Question

• This plan design has a network of participating physicians throughout the U.S.
• In-Network: no deductible, $20 office co-payment (does not apply to out-of-pocket maximum) and/or 10% co-insurance, coverage of routine services (annual physical exams and any related lab tests, hearing and eye exams).
• Out-of-Network: $300 single/$600 spouse/partner/child/family contract deductible, 20% co-insurance, no coverage for routine services.
• Out-of-pocket maximum (in-network) of $1,500 per single contract and $3,000 per spouse/partner, child or family contract on eligible medical expenses.
• Out-of-pocket maximum (out-of-network) of $3,000 per single contract and $6,000 per spouse/partner, child or family contract on eligible medical expenses.
• $100 emergency room co-payment (waived if admitted).
• Self-referral allowed.

Health care coverage amount. Megan recently received office surgery, medical care and laboratory services on 3/22/19. Her total bill for this medical treatment, which was her only health care expense for the year, came to $1,208. Her health insurance plan benefits (single contract) are included above.

• How much of the bill will Megan pay if she uses an in-network provider? (5 points)

Deductible
Copayment
Coinsurance
Megan is responsible for:

• How much of the bill will Megan pay is she uses an out-of-network provider? (5 points)

Deductible
Copayment
Coinsurance
Megan is responsible for:

Answer 1

Total Health Care Expenditure	$1,208
(In Network)
Deductible	(in US$)
Copayment	20
Coinsurance	121
Megan is responsible for:	141
(Out of Network)
Deductible	(in US$)
Copayment	300
Coinsurance	242
Megan is responsible for:	542