Sarah\'s comprehensive major medical health insurance plan at work has a deducti

Question

Sarah's comprehensive major medical health insurance plan at work has a deductible of $550. The policy pays 85 percent of any amount above the deductible. While on a hiking trip, she contracted a rare bacterial disease. Her medical costs for treatment, including medicines, tests, and a six-day hospital stay, totaled $9,460. A friend told her that she would have paid less if she had a policy with stop-loss feature that capped her out-of-pocket expenses at $3,400. The policy with the stop-loss feature has the same deductible and coinsurance requirement as Sarah's current policy 4204) Determine which policy would have cost Sarah less and by how much.(Round your intermedilate calculations and final answer to 2 decimal places.) Current policy Stop-loss feature No difference in Sarah's cost for this claim. Prex8 of 25 Next >

Explanation / Answer

Current policy requirements:

deductible amount = $550

co-insurance ratio= 85/15

Medical expenditure= $9,460

Therefore, Sarah's co insurance amount= (9,460-550) x 0.15= $1,336.5

Stop loss policy requiremnts:

deductible amount = $550

co-insurance ratio= 85/15

Medical expenditure= $9,460

Therefore, Sarah's co insurance amount= (9,460-550) x 0.15= $1,336.5

Total out of pocket expenses for Sarah= 1336.5+550= $1,886.5

Stop loss amount limit= $3,400

Therefore, no difference will arise in sarah's cost for this claim since her out of pocket expenses are less than the stop loss limit

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