In-Network Medical Care:

Jamie Lee and Ross currently have a $15 copayment on regular preventive 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 percent/20 percent. The insurance company will cover 80 percent of the allowable medical fees and the policyholders will be responsible for the other 20 percent of the allowable medical fees.

Medical fees that are not allowed under the medical plan provisions would be 100 percent of the policyholders' responsibility.

Out-of-Pocket Limits:

Their health insurance plan provides an out-of-pocket limit of $7,500 per year.

Questions:

• Jamie Lee and Ross learned that the hospital that they plan to use for the delivery is

not a participating hospital. What will their financial responsibility be for the nonparticipating

hospital expenses?

• The doctor's office has estimated the hospital expense for Jamie Lee and the babies'

delivery, without complications, to be approximately $18,000. Based on their health

insurance policy, how much would Jamie Lee and Ross owe for this out-of-network

hospital stay?