MTOP Inc. offers its employees the choice between a private insurance company pl
ID: 450458 • Letter: M
Question
MTOP Inc. offers its employees the choice between a private insurance company plan (Blue Cross/Blue Shield), an HMO, and a POS. Ronald needs to review the packet and make a decision on which health care program fits his needs. The following is an overview of that information. Blue Cross/Blue Shield plan: The monthly premium cost to Ronald will be $46. For all doctor office visits, prescriptions, and major medical charges, Ronald will be responsible for 20 percent of covered charges and the insurance company will cover the rest. The annual deductible is $450. HMO Plan: The HMO is provided to employees free of charge. The copayment for doctors' office visits and major medical charges is $35. Prescription copayments are $15. The HMO pays 100 percent after the Ronald's copayment. No annual deductible. POS Plan: The POS requires that the employee pay $28.94 per month to supplement the cost of the program with the company's payment. If Ron uses health care providers within the plan, he pays the copayments as described above for the HMO. He can also choose to use a health care provider out of the service and pay 15 percent of all charges after he pays a $350 deductible. The POS will pay for 85 percent of those covered visits. No annual deductible. Ronald decided to review his medical bills from the previous year to see what costs he had incurred and to help him evaluate his choices. He visited his general physician 3 times during the year at a cost of $156 for each visit. He also spent $75 and $130 on prescriptions during the year. What annual medical costs will Ronald pay using the sample medical expenses provided if he were to enroll in the Blue Cross/Blue Shield plan?
Explanation / Answer
Monthly premium cost to Ronald = $46
Ronald will be responsible for 20 percent of covered charges and the insurance company will cover the rest
Annual deductible = $450
co payment for doctors' office visits and major medical charges = $35
Prescription co payments = $15
He visited his general physician 3 times during the year at a cost of $156 for each visit.
Ronaldo visited his doctor 3 times. He pays 20 percent of the cost of each visit. Each visit costs $156. So he pays 4 times 20 percent of $ 156 for his doctor's visits.
Visit cost = $ 156 *0.20 * 3
= $ 93.6 ------------------------------------------------------(1)
Ronaldo also pays 20 percent of his prescription cost. So he pays 20 percent of (75 plus 130) for his prescriptions.
Prescription cost = 20% * (75+130)
= $ 41 ------------------------------------------------------(2)
He also pays $46 per month for his monthly premiums. So he pays
Premium cost = 12 x 46
= $ 552 -----------------------------------------------(3)
Total cost = Visit cost + Prescription cost + Premium cost
= $ 93.6 + $ 41 + $ 552
= $ 686.6
Annual medical costs will Ronald pay using the sample medical expenses provided if he were to enroll in the Blue Cross/Blue Shield plan is $ 686.6
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