HEALTH AND DISABILITY INCOME INSURANCE
Jamie Lee and Ross, happy newlyweds with a new home and twins on the way, are anxiously awaiting their new bundles of joy. Ross was understandably nervous as he wondered if everything would go smoothly with Jamie’s pregnancy. Fortunately, they coordinated benefits from the medical insurance group plan offered by Ross’s employment at the graphics agency and Jamie Lee’s own plan, although Ross’s plan would be their primary. His employer offers a health care savings plan, but Ross had not previously realized the benefit of participating. Jamie Lee has had maternity care that she has been comfortable with so far, but Ross needed to review their health insurance policies with the potential of extensive medical expenses just on the horizon. He wondered if his salary would be enough to pay for the expenses that were not covered for out-of-network doctors. Current Medical Insurance Plan Provisions Jamie Lee and Ross have a PPO, or preferred provider organization, plan. In-Network Medical Care: Jamie Lee and Ross currently have a $15 copayment on regular preventive care doctor visits and a $30 copayment on specialists that are preferred providers or participating members from the PPO plan’s list. Out-of-Network Medical Care: Jamie Lee and Ross have the choice of seeking medical care from the professional of their choice outside the PPO member list, but will incur a deductible of $500 per person/$1,000 per family, per year. After the deductible is met, there is a coinsurance of 80 percent/20 percent. The insurance company will cover 80 percent of the allowable medical fees and the policyholders will be responsible for the other 20 percent of the allowable medical fees. Medical fees that are not allowed under the medical plan provisions would be 100 percent of the policyholders’ responsibility. Out-of-Pocket Limits: Their health insurance plan provides an out-of-pocket limit of $7,500 per year.
1. Using the information on the ACA and health planning from the “Personal Finance in Practice” box in this chapter, what are some of the strategies that Ross can use to better prepare financially for the arrival of the twins?
2. How could Jamie Lee and Ross prepare for the birth of the twins with their existing PPO plan?
3. Jamie Lee and Ross learned that the hospital that they plan to use for the delivery is not a participating hospital. What will their financial responsibility be for the nonparticipating hospital expenses?
4. The doctor’s office has estimated the hospital expense for Jamie Lee and the babies’ delivery, without complications, to be approximately $18,000. Based on their health insurance policy, how much would Jamie Lee and Ross owe for this out-of-network hospital stay?
5. Surprise! The babies arrived five weeks early and Jamie Lee and Ross are the proud parents of triplets: two boys and a girl! Since they were preterm, they will need to spend a few extra days in the hospital for observation. How will Ross and Jamie Lee make provisions for adding the babies to their health insurance policy now that they have arrived?
QUESTION 1: The centralized employee travel department of Kensy Company has expenses of $435,000. The department has serviced a total of 4,000 travel reservations for the...May 21 2020
The Allied Group has acquired Kramer Industries and is now considering additional investments. They have determined that there is a firm that is a good fit for their port...Apr 16 2020
Price and efficiency variances. Sunshine Foods manufactures pumpkin scones. For January 2017, it budgeted to purchase and use 14,750 pounds of pumpkin at $0.92 a pound. A...Jul 19 2020
List several potential difficulties with ratio analysis.Here is a tip:Ratios standardize numbers for comparisons between companies. This does not mean that the companies ...Apr 24 2021
Mapleton Family Medicine is a physician group practice located in a small city (population 150,000) in the Midwest. Mapleton is an eight-physician practice, consisting of...Jul 09 2020
Discuss the origin, meaning, and use of the macroscopic balances, and explain what assumptions have been made in deriving them ? How does one decide which macroscopic bal...Aug 06 2020
Al Maha Company is specialized in mangoes distribution in the city of Muscat. Sales are 400 boxes per month (four weeks). It costs OR 10 to make and receive an order and ...Apr 29 2021
Use the applet entitled Simulating the Stock Market to estimate the probability that the stock market will go up each of the next two days. Repeatedly run the applet for ...Aug 07 2020
A commercial bakery has recorded sales (in dozens) for three products, as shown below: Day Blueberry Muffins Cinnamon Buns Cupcakes 52 a. Predict orders for the following...Aug 23 2020
Assuming no Fair Value Adjustment (available-for- sale) account balance at the beginning of the year, prepare the adjusting entry at the end of the year if Laura Com- pa...Jun 18 2020