Answer the multiple choice questions

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

Seans been hospitalized for an illness. His insurance company has started paying 90% of covered medical expenses. What does the 10% of expenses Sean will have to pay out of his pocket represent?

A. Internal limits

B. Participation (co-insurance)

C. Deductible

D. Coordination of benefits

Bob suffered a profound knee injury. Bob lives in a remote part of the country and depends on being in excellent physical condition to work. Bob has decided to be extra cautious when having his knee repaired. He is going to a major orthopedic hospital 2,000 miles away and having his surgery performed by one of the top 10 knee specialists in the country. He already knows that claims for the hospital services and the surgeon will exceed the reasonable and customary charges for his area. Bob is willing to pay extra for the peace of mind of knowing he received extraordinary care.

A. Internal limits

B. Deductible

C. Participation (co-insurance)

D. Coordination of benefits