Plan Design

What is a deductible?

• The amount the member must pay before insurance will pay a claim

• A fixed amount you pay for a covered health care service

• The most you have to pay for covered services in a plan year

• A % cost of a covered health care service you pay after the deductible

What is a coinsurance?

• The amount the member must pay before insurance will pay a claim

• A % cost of a covered health care service you pay after the deductible

• The most you have to pay for covered services in a plan year

• A fixed amount you pay for a covered health care service

What is a copay?

• A fixed amount you pay for a covered health care service

• A % cost of a covered health care service you pay after the deductible

• The most you have to pay for covered services in a plan year

• The amount the member must pay before insurance will pay a claim

What is an annual out of pocket max?

• A fixed amount you pay for a covered health care service

• A % cost of a covered health care service you pay after the deductible

• The most you have to pay for covered services in a plan year

• The amount the member must pay before insurance will pay a claim

Nebula has a $2,500 deductible

20% Coinsurance

$6,000 OOPM.

She has a $750K arm transplant.

How much does she pay?

• $2,500

• $747,500

• $149,500

• $6,000

What are employee contributions?

• The amount the company pays for employees' health plan

• The amount employees pay for their health plan

• The amount budgeted by the company for the employee health plan

• The deductible paid by employees for their health plan

Avengers Co. pays $2,000 per employee per month to Cigna. Cigna pays for all claims. What type of funding is this?

• Self Funded

• Level Funded

• Fully Insured

• Simple funded

Group A enters into a 12/24 contract on 1/1/2022. What is the latest incurred date that is covered by the contract?

• 12/31/2021

• 12/31/2022

• 12/31/2023

• 12/31/2024

Deductible: $500

Coinsurance 40%

OOP Max: $5,000

Claim $450,000

How much does the member pay?

• $2,700

• $6,000

• $5,000

• $269,700

Deductible: $100

Coinsurance: 20%

OOP Max: $10,000

Claim: $2,000

How much does the member pay?

• $1,900

• $380

• $480

• $2,000