Your personal health insurance policy provides the following coverage: For all covered medical bills, you must pay a $100 annual aggregate deductible.
After meeting that deductible, you must share in all additional expenses on a 90/10
Basis. In any one year, your out-of-pocket maximum expenditure will not exceed $1,000.
In 2009 you fall and crack your skull. The covered medical bills you incur total $7,100. How much will you have to pay for this loss, and how much will the insurer pay?

Question

Quizplus · Accepted Answer

You must first meet the $100 deductible, leaving you with $7,000 in covered medical bills. Since you share in all additional expenses on a 90/10 basis, you will be responsible for 10% of the remaining $7,000, or $700. This brings your total out-of-pocket expenses to $800. Since your out-of-pocket maximum expenditure will not exceed $1,000, the insurer will pay the remaining $6,300.

Your Personal Health Insurance Policy Provides the Following Coverage: for All