1. Using the Personal Finance in Practice information box located on page 286 what are some of the strategies that Ross can use to better prepare financially for the arrival of the twins?

2. How could Jamie Lee and Ross prepare for the birth of the twins with their existing PPO plan?

3. Jamie Lee and Ross learned that the hospital that they plan to use for the delivery is not a participating hospital. 

4. Based on their responsibility as per their health insurance policy for an out-of-network hospital stay, how much would Jamie Lee and Ross owe for the hospital stay?

5. How will Ross and Jamie Lee make provisions for adding the babies to their health insurance policy now that they have arrived?

Health and Disability Income Insurance

Jamie Lee and Ross, happy newlyweds with a new home and twins on the way, are anxiously awaiting their new bundles of joy. Ross was a little nervous, and understandably so, as he quietly wondered if everything will go all right with Jamie’s pregnancy. Fortunately for them, they coordinated benefits from the medical insurance group plan offered by Ross’ employment at the graphics agency and Jamie Lee’s own plan, although Ross’ plan would be their primary. His employer offers a Health Care Savings Plan, but Ross previously had not realized the need to participate in this benefit.

Jamie Lee has had maternity care that she has been comfortable with so far, but Ross needed to review their health insurance policies with the potential of extensive medical expenses just on the horizon. He wondered if his salary be enough to pay for the expenses that were not covered or even the deductibles for out-of-network doctors.

Current Medical Insurance Plan Provisions:

Jamie Lee and Ross have a PPO or Preferred Provider Organization plan.

In-Network Medical Care:

Jamie Lee and Ross currently have a $15 copayment on regular preventative care doctor visits and a $30 copayment on specialists that are preferred providers or participating members from the PPO plan’s list.

Out-of-Network Medical Care:

Jamie Lee and Ross have the choice of seeking medical care from the professional of their choice outside the PPO member list, but will incur a deductible of $500 per person/ $1,000 per family, per year. 

After the deductible is met, there is a coinsurance of 80%/20%, whereas the insurance company would cover 80% of the allowable medical fees and the policyholders would be responsible for 20% of the allowable medical fees. 

Medical fees that are not allowed under the medical plan provisions would be 100% of the policyholder’s responsibility.

Out-of-Pocket Limits:

Their health insurance plan provides an out-of-pocket limit of $75,000 per year.