In: Finance
Rico has a comprehensive health care insurance policy with a $500 deductible per case and 80-20 with a maximum $1,500 copayment cap per calendar year. In March, Rico has a $1,200 claim. Rico experienced another claim in September resulting in a total bill of $9,000.
a. How much the insurance company needs to pay to Rico for the first claim incurred in March? b.How much is the total payment that Rico needs to pay for the second claim incurred in September?
a: Amount paid by Insurance company = (claim-deductible)*80% =
= (1200-500)*80%
= $5600
b: Amount paid by Rico in first claim = (1200-500)*20% = 140
Second claim = 9000
Less deductible = 500
Balance = 8500
20% copayment = 1700
Maximum copayment = 1500
Less: first claim = 140
Amount payable by Rico = 1360