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Pauline, age 33, made a purchase of an individual major medical insurance policy with a lifetime limit of $1 million, a calendar-year deductible of $250,
Pauline, age 33, made a purchase of an individual major medical insurance policy with a lifetime limit of $1 million, a calendar-year deductible of $250, and an 80-20% coinsurance provision. Pauline had emergency surgery for a strangulated hernia. Covered medical expenses are $30,750. Pauline also lost $1,000 in wages because she could not work for one week. What is the amount paid by the insurer? What is the amount paid by Pauline? How would your answer change if Paulines policy contained an annual stop-loss limit of $3,000?
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