water reabsorption in the kidneys to promote fluid excretion in the urine and prevent excess fluid from building up within the body. Recommendations by the Eighth Joint National Committee of the American Medical Association for the general population, including those with diabetes, nursece4less. Thiazide diuretics promote excretion of sodium, chloride, potassium, and bicarbonate and prevent reabsorption of sodium and chloride to increase output. A typical dose is available as an oral tablet that the affected patient takes on a daily basis; the dose ranges from 12. When starting captopril, the initial dose is actually given 2 to 3 times daily until normal blood pressure levels are achieved. The initial dose is 5 mg daily, although doses can reach up to a total of 40 mg/day, given in divided doses. Enalapril may also be administered intravenously when needed; and, the typical dose is approximately 1. It should not be taken with a diuretic medication, as the combination of the two agents may lead to hypotension. Diuretic use should be discontinued prior to starting lisinopril therapy because of its potency. Systemic Vascular Resistance A patient may develop hypertension when the blood vessels have lost some of their elasticity and they are more resistant to blood flow. Increased vascular resistance may develop due to intrinsic factors such as increased blood viscosity, turbulent blood flow, or size of the vessel diameter. An increase in sympathetic output from the medulla in the brain can lead to an increase in intravascular resistance and increased vasomotor tone. This is often able to explain how certain factors, such as increased stress and anxiety, may contribute toward high blood pressure when these elements contribute to an increase in the sympathetic nervous system output. When blood pressure levels drop too low, the kidneys release the enzyme renin; and, renin travels to the liver to convert angiotensinogen, an inactive protein, to its active form, angiotensin I. This would then increase blood volume because sodium and water are being reabsorbed and are not being excreted through the urine. As described in the previous section, thiazide diuretics are a type of diuretic medication that are responsible for stimulating the body to release excess fluid through the urinary tract, thereby lowering plasma levels and levels of extracellular fluid to control blood pressure levels. Thiazide diuretics are frequently prescribed in conjunction with some other types of cardiac medications for the management of hypertension. Although thiazide diuretics primarily work by promoting fluid loss, which decreases overall blood volume levels, they may also have some effects on vascular resistance. Various animal studies have shown vasodilatory effects with use of different types of thiazide diuretics. The review showed that indapamide, a thiazide diuretic, has been shown to have some calcium channel blocking effects in the arteries. However, there remains evidence that thiazide diuretics can impact vascular resistance through some of their mechanisms to control blood pressure levels in addition to their activity to increase urine production. Indapamide inhibits sodium reabsorption in the kidneys and enhances sodium and water excretion through the urine. Because indapamide controls blood volume levels so well, it has the potential to cause hypotension among some patients, although for those who initially suffer from hypertension, its effects are more likely to lead to normalization of blood pressure levels. Its potent blood volume lowering effects are thought to explain why indapamide is also able to affect the cardiovascular system through decreasing vascular resistance.
The coverage under the individual policy must be for at least $25 cardiovascular disease versus coronary heart disease purchase 30mg procardia with amex,000 and cannot be more than the greater of the amount of your employee coverage or $500 cardiovascular system importance generic procardia 30 mg on line,000 cardiovascular or aerobic exercise effective procardia 30mg. Coverage for an employee ends when the employee is no longer considered to be benefits-eligible under the terms of the policy cardiovascular perfusion salary buy procardia 30 mg on line. If proper notice, as indicated, is not given in that time, the claim will not be invalidated or reduced if it is shown that proper notice was given as soon as was reasonably possible. January 1, 2017 Insurance Benefits 303 Survivor Support will send claim forms for filing proof of loss when it receives notice of a claim. If Survivor Support does not send claim forms within 15 days after it receives notice of a potential claim (this may be longer if additional documentation is required), you or your beneficiary can submit - within 90 days - written or authorized electronic proof of the nature and extent of the loss for which the claim is made. Failure of a claimant to cooperate in the administration of the claim may result in termination of the claim. Such cooperation includes, but is not limited to , providing any information or documents needed to determine whether benefits are payable or the actual benefit amount due. You will pay for coverage with after-tax dollars; the cost is based on your age when you become insured. Family members who call to obtain information should provide your name as the Citi employee. Activities of daily living generally are bathing, maintaining continence, dressing, toileting, eating, and transferring into or out of a bed or chair. You become eligible for benefits only upon confirmation of your qualifying condition by a care coordinator from John Hancock. The qualification period needs to be met only once as long as you remain continuously insured. Your qualifying condition must continue through this period, but you do not have to actually incur expenses, receive long-term care services, or be hospitalized during this period. Depending on the type of service, benefits are subject to a maximum, which will vary based on the coverage level you choose. Community-based professional care includes adult day care (Washington state refers to this as adult day health care) and the following services provided in your home: Home health care, hospice care, and homemaker services provided by a person certified or employed through a licensed home health care agency. It is available during the qualification period; it is not available if coverage is in reduced paid-up status and cannot be restored under the restoration-of-benefits provision. January 1, 2017 Insurance Benefits 305 Any benefits paid will be subtracted from the recalculated amount. Except for the care-planning visit, you must be residing in your home to be eligible. If you did not elect this option, the contingent non-forfeiture benefit will be included in your coverage at no additional cost. The contingent non-forfeiture benefit can be exercised only in the event of a substantial premium increase. The contingent non-forfeiture benefit allows you to stop paying premiums and keep a reduced level of coverage. A substantial premium increase would range from 10% at issue-age 90 or older to 200% at issue-age 29 or younger as detailed in the certificate that you will receive if you are approved for coverage. If you do not elect this option, the future purchase option provision will be included in your coverage. The benefit increase will continue to be made annually regardless of your age or whether you have met the benefit eligibility requirements under the policy. However, no future increases in benefit amount will apply if you stop paying premiums and continue coverage in effect on a reduced paid-up basis under the non-forfeiture benefit. Under the future purchase option, you will be offered additional amounts of coverage every three years to keep up with inflation. The premium rates for the inflation increase will be based on your issue age on the effective date of the increase and will include an additional charge to account for the added risk associated with accepting these offers. An inflation adjustment will not be available if you are issue-age 85 or older or if you have met the benefit eligibility requirements under the policy in the six months prior to the increase effective date or if your coverage is in reduced paidup status. The portion of the premium is based on your age at the time of death as shown below. Premiums are not returned if you are age 75 or older or if coverage is in reduced paid-up status.
She is already beginning to notice early symptoms of depression during her second pregnancy capillaries diseases order 30mg procardia. A 20-year-old athletic man would like to take Asian ginseng to increase his physical stamina capillaries that serve as the major blood supply to the kidneys buy generic procardia 30mg on line. His girlfriend suggested that he ask a pharmacist about the safety of Asian ginseng cardiovascular 2013 generic procardia 30 mg mastercard. The Dietary Supplement Health and Education Act of 1994 states that dietary supplements are not considered drugs or food cardiovascular renal disease discount 30 mg procardia mastercard. Dietary supplements are intended to supplement the diet, do not have to be standardized, may make claims regarding only the effects on structure or function of the body. Caution should be used in patients who are allergic to members of the ragweed family. Side effects include nausea, vomiting, allergic reactions, anaphylaxis, and interference with male fertility. Garlic should be avoided in pregnancy because it is an emmenagogue and abortifacient. Side effects include gastrointestinal discomfort (heartburn, flatulence), sweating, light-headedness, allergic reactions, and menorrhagia. It may interact with anticoagulants and antihypertensives and may inhibit cytochrome P450 isoenzymes. Contraindications and precautions for ginkgo include diabetes, epilepsy, bleeding disorders, and infertility. For definitions of the terms used and the concepts applicable in basic and clinical pharmacokinetics, see Chapter 5 on pharmacokinetics. Drug levels are used in conjunction with other clinical data to assist practitioners in determining how a patient is responding. Drug levels assist in determining if a change in patient-specific pharmacokinetics has occurred during a course of treatment, whether as a result of a change in physiological state, a change in diet, or addition of other drugs. Note that the only variables that the practitioner controls are the amount of drug administered and how often it is given. For many drugs, a specific serum concentration range can be designated for each drug that maximizes effectiveness and minimizes toxicity. The notion of a therapeutic range is more a probabilistic concept than an absolute entity. It is probable that most patients will show effective and safe responses within the therapeutic range. More often than not, a patient-specific range will fall within the generally stated therapeutic range. A population pharmacokinetic value or parameter refers to the mean (average) value noted for a given cohort of people. When a population parameter is stated without defining the target population, it usually refers to adults; further, when the value also is not normalized. Individual values of the population studied are summed to determine a mean value that is then reported as the population value. Individualizing patient dosage regimens takes this into account by adjusting observed patient-specific values and responses to expected population measures. If the patient is responding appropriately after administering the dosage regimen until steady state is reached based on using population values, then no adjustment in regimen is necessary. Pharmacokinetic factors influencing serum drug concentration and pharmacological response. In other words, is the therapeutic range the practitioner is using as a basis for individualizing regimens based on Css measured early (apparent Cmax,ss), near the midpoint (apparent Cavg,ss), or near the end (apparent Cmin,ss) of ss? Errors in interpretation occur when Css for a patient is measured at a time during ss that is markedly different than the time used for establishing the therapeutic range. Errors in timing of Css are of greater concern for drugs with a short tЅ than for drugs with a long tЅ. Acute, short, or intermittent effects are not well regulated by using serum drug levels. A drug assay is available that is accurate, precise, specific, rapid, and relatively inexpensive. Maximum concentration (Cmax,ss) during ss, when absorption is assumed to be much faster than elimination. Minimum concentration (Cmin,ss) during ss, when absorption is assumed to be much faster than elimination.
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