Alvin Robinson works for the gas company and receives full family health care benefits as part of his compensation package. His health care policy is a major medical policy with a $2,000 family deductible, $25 copay, 80% coinsurance provision and $7,000 stop-loss provision.
Alvin's wife, Odessa, works as an office manager for a local company. Her benefits package includes employee only health care coverage. Her company allows employees to "opt out" of the health care benefit for a cash incentive of $250 per month.
-Alvin had an emergency gall-bladder operation with major complications. His medical expenses totaled $42,000. Assuming this was the only family medical expense for the year, how much will the Robinson's pay out-of-pocket for this bill?

Question

Quizplus · Accepted Answer

The Robinsons will pay the $2,000 deductible first. After that, they pay 20% of the remaining $40,000 ($42,000 - $2,000) until they reach the $7,000 stop-loss. The 20% of $40,000 is $8,000, but since the stop-loss is $7,000, they will only pay up to $7,000 in total out-of-pocket expenses.

Alvin Robinson Works for the Gas Company and Receives Full