Part 1 of 3 (40 pts): SSSS ANNUAL SUMMARY MEDICAL COSTS SSSSE 10.11.2020 Steps for emplovee costa calculation; Plan A Plan B Plan C Plan D 1. Premium Employee Premium Employee Premium= $900/year Employee Premium= $900/year Employee Premium 2. Any amount above R&C $600/year Cost Share=90/10 In Network Deductible In Network=5200 $1200/year 3. Deductible in network until gone Deductible=$500 Cost Share=50/50 Out of Net. Deductible Out of Ne=3700 Co Pay =$20 in network 4. Co Insurance % bil network Cost Share=80/20 R&C Cost Share=80/20 in network Cost Share=100/0 in net. 5. Deductible out network until gone Reasonable&Customarx* Cost Share=40/60 out of net. Cost Share=0/100 out of 6. Co-Insurance % out network Co Pay=320 per visit in net net. 7. Co-pas Co Pay=$50 per visit out net No R&C 8. Exclusions No R&C Situation 1 1.5600 1.$900 1.8900 1.$1200 $600 Included expenses in network all R&C 2.0 2.NA 2 n/a $200 Included expenses out of network R&C 3.5600 - $500 = $100 3.$900 - 3.SO $300 Excluded expenses 4.$100 * 20%= $20 4.$600 * 0%= $0 2 Visits 5.na 5.50 6.$200 * 20%= $40 6.$200 * 100% =$200 7.n/a 7.2 visits * $20-$40 8.$300 8.$300 Total = $1460 Total = $1700 Situation 2 1.$600 1.$900 1.9900 2.$1200 $5400 Included expenses in network 2.5200 of above RC (3200 above R&C) $4700 Included expenses out of network (all R&C) 4.$5400 - 200 = 5200 * $200 Excluded expenses in network 10%= $520 10 Visits 5.na 6. $4700 * %50 = $2350 7. na 8. $200 Total = $4170 Situation 3 1.$900 1.$1200 $21200 Included expenses in network 2.n'a 2.NA (31000 above R&C) 3.521,200-$200=21,00 3.NA $2500 Included expenses out of network 4.$21,000 * 20%= $4,200 4.$21200*0%=$50 $2500 Excluded expenses in network 20 Visits 5.52500 - $700 = $1800 5.NA 6.$1800 * 60% = $1080 6.52500*100=$2500 7.20 visits * $20 = $400 7.20%20=$400 8. $2500 8.$2500 Total = $9,980 Total = $6600 3.na Situation 4 $501200 Included expenses in network (51000 above R&C) $50700 Included expenses out of network ($1000 above R&C) 55000 Excluded in network expenses ($200 above R&C) 50 visits regular 30 visits specialists Part 1 of 3 (40 pts): SSSS ANNUAL SUMMARY MEDICAL COSTS SSSSE 10.11.2020 Steps for emplovee costa calculation; Plan A Plan B Plan C Plan D 1. Premium Employee Premium Employee Premium= $900/year Employee Premium= $900/year Employee Premium 2. Any amount above R&C $600/year Cost Share=90/10 In Network Deductible In Network=5200 $1200/year 3. Deductible in network until gone Deductible=$500 Cost Share=50/50 Out of Net. Deductible Out of Ne=3700 Co Pay =$20 in network 4. Co Insurance % bil network Cost Share=80/20 R&C Cost Share=80/20 in network Cost Share=100/0 in net. 5. Deductible out network until gone Reasonable&Customarx* Cost Share=40/60 out of net. Cost Share=0/100 out of 6. Co-Insurance % out network Co Pay=320 per visit in net net. 7. Co-pas Co Pay=$50 per visit out net No R&C 8. Exclusions No R&C Situation 1 1.5600 1.$900 1.8900 1.$1200 $600 Included expenses in network all R&C 2.0 2.NA 2 n/a $200 Included expenses out of network R&C 3.5600 - $500 = $100 3.$900 - 3.SO $300 Excluded expenses 4.$100 * 20%= $20 4.$600 * 0%= $0 2 Visits 5.na 5.50 6.$200 * 20%= $40 6.$200 * 100% =$200 7.n/a 7.2 visits * $20-$40 8.$300 8.$300 Total = $1460 Total = $1700 Situation 2 1.$600 1.$900 1.9900 2.$1200 $5400 Included expenses in network 2.5200 of above RC (3200 above R&C) $4700 Included expenses out of network (all R&C) 4.$5400 - 200 = 5200 * $200 Excluded expenses in network 10%= $520 10 Visits 5.na 6. $4700 * %50 = $2350 7. na 8. $200 Total = $4170 Situation 3 1.$900 1.$1200 $21200 Included expenses in network 2.n'a 2.NA (31000 above R&C) 3.521,200-$200=21,00 3.NA $2500 Included expenses out of network 4.$21,000 * 20%= $4,200 4.$21200*0%=$50 $2500 Excluded expenses in network 20 Visits 5.52500 - $700 = $1800 5.NA 6.$1800 * 60% = $1080 6.52500*100=$2500 7.20 visits * $20 = $400 7.20%20=$400 8. $2500 8.$2500 Total = $9,980 Total = $6600 3.na Situation 4 $501200 Included expenses in network (51000 above R&C) $50700 Included expenses out of network ($1000 above R&C) 55000 Excluded in network expenses ($200 above R&C) 50 visits regular 30 visits specialists