health insurance benefits pp. 375-377 11-2 section
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Health Insurance Benefits pp. 375-377
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Copyright © Glencoe/McGraw-Hill MBA, Section 11-2, Slide 2 of 16
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deductible (p. 375)
An amount of money someone with insurance must pay before the insurance company pays anything.
co-insurance (p. 375)
A percentage of medical expenses a person with health insurance must pay beyond the deductible.
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Copyright © Glencoe/McGraw-Hill MBA, Section 11-2, Slide 3 of 16
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co-payment (p. 375)
An amount a person with health insurance must pay for a service, such as a prescription or a doctor’s visit, along with the insurance company.
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Copyright © Glencoe/McGraw-Hill MBA, Section 11-2, Slide 4 of 16
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Amount Paid by Patient = Deductible + Co-payments + Co-insurance Amount + Hospital Charges
Formula Formula
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Copyright © Glencoe/McGraw-Hill MBA, Section 11-2, Slide 5 of 16
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Brooke Burk is single and has a health insurance plan with the benefits shown in Figure 11.1 on page 376 of your textbook.
Her recent network health costs include co-payments for 8 physician visits and 9 specialist visits.
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Copyright © Glencoe/McGraw-Hill MBA, Section 11-2, Slide 6 of 16
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Following hospital surgery, she made co-payments for 12 physical therapy visits, and she had 75 home visits from a nurse at $55 each.
The hospital admission charge was $200, and her hospital bill was $14,560.
What amount did she pay?
Example 1 (cont.)Example 1 (cont.)
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Copyright © Glencoe/McGraw-Hill MBA, Section 11-2, Slide 7 of 16
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Find the deductible.
The deductible is $300.
Example 1 Answer: Example 1 Answer: Step 1Step 1
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Copyright © Glencoe/McGraw-Hill MBA, Section 11-2, Slide 8 of 16
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Find the cost of the co-payments.
Physician + Specialists + Physical Therapy
($10 × 8) + ($20 × 9) + ($15 × 12)
$80 + $180 + $180 = $440
Example 1 Answer: Example 1 Answer: Step 2Step 2
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Copyright © Glencoe/McGraw-Hill MBA, Section 11-2, Slide 9 of 16
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Find the co-insurance amount for home health care. (Note: Co-insurance requires the insurance company to pay 80 percent of the costs and the patient pays 20 percent of the costs.)
$55 × (75 – 50) × 20%
$55 × 25 × 20% = $275
Example 1 Answer: Example 1 Answer: Step 3Step 3
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Copyright © Glencoe/McGraw-Hill MBA, Section 11-2, Slide 10 of 16
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Find the hospital charges. (Note: The patient pays a small percent of the hospital charge, such as 10 percent.)
$14,560 × (100% – 90%)
$14,560 × 10% = $1,456
Example 1 Answer: Example 1 Answer: Step 4Step 4
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Copyright © Glencoe/McGraw-Hill MBA, Section 11-2, Slide 11 of 16
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Find the amount paid by patient.
Deductible + Co-payment + Co-insurance + Hospital Amount Charges
$300 + $440 + $275 + ($1,456 + $200) = $2,671
Example 1 Answer: Example 1 Answer: Step 5Step 5
376:1-16376:1-16