Nick has a comprehensive health care policy with a $250 per-calendar-year deductible,an 80% co-insurance provision,and a $1,000 copayment cap per calendar year.In January,Nick had a $600 claim for which the insurance company paid $280.Nick experiences another unrelated claim in October resulting in total bills of $5,000.How much will Nick have to pay for the second claim?
A)$5,000
B)$3,930
C)$1,800
D)$930
E)None of the above

Question

Quizplus · Accepted Answer

Nick has already paid $320 out of pocket for the first claim ($600 - $280). For the second claim, he needs to pay the remaining $250 deductible, which he hasn't yet met. After the deductible, the insurance covers 80% of the remaining $4,750 ($5,000 - $250), which is $3,800. Nick pays 20% of $4,750, which is $950. However, since he has a $1,000 copayment cap and has already paid $320, he only needs to pay an additional $680 to reach the cap, totaling $930 for the second claim.

Nick Has a Comprehensive Health Care Policy with a $250