Florida 2-15 Life, Health and Variable Annuity AgentGeneral Knowledge of Health InsuranceEasy
A client has a comprehensive major medical policy with a $2,500 deductible and a 70/30 coinsurance provision. After meeting their deductible, they incur an additional $10,000 in covered medical expenses. What amount will the client be responsible for paying out of pocket for these additional expenses?
- A$3,000
- B$7,000
- C$10,000
- D$2,500
Show answer & explanationAnswer & explanation
Correct answer: A. $3,000
The client has a 70/30 coinsurance, meaning they are responsible for 30% of covered expenses after the deductible. 30% of $10,000 is $3,000.
Why the other options are wrong
- B. This is the insurer's portion (70%) of the additional expenses, not the client's.
- C. This is the total additional expense amount, not the client's coinsurance portion.
- D. This is the deductible amount, which has already been met for these expenses.
Coinsurance Calculation
The calculation of the insured's portion of covered medical expenses after the deductible has been met, typically expressed as a percentage.
- Applies after the deductible.
- Client pays their coinsurance percentage.
- Insurer pays the remaining percentage.
Memory trick: Coinsurance is the share you 'coin' up after the deductible.