3. Terms of payment for medical expense plans But I Paid My Premiums! Besides possibly paying the premiums for a medical insurance plan, the insured is almost always responsible for making other, out-of-pocket payments. This practice helps keep overall costs down for both insureds and the insurance companies and ensures that insureds are informed about the costs of health care. For each of the following scenarios, select which type of other cost or provision is illustrated. Dmitri had routine surgery performed at His local hospital. Nil charges were within the reasonable and customary costs in His area. Participation (co-insurance) Internal limits Deductible Coordination of benefits Giberto has had an liness and an accident during the year, His combined out-of-pocket expense for both incidents was $1,000. The insurance company wal now start to pay some of his medical expenses. What does the $1,000 represent? Coordination of benefits Deductible Internal limits Participation (co-insurance) - a $3,000,000 lifetime limit - a $1,500 deductible and 80% coinsurance clause - internal limits of $400 per day for a semi-private room and board, $7,500 per occurrence for x-rays, prescription drugs, and other. medical expenses, and a $40,000 maximum limit per occurrence on surgical procedures - a $25,000 limit per occurrence on rehabilitation and physical therapy - If a hospital charges a room rate that is greater than the policy's stated internal limit, the hospital agrees to reduce the room rate to the policy's internal limit. Last month, Neha was injured in an automobile accident. She spent 4 doys in the hospital in o room that cost s600 per day, incurred 55,500 for other medical expenses, and $20,000 in surgical expenses. Given these claim costs, complete the following table and answer the related questians 3. Terms of payment for medical expense plans But I Paid My Premiums! Besides possibly paying the premiums for a medical insurance plan, the insured is almost always responsible for making other, out-of-pocket payments. This practice helps keep overall costs down for both insureds and the insurance companies and ensures that insureds are informed about the costs of health care. For each of the following scenarios, select which type of other cast or provisian is Wustratod. Dmitri had routine surgery performed at His local hospital. All charges were within the reasonable and customary costs in His area. Participation (co-insurance) Internal limits Deductible Coordination of benefits Gilberto has had an illiness and an accident during the year. His combined out-of-pocket expense for both incidents was $1,000. The insurance company will now start to pay some of his medical expenses. What does the $1,000 represent? Coordination of benents Deductible Internal limits Participation (co-insurance) Juanita had a horrible accident that required a year of treatments and rehablitation. Fortunately, Juanita's policy has a stop-loss provision that limits how much out-of-pocket expense she has to pay. Internal limits Deductible Participation (co-insurance) Coordination of benefits Lorenzo has standard, personal medical insurance. After a recent accident, he visited the emergency room. One of the questions on the admission form asked if the accident occurred at work. Participaton (CO-insurance) Deductible Internal limits Coordination of benefits Juanita had a horrible accident that required a year of treatments and rehabilitation. Fortunately, Juanita's policy has a stop-loss provision that limits how much out-of-pocket expense she has to pay. Internal limits Deductible Participation (co-insurance) Coordination of benefits Lorenzo has standard, personal medical insurance, After a recent accident, he visited the emergency room. One of the questions on the admission form asked if the accident occurred at work. Participation (co-insurance) Deductible Internal limits Coordination of benents Neha, a graphic artist, is 24 years oid and has owned a major medical insurance policy for three years. The policy, which she purchased through her. alumnl association, provides the following coverage: Based on this data, the total cost to the insurance compony is 1. while the out-cl-pocket cost to Neha is How much did Neha save by having her medical insurance policy? Assume that the hospital changed its payment policy to make the pationt responsiblo for the difference between the hospital's roont rate and the insurance company's responsibility ( $600 per day versus $400 per day). By how much would Neha's out-of-pocket cost for her hospital room change due in haspital billing? Neha's costs would increase by 1800 . Neha's costs would increase by $480. Neha's costs would increase by $320