Question

Ronald Roth started his new job as controller with Aerosystems today. Carole, the employee benefits clerk, gave Ronald a packet that contains information on the company’s health insurance options. Aerosystems offers its employees the choice between a private insurance company plan (Blue Cross/Blue Shield), an HMO, and a PPO. 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.

  

a.	Blue Cross/Blue Shield plan: The monthly premium cost to Ronald will be $59.79. For all doctor office visits, prescriptions, and major medical charges, Ronald will be responsible for 20 percent and the insurance company will cover 80 percent of covered charges. The annual deductible is $840.
b.	The HMO is provided to employees free of charge. The copayment for doctors’ office visits and major medical charges is $25. Prescription copayments are $20. The HMO pays 100 percent after Ronald’s copayment. No annual deductible.
c.	The POS requires that the employee pay $41.97 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 with no annual deductible. He can also choose to use a health care provider out of the network and pay 20 percent of all charges after he pays a $840 deductible. The POS will pay for 80 percent of those covered visits.

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 six times during the year at a cost of $140 for each visit. He also spent $82 and $106 on prescriptions during the year. Assume Ron visited a physician outside of the network plan but had his prescriptions filled at a network-approved pharmacy.

If Ronald selects the POS plan, what would his annual medical costs be?

Answer 1

Answer:

To find out the annual medical costs, first we will find out the Out-of-network coinsurance expenses and find out the maximum (max), that is:

Out-of-network coinsurance expenses = Max[(Total out-of-network expenses − Deductible), 0]
= Max{[(Physician's vists × Cost per visit) − Deductible], 0}

Out-of-network coinsurance expenses = Max{[(6 × $140) − $840], 0} = $0

Now we will find out the Ronald's annual medical costs, if he selects the POS plan be:

Annual medical costs = Annual premiums + In-network costs + Out-of-network costs

Annual medical costs = (Monthly premium × 12) + (Number of prescriptions × Prescription co-pay)

+ {[Min(Deductible, Total out-of-network costs)] + Coinsurance cost}

Annual medical costs = ($41.97 × 12) + (2 × $20) + {Min[(6 × $140), $840] + (0.20 × $0)} = $1383.64

So, the annual medical costs will be $1383.64