Benefit Essay Situation Questions

Question 1

Dave has medical coverage through a managed care plan. His plan has a $200 annual deductible, and an 80/20 payment scheme for in-network care. For out of network care, his deductible is $500 and there is a 50/50 payment scheme. He has received no medical care this year

While playing basketball with friends, Dave injures his ankle and a friend takes him to the local emergency room. The total bill for care is $1,000.

(a) How much will Dave have to pay out of pocket if the emergency room is within his insurance network?

(b) How much will Dave have to pay out of pocket if the emergency room is NOT within his insurance network?

Question 2

(a) Jill is a 27-year-old worker at a technology firm. Her company provides a group life term insurance benefit of $150,000, and the company pays the entire premium. Using the Uniform Premium Table, what is the taxable monthly cost of her life insurance benefit?

(b) Jill’s boss, Susan, is 62 years old, and has an insurance benefit of $150,000 as well. What is the taxable monthly cost of her life insurance benefit?

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Solution Preview

Question 1
(a) How much will Dave have to pay out of pocket if the emergency room is within his insurance network?
Out network
Deductible 500 for insurance
And $500 for Dave
Dave would not pay anything since he has not exceeded his limit.
In network 80/20
Dave deductible 200
Insurance 800
Dave would not need to pay anything

(308 words)