8. 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. Manuel has been hospitalized for an illness. His insurance company has started paying 80% of covered medical expenses. Internal limits Coordination of benefits Participation (co-insurance) Deductible Rajiv is covered under his medical insurance policy at work and also covered under his spouse's work plan. Rajiv has some large medical bills and since both Rajiv and Souse contribute to their plans at work, Rajiv is trying to figure out a way to collect benefits for some of the same charges under both plans Participation (co-insurance) Internal limits Rajiv is covered under his medical insurance policy at work and also covered under his spouse's work plan. Rajiv has some large medical bills and since both Rajiv and his spouse contribute to their plans at work, Rajiv is trying to figure out a way to collect benefits for some of the same charges under both plans O Participation (co-insurance) Internal limits O Coordination of benefits Deductible Simone had routine surgery performed at her local hospital. All charges were within the reasonable and customary costs in she area. Deductible O Participation (co-insurance) Coordination of benefits Internal limits Yakov had a run of bad luck. He sprained his arm, had a staph infection, and needed surgery to remove his appendix. Out-of-pocket, Yakov has paid $300 for the sprain, $500 for the infection, and $1,200 for the operation. He still has medical expenses for all three incidents, his insurance company is now paying part of the expenses related to the surgery but not the other two incidents What does Yakov's responsibility for still paying all expenses for the sprain and infection represent? O Coordination of benefits Deductible Simone had routine surgery performed at her local hospital. All charges were within the reasonable and customary costs in she area. O Deductible Participation (co-insurance) Coordination of benefits Internal limits Yakov had a run of bad luck. He sprained his arm, had a staph infection, and needed surgery to remove his appendix. Out-of-pocket, Yakov has paid $300 for the sprain, $500 for the infection, and $1,200 for the operation. He still has medical expenses for all three incidents. his insurance company is now paying part of the expenses related to the surgery but not the other two incidents. What does Yakov's responsibility for still paying all expenses for the sprain and infection represent? Deductible Coordination of benefits Internal limits Participation (co-insurance) 8. 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. Manuel has been hospitalized for an illness. His insurance company has started paying 80% of covered medical expenses. Internal limits Coordination of benefits Participation (co-insurance) Deductible Rajiv is covered under his medical insurance policy at work and also covered under his spouse's work plan. Rajiv has some large medical bills and since both Rajiv and Souse contribute to their plans at work, Rajiv is trying to figure out a way to collect benefits for some of the same charges under both plans Participation (co-insurance) Internal limits Rajiv is covered under his medical insurance policy at work and also covered under his spouse's work plan. Rajiv has some large medical bills and since both Rajiv and his spouse contribute to their plans at work, Rajiv is trying to figure out a way to collect benefits for some of the same charges under both plans O Participation (co-insurance) Internal limits O Coordination of benefits Deductible Simone had routine surgery performed at her local hospital. All charges were within the reasonable and customary costs in she area. Deductible O Participation (co-insurance) Coordination of benefits Internal limits Yakov had a run of bad luck. He sprained his arm, had a staph infection, and needed surgery to remove his appendix. Out-of-pocket, Yakov has paid $300 for the sprain, $500 for the infection, and $1,200 for the operation. He still has medical expenses for all three incidents, his insurance company is now paying part of the expenses related to the surgery but not the other two incidents What does Yakov's responsibility for still paying all expenses for the sprain and infection represent? O Coordination of benefits Deductible Simone had routine surgery performed at her local hospital. All charges were within the reasonable and customary costs in she area. O Deductible Participation (co-insurance) Coordination of benefits Internal limits Yakov had a run of bad luck. He sprained his arm, had a staph infection, and needed surgery to remove his appendix. Out-of-pocket, Yakov has paid $300 for the sprain, $500 for the infection, and $1,200 for the operation. He still has medical expenses for all three incidents. his insurance company is now paying part of the expenses related to the surgery but not the other two incidents. What does Yakov's responsibility for still paying all expenses for the sprain and infection represent? Deductible Coordination of benefits Internal limits Participation (co-insurance)