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14 March, 08:46

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

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Answers (1)
  1. 14 March, 09:06
    0
    Nick pay maximum $930

    so correct option is d. $930

    Explanation:

    given data

    health care policy = $250

    co-insurance provision = 80 %

    it mean claim to be paid by insurance company = 80%

    and claim to be paid by Nick = 20 %

    co payment cap = $1,000

    claim insurance = $600

    company paid = $280

    total bills = $5,000

    to find out

    How much will Nick have to pay for the second claim

    solution

    we get first amount to be paid by insurance company and nick is

    amount to be paid by insurance company and nick = $600 - $250

    amount to be paid by insurance company and nick = $350

    and

    we know here 80% of $350 paid by insurance company

    so paid by insurance company = 80% of $350 = $280

    and paid by Nick = $350 - $280 = $70

    so Limit available to co payment = $1000 - $70

    Limit available to co payment = $930

    so Nick pay maximum $930

    so correct option is d. $930
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