Today’s Lecture U of I Student Injury and Sickness Insurance - Undergraduate Plan 2007-2008...
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Transcript of Today’s Lecture U of I Student Injury and Sickness Insurance - Undergraduate Plan 2007-2008...
Today’s LectureU of I Student Injury and Sickness
Insurance - Undergraduate Plan2007-2008Coverage
Deductibles, Coinsurance and Limits
Examples
Maximum Amount Payable
Aggregate
$200,000 for each Injury or Sickness
Psychiatric and Substance Abuse Treatment $20,000 per lifetime
Intercollegiate, Club and Intramural Sports Injuries
$75,000 per injury
In-Hospital Expense Benefit
$100 Deductible
80% of next $10,000
100% of balance of room and board and other hospital expenses incurred
In-Hospital Expense BenefitExample
In hospital for 10 days at $500 per day room and board.
Total charge: 10 x $500 = $5000
Deductible 100
80% of first $10,000 4900 = 3920
Amount payable = $3920
In-Hospital Expense BenefitExample 2
In hospital for 30 days at $500 per day room and board. How much does the U of I Student Plan pay?
A) 0
B) 10,000
C) 11,920
D) 12,900
E) None of the above
Pre-Admission TestingIf testing is performed within 7 days of the surgery, it is included under Hospital Expense Benefit.Otherwise, it would be considered an Outpatient Miscellaneous Expense Benefit.Example:
Tests performed on October 7Surgery on October 10Costs included in In-Hospital Expense BenefitIf no surgery was performed, or if it was performed after October 14, then it would be considered an Outpatient MiscellaneousExpense
Surgical Expense Benefit - Example
You have surgery and the surgeon charges you $10,000. The Usual and Customary fee is $12,000. How much does the U of I Student Plan pay?
A) 0
B) 8,000
C) 9,600
D) 10,000
E) None of the above
Assistant Surgeon Expense Benefit Example
You have surgery and an assistant surgeon charges $3000 (Usual and Customary). How much does the U of I Student Plan pay?
A) 0
B) 2000
C) 2400
D) 2500
E) None of the above
Anesthesia Expense Benefit - ExampleDuring surgery, an anesthetist administers anesthesia. You are charged $6000. The Usual and Customary charge is $5000. How much does the U of I Student Plan pay?
A) 0
B) 4,000
C) 4,800
D) 5,000
E) None of the above
In-Hospital Physician’s Expense Benefit
Lower of:80% of Usual and Customary or80% of Actual Charge
Limited to 1 visit per dayIf in Intensive Care Unit, pays 50% (not 80%)
In-Hospital Physician’s Expense Benefit - Example
You are hospitalized for 2 days; the doctor visits you once each day, charging $200 for each visit (U&C). How much does the U of I Student Plan pay?A) 0B) 160C) 200D) 320E) None of the above
Outpatient BenefitsIncludes the following benefits (page 8):
Surgical Expense BenefitDay Surgery MiscellaneousAssistant Surgeon Expense BenefitAnesthetistOutpatient ExpensesMedical EmergencyPhysician’s VisitsX-Rays/LaboratoryTests & ProceduresInjectionsPhysiotherapyChemotherapy and Radiation Therapy
Outpatient Benefits (cont.)Outpatient Expenses Benefit
Students have a $150 Deductible per policy yearInsured Dependents have no deductibleMedical Emergency Room visits have extra $50 deductible per visit
Coverage80% of Usual and Customary or 80% of the actual charge, whichever is less$900 maximum per policy year for Physiotherapy (chiropractic or physical therapy)
Outpatient Expense Benefit - ExampleYou (a student) visit a doctor four times for treatment of mononucleosis. Each visit costs $100 (U&C). In addition, lab tests cost $250. How much does the U of I Student Plan pay?
A) 0
B) 80
C) 400
D) 520
E) None of the above
Outpatient Expense Benefit – Example 2
You fall off a skateboard and skin your knee. You go to the emergency room to have it treated. You are billed $500 for the emergency room visit (U&C). How much does the U of I Student Plan pay?A) 0B) 240C) 280D) 300E) None of the above
Ambulance Expense Benefit
For land ambulance or air ambulance (medical emergency only)
80% of Usual and Customary or
80% of actual charge
Outpatient Diagnostic Procedures
For illness or accidental bodily injury, plan pays 80% of lower of U & C or
80% of actual charge up to:
CT scans $800
MRI 1200
Nuclear Imaging 782
Psychiatric and Drug Abuse Treatment
Inpatient
Same as any other illness (but with $20,000 lifetime maximum)
Outpatient
50% of charge up to maximum of:
$35 per day
45 days per policy year