9.4 finance assignment
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Health Plan Overview
Health insurance plans often have different coverage for In-Network and Out-of-Network providers.
- In-Network doctors, hospitals, and medical providers have contracted with the insurance company to provide medical services to members at a certain rate and these savings are passed on the to the health plan members.
- Out-of-Network providers are still covered by a member’s health plan, but the cost for using these providers is greater.
| Service and Cost | Health Choice | Super Health |
|---|---|---|
| Emergency Room | $25 co-pay |
90% of approved amount after deductible 100% of approved amount for accidental injury |
| Urgent Care |
In-network: $10 co-pay; 100% for initial exam for accidental/medical emergency Out-of-network: 80% of approved amount after deductible; 100% for initial exam for accidental/medical emergency |
90% of approved amount after deductible |
| Surgery |
In-network: 100% of approved amount Out-of-network: 80% of approved amount after deductible |
100% of approved amount |
| Hospital Care |
In-network: 100% of approved amount Out-of-network: 80% of approved amount |
100% of approved amount plus $5 a day for a private room |
| Prescriptions |
In-network: Co-pay $5 generic/$10 brand Out-of-network: 75% of approved amount after deductible |
Co-pay $5 generic/brand |
| Physician Office Visit |
In-network: $5 co-pay; 100% for initial exam for injury/medical emergency Out-of-network: 80% of approved amount after deductible; 100% for initial exam for injury/medical emergency |
90% of approved amount after deductible 100% of approved amount for accidental injury |
| Vision |
In-network: $10 for one exam per calendar year Out-of-network: 80% of approved amount after deductible |
90% of approved amount after deductible |
| Deductible |
In-network: none Out-of-network: $250 individual per calendar year |
$250 individual per calendar year |
| Maximum Out-of-Pocket |
In-network: none Out-of-network: 100% after payments reach $2,500 |
100% after payments reach $1,000 |
Instructions:
- Carefully review the in-network/out-of-network information in the Health Plan Comparison chart.
- Open the Health Plan Overview .doc
or .rtf. - Calculate the out-of-pocket cost (the portion of the medical bill insurance does not cover) for each health plan based the services listed.
Rubric
| Excellent | Good | Needs Improvement | Poor | |
|---|---|---|---|---|
| Content | 20-25 points The work contains all the required elements: Health Plan Comparison chart |
16–19 points The work contains most of the required elements: Health Plan Comparison chart |
12–15 points The work contains some of the required elements: Health Plan Comparison chart |
0–11 points The work contains few or none of the required elements: Health Plan Comparison chart |
| Quality | 20–25 points Health Plan Overview chart has completely accurate information. |
16–19 points Health Plan Overview chart has mostly accurate information. |
12–15 points Health Plan Overview chart has somewhat accurate information. |
0–11 points Health Plan Overview chart has inaccurateinformation. |
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