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Rico has a comprehensive health care insurance policy with a $500 deductible per case and 80-20...

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.

i. How much the insurance company needs to pay to Rico for the first claim incurred in March?

ii. How much is the total payment that Rico needs to pay for the second claim incurred in September?

Solutions

Expert Solution

1: First claim amount = 1200

Less: Deductible = 500

Balance = 700

Insurance company will pay 80% = $560

2: Secondclaim amount = 9000

Less: deductible = 500

Balance = 8500

Amount payable by Rico = 20%*8500=1700

but the maximum copayment = 1500

Amount paid by Rico in first claim = 700-560=140

Balance payable by Rico = 1500-140 = 1360

jeff jeffy answered 2 years ago
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