Sometimes it can be challenging’s to find these details, but that is part of the assignment, so that will not be a reasonable excuse for not answering or answering incompletely. If you don’t want to use your health insurance plan or don’t have health insurance, you should use the student health insurance plan to answer the questions. Unless the question specifies otherwise, you should answer cost questions based on both the in-network and out-of-network costs as sometimes circumstances dictate that we don’t get to choose in-network providers. has a publicly available benefit summary (be sure to use the same plan for the entire assignment).
Fully answer all questions (just the amount and yes/no on most questions is acceptable) and include a copy of the plan benefits you used to answer the questions. Answer questions for both in and out of network costs unless one is specifically indicated in the question. You may submit this anytime during the semester before the due date.
Grading:
10 pts for an attached benefits plan
Is your plan a private or public insurance plan; how did you determine this?
What type of plan do you have? (PPO, HMO, etc.)
When is your open enrollment period (when you can make changes to your insurance)?
What is your premium (usually the amount you pay monthly or per semester for a student plan)?
What is your individual and/or family deductible?
What is your cost for preventative/wellness care?
What is your cost to see your primary care doctor (may be listed as a diagnostic visit)?
What is your cost to see a specialist?
What is the cost of diagnostic lab tests and x-rays?
What is the coinsurance or copayment for durable medical equipment?
Does your insurance cover genetic testing? If so, which ones and under what circumstances?
If you have private insurance, which classifications apply to your plan (MC, group, self, HDHP, individual)?
If you have an HDHP, do you have an HRA or HSA?
If you have a public insurance plan, exchange plan, or military plan, do any of the above apply?
You were hiking and took a fall. You go to the nearest urgent care center (you do not check to see if it’s in-network). They decide an x-ray is necessary. The x-ray shows that there is no fracture. You have been prescribed generic pain medication. Assume the negotiated rate for your x-ray is $500 and the medication is $50.
How much will you pay out of pocket for the visit to the urgent care? For the x-ray?
How much will you pay for the medication?
How much more would you have paid to access an emergency room?
It’s time for your annual wellness visit. You see your primary care provider. You receive a recommended immunization, and your PCP orders additional blood work because you report some recent medical concerns.
How much is the cost of the visit?
Do you have to pay for the immunization?
How much will the blood work cost you (assume a negotiated rate of $100)?
You or a female on your insurance plan was pregnant and delivered a healthy baby. The cost of the hospital stay is $4,000 and the delivery costs for an uncomplicated birth are $8,000. You have met your deductible for the year. Assume you made sure your hospital and provider are in-network.
How much will you/her be responsible for paying for delivery costs?
How much will you/her be responsible for paying for facility costs?
You experience excruciating pain and sudden fever while at work. Your boss calls an ambulance and you are transported to an in-network ER. You are admitted to the hospital and require an emergency appendectomy. You have met your deductible for the year. The transportation fees total $1,000. The physician and surgeon fees total $10,000 and the facility fees total $12,000.
How much will you pay for emergency transportation?
How much of the in-network physician/surgeon fees would you be responsible for paying?
How much of the in-network facility fees would you be responsible for paying?
Uh-oh. A hospital administrator made a mistake. Due to scheduling challenges, the surgeon who removed your appendix is out-of-network. You get balanced-billed by the hospital for $1,000 for surgeon services. How much will you have to pay and why that amount (check regulations for the state of Texas to answer this one)?
18. Now that you’ve had a chance to see how your health insurance operates, do you think
it’s a “good” plan?
19. What changes, if any, would you like to consider during your next open
enrollment period?
20. If your health changed dramatically over the next year, would this plan still meet your
needs at a cost you believe you could afford?
