Third Exercise (HPEX 300) PDF

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This is an assignment from my class with Professor Pyles. Happy studying!...

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HPEX 300: Health Care Delivery in the U. S.

Virginia Commonwealth University Department of Kinesiology and Health Sciences

EXERCISE #3 Worksheet – Six Health Plans You must complete the Bb assessment for this exercise by the deadline to receive credit. The deadline is 11:59 p.m., MONDAY, NOVEMBER 16, 2020. This worksheet is for your personal use and WILL NOT be submitted for grading. You should refer to the handout containing the information for the six health plans and to course content for Chapters 8 and 9 to answer the questions below. 1.

In general, POS plans are more restrictive than HMOs. __True _X_False

2. How much would an insured pay in premiums for Plan DEF in one year? $___7151.05___ 3. How much would an insured pay in premiums for Plan JKL in one year for family coverage? $___12000.00___ 4. If out-of-pocket costs for premiums is the only important factor for an individual seeking single coverage, assuming that he/she would select one of the six plans on the list, which of the plans should that individual choose? ABC DEF GHI JKL MNO PQR 5. If out-of-pocket costs for an applicable deductible is the only important factor for an individual seeking either individual or family coverage, assuming that he/she would select one of the six plan on the list, which of plans would be the likely choice of the person shopping for a plan? ABC DEF GHI JKL MNO PQR 6.

What is the average annual deductible for a. the PPO Plans $__1766.67___ b. the HMO Plans

7.

$__400.00___

Which plan has the highest PCP copayment for office visits? _ABC_ Which plan has the lowest non zero PCP copayment for office visits? _GHI_

8. An emergency room visit will cost an insured with Plan _GHI/PQR_ the most in terms of emergency room copayments. Page 1of 2

Worksheet: Exercise #3 – The Six Health Plans On average, in terms of copayments, an emergency room visit will cost insureds with PPO plans $ _441.67_. Such visits, on average, in terms of copayments, will cost insureds with HMO plans $ _412.50_. 9. Rank the plans in terms of hospital coinsurance rates from lowest to highest Assign a rank of 1 to the plan with the lowest hospital coinsurance rate and a rank of 2 to the plan with the next lowest hospital coinsurance rate and so forth. List the Plans: 1 _MNO_ 2 _DEF_ 3 _ABC_ 4 _PQR_ 5 _JKL_ 6 _GHI_ 10.

When it comes to laboratory services, insureds covered by one of these six plans pay an average of _31.3_% for their laboratory services. If laboratory services are the only important plan benefits for an insured, which of the plans would be the most preferred based on the coinsurance rate for laboratory services? List the plan _DEF_

Which plan would be the least preferred? List the plan. _PQR_

11.

What is the impact of a plan having a maximum out-of-pocket liability for an insured? The insurer would have lower out-of-pocket costs because when the maximum liability is reached the insurance company will cover 100% of the approved plan amounts.

12.

All six of the plans offer a prescription drug benefit. In light of this fact, and considering the different copayments for these drugs, which plan would seem to be the most logical choice for an insured if she has one prescription drug that costs $3,500 for a 45 day supply (assume the drug would be in Tier 4 for all of the plans)? List the plan. _MNO_ What would her copayment be for her prescription if she chooses this plan? $_55_

HPEX 300: Health Care Delivery in the U. S.

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