Question

Manuel has basic health insurance including prescription drug coverage that starts January 1, but he has no vision or dental coverage. His coverage includes a $1,500 deductible, 80%/20% coinsurance, and a stop-loss point of $5,500. He goes to an urgent care center on New Year’s Day (thinking he has food poisoning from the oysters he ate on New Year’s Eve).

Using Manuel's info from above, calculate the total amount he will have to pay for new glasses for the summer (assume he has already met his deductible for the year but has not reached his maximum out-of-pocket amount). Manuel has chosen Ray-Ban glasses with anti-glare and anti-scratch protection that are $275.

		$220
		$225
		$55
		$275

Answer 1

$275 :Because the basic health insurance does not have vision coverage.

Although deductible means that it the total amount of money the insured person pay before commencing or availing the benefits of the insurance,

whereas 80%/20 % coinsurance means that the insurance company will pay 80 % and 20% will be paid by the insured person for additional medical expense other than the deductible money,

also stop loss point is the amount of medical expense in whole year that the insured person is abide to pay in coinsurance.once the insured person pays the money upto stop loss point in coinsurance, rest 100% of the remaining medical expense will be covered by insurance company.

but none of the above key terms of basic health insurance will cover manuel ray ban glasses due to non coverage of vision into it.