If an individual incurs $15,000 in covered medical expenses under a Major Medical policy with a $5,000 deductible and 80/20 coinsurance, how much will the insured have to pay?

Study for the South Dakota Life and Health Exam. Learn with multiple choice questions, each with explanations. Prepare effectively and excel in your exam!

To determine how much the insured will have to pay, it is crucial to break down the costs involved with the major medical policy.

First, the deductible of $5,000 needs to be satisfied. This amount is the portion that the insured must pay out of pocket before the insurance starts to contribute. After the insured pays the deductible, the remaining covered medical expenses are $15,000 - $5,000 = $10,000.

Next, the coinsurance provision comes into play. With an 80/20 coinsurance arrangement, the insurer pays 80% of the covered expenses, and the insured pays 20%. Therefore, on the remaining $10,000, the insured is responsible for 20%, which amounts to $10,000 x 0.20 = $2,000.

Adding these costs together gives the total amount the insured will pay: the deductible of $5,000 plus the coinsurance portion of $2,000, totaling $5,000 + $2,000 = $7,000.

Thus, the insured is required to pay $7,000 for the covered medical expenses after considering both the deductible and the coinsurance. This aligns with the correct choice.

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