Health Plan Overview
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3Health Plan Overview
CHAPTER 11
ACTIVITY
ObjECTivE
Teacher Directions
The purpose of this
activity is for students
Hand out the student activity sheet and health plan comparison.
to analyze and compare
different health
Explain the difference between In Network and Out of Network coverage (“In-
insurance plans, and to
Network” doctors, hospitals, and medical providers have contracted with the
calculate the amount of
insurance company to provide medical services to members at a certain rate.
out-of-pocket expenses
Members still have coverage at “Out of Network” providers; however, the cost is
paid on insurance
greater.)
claims given different
scenarios.
Students will compare the two plans and calculate the out-of-pocket expense
(the portion of the medical bill that insurance doesn’t cover) for each service.
Answers
Health Choice
Super Health
1.
$5 (doctor visit in network)
$95 (hasn’t met deductible yet)
2.
$25 (hospital was in network)
$115 (after this meets deductible)
3.
Prescriptions $10 (hospital
Prescription $5 (hospital and
and surgery covered because in
surgery covered)
network)
4.
$10 (co-pay for in network)
You pay $4.50, insurance pays 90%
(deductible met)
5.
You pay $17, insurance pays 80%
You pay $8.50, insurance pays 90%
(out of network, deductible met)
(deductible met)
6.
$5 (generic)
$5 (generic)
7.
You pay $56.25, insurance pays
$5 (brand)
75% (out of network)
8.
Co-pay is $5
$9.50 (insurance pays 90%)
9.
Co-pay is $25
Covered
10.
$10 (in network)
You pay $10.50 (insurance pays
90%)
FOUNDATIONS in PERSONAL FINANCE
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