Objective The purpose of this activity is to analyze and compare different health insurance plans and to calculate the amount of out-of-pocket expenses paid on insurance claims given different scenarios. Directions Use the health plan comparison sheet to calculate what each out-of-pocket medical expense will be under each insur- ance plan, Health Choice or Super Health, and record your answers in the chart below. When you begin, your deductible has not been met. (The fees listed next to each item are what the services cost without any health insurance.) SERVICE AND COST COST WITH HEALTH CHOICE COST WITH SUPER HEALTH 1. Doctor's office visit for a sore throat and cough (in network) $95 2. Emergency room for stitches (in network) $115 DEDUCTIBLE NOW MET 3. Appendectomy (in network) Two-night hospital stay $2,000 Surgery $14,000 Prescription (brand) $185 4. Eye exam (in network) $45 5. Urgent care (out of network) $85 6. Prescription (generic) $85 7. Prescription (brand, out of network) $225 8. Annual physical (in network) $95 9. Emergency room for snow board accident (concussion, broken leg, x-rays, etc.) $6,500 10. Urgent care (in network) $105 Health Plan Comparison Sheet 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 90% of approved amount after deductible IN NETWORK: $10 co-pay: 100% for initial exam for accident/medical emergency OUT OF NETWORK: 80% of approved amount after deductible, 100% of approved amount for initial exam for accident/medical emergency Surgery 100% of approved amount IN NETWORK: 100% of approved amount OUT OF NETWORK: 80% of approved amount after deductible Hospital Care IN NETWORK: 100% of approved amount 100% of approved amount plus $5 per OUT OF NETWORK: 80% of approved amount day for private room after deductible Prescriptions IN NETWORK: Co-pay $5 generic/$10 brand Co-pay $5 generic/brand OUT OF NETWORK: 75% of approved amount Physician Office Visit 90% of approved amount after deductible; 100% for accidental injury IN NETWORK: $5 co-pay: 100% approved amount for initial exam for injury/medical emergency OUT OF NETWORK: 80% of approved amount after deductible; 100% approved amount for initial exam for injury/medical emergency Vision 90% of approved amount after deductible IN NETWORK: $10 co-pay for one exam per calendar year OUT OF NETWORK: 80% of approved amount after deductible Deductible $250 per calendar year IN NETWORK: None OUT OF NETWORK: $250 individual per calendar year Maximum Out of Pocket 100% after payments reach $1,000 IN NETWORK: None OUT OF NETWORK: 100% after payments reach $2,500
