Question

Nick has a comprehensive health care policy with a $250 per-calendar-year deductible, an 80% co-insurance provision, and a $1,000 copayment cap per calendar year. In January, Nick had a $600 claim for which the insurance company paid $280. Nick experiences another unrelated claim in October resulting in total bills of $5,000. How much will Nick have to pay for the second claim?
a. $5,000
b. $3,930
c. &1,800
d. $930

Answer 1

Answer:

Nick  pay maximum $930

so correct option is d. $930

Explanation:

given data

health care policy = $250

co-insurance provision = 80 %

it mean claim to be paid by insurance company = 80%

and claim to be paid by Nick =  20 %

co payment cap = $1,000

claim insurance = $600

company paid  = $280

total bills = $5,000

to find out

How much will Nick have to pay for the second claim

solution

we get first amount to be paid by insurance company and nick  is

amount to be paid by insurance company and nick  = $600 - $250

amount to be paid by insurance company and nick = $350

and

we know here 80% of $350  paid by insurance company

so paid by insurance company  = 80% of $350 = $280

and  paid by Nick = $350 - $280 = $70

so Limit available to co payment = $1000 - $70

Limit available to co payment = $930

so Nick  pay maximum $930

so correct option is d. $930