Question

Joy’s health insurance includes a 20-80 coinsurance provision, after a $250 deductible is satisfied. Joy needed medical attention and the covered medical expenses totaled $25,250. How will this claim be settled? What if there is also a stop-loss limit of $5,000?

Answer 1

Joy needed medical attention and the covered medical expenses totaled - 25250$

Joy's pays $250 deductible is satisfied

Now the actual Balance claim will be =  25000$

Joy’s health insurance includes a 20-80 coinsurance provision

So now, the insurer pay the 80% of 25000$ and

the insured pay only 20% of 25000$

Insurer pay will be = 80% × 25000$ = 20,000$

insured pay= 20% × 25000$ = 5000$ + 250$ Joy's Pay deductible amount

So the total amount insured pay will be = 5250$

Finally,

Joy's pay will be = 5250$

Health Insurance company pay will be = 20,000$

This Claim will be settled when the joy's pay will be 5250$ and the insurance company will pay 20,000$.