Use the following information to determine the costs to you and/or to the insurance company for the following occurrences: 1) You have $500 per person Wellness Benefit. 2) You have a $500 Individual Deductible and your family (spouse and children) has a $500 Family Deductible. 3) You have a $10,000 annual Maximum Family Out-of- Pocket expense provision. 4) Once you have met your Individual or Family Deductible, your insurance will pay 80% of the expenses and you will pay 20% as your co-pay. Unless the occurrence is a Wellness expense, you and/or your family have to meet their deductibles first before insurance will pay anything. Example: Assume that you have met your deductible, and you go to the Emergency Room for a large cut on your shin which required cleaning, 20 stitches, a tetanus shot, and antibiotics. (80/20 plan) Total Charges = $2,500 total Your Responsibility = $2,500*.20 = $500 (goes toward your Max Out of Pocket) Insurance Responsibility = $2,500*.80 = $2,000

Question: Chiropractic visit for you and your spouse - $50 each. What are my costs and what are the insurance costs?