RMIN 4000 Exam 4 Brown UGA with Complete Solutions!

Cost Sharing in Health Insurance - ANSWER-• Copayments • Deductibles • Coinsurance • Out-of-Pocket Maximum Limits Copayment - ANSWER-A flat amount the insured must pay for certain benefits, such as an office visit or generic drug. Does not count towards annual deductible. Examples : -$25 for visit to primary care physician. -$5 for a generic drug (prescription). Calendar-Year Deductible - ANSWER-• An aggregate deductible that must be satisfied during the calendar year. • The amount the insured is responsible for in total (over all claims during the policy period) before the insurer pays anything. • Policies may include an individual and/or family deductible. Coinsurance - ANSWER-• The percentage of the bill in excess of the deductible, which the insured must pay out-of-pocket up to some maximum annual dollar limit. Helps to prevent overutilization of plan benefits. Typically 20%, 25%, or 30%. Out-of-Pocket (OOP) Maximum Limit - ANSWER-• The most the insured will have to pay out-of-pocket in a calendar year. • After the out-of-pocket limit is met, the insurer pays 100% of all eligible expenses. • Also called a stop-loss limit. Jon Snow was recently stabbed with resulting medical bills of $4,000. His health insurance includes the following: • $1,000 calendar- year deductible • 80/20 coinsurance clause • $5,000 out-of-pocket max 1. After insurance is applied, how much will Jon owe for the medical bill? 2. Jon needs surgery during the same calendar year that costs $30,000. After insurance is applied, how much will Jon owe for the surgery? - ANSWER-4,000-1,000 (deductible) = 3,000 3,000 *.20 = 600 Consider the out of pocket max, John already paid 1,000 (deductible) + 600 (coinsurance). 5,000 - 1,600 = 3,400 is all Jon will pay for the 30,000 dollar surgery Individual Medical Expense (Health) Insurance - ANSWER-• Protects an individual or