Health Insurance
Answer the questions below using the information on the hypothetical insurance plan.
Ryan has purchased health insurance for himself and his family, a wife and two sons.
The premium for a single person is $490/month while the premium for a family is
$725/month. Each single person has a deductible of $2,000 while on a family plan it is
$975/person or $3,000/family. The out-of-pocket max for Ryan's family plan is $6,000.
This $6,000 does not include co-payments, premiums, and prescription drugs. This plan
does not cover infertility, maternity, cosmetic surgery, weight loss programs, vision or
dental costs. The following are co-pays and co-insurance costs.
Medical Events
Physician's Office visit
Prescription Drugs
Immediate Medical
Attention
Hospital Stay
Services
Primary Care for injury or
illness
Specialist visit
Preventative care
Generic Drugs
Preferred Brand Name
Drugs
ER services
Urgent Care
Facility fee (ex. Hospital
room)
Participating
Provider Subscriber
Costs
$35 co-pay/visit
$50 co-pay/visit
$0
$10 co-pay
20% co-insurance
0% co-insurance
0% co-insurance
0% co-insurance
0% co-insurance
Physician/Surgeon fee
What are the premiums paid for this insurance plan?
premiums paid?
Non-Participating
Provider Subscriber
Costs
40% co-insurance
$40 co-insurance
40% co-insurance
40% co-insurance
40% co-insurance
40% co-insurance
40% co-insurance
40% co-insurance
40% co-insurance
How often are these
Ryan's youngest son was playing football and suffered a particularly bad injury which
brought him to the ER. Because it was an away game, the family went to an
out-of-network hospital where the service incurred cost $4,250. He was prescribed
brand-name anti-inflammatory, pain and steroid medication which totaled $1,345. There
was a follow-up appointment in their hometown the next day with his primary care
physician who sent him down to Urgent care for a concussion evaluation. Write up a list
of what the out-of-pocket expenses are for this bill. Detail out each amount, and total th
costs at the bottom. Show your work!