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.
Health Plan Comparison
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:
  1. Carefully review the in-network/out-of-network information in the Health Plan Comparison chart.
  2. Open the Health Plan Overview .docword documentor .rtf.
  3. 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

Health Plan Overview 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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