Premiums = Cost of having insurance
Out of Pocket
Maximum $5,000
Once this is met,
all medical services are covered at 100% for the rest of the year.
How does it work? See below
Jane has to sleep
overnight in the hospital.
She receives a bill
from the hospital
for $100,000.
Jane calls FD National and they review her Explanation of Benefits, which shows Jane is only responsible for $5,000.
According to Jane’s insurance policy, for her hospitalization benefit she must meet her $3,000 deductible and then has 20%
co-insurance until she reaches her out of pocket maximum of $5,000.
Let’s break it down
Hospital Bills: $100,000
Negotiated Rate: $70,000
Rate that Providers have with the Insurance Company
Deductible: $3,000
Co-insurance: 20% (67,000 x 20%) = $13,400
Jane’s insurance says her Out of Pocket Maximum is $5,000.
So Jane would pay $3,000 in deductible and $2,000 in co-insurance and now for the rest of the year, Jane’s medical coverage is 100% covered.
Insurance company pays: $65,000
