A&S: Extended Health Care Plans (EHP)

Question 1

Extended health Plans (EHP)

Answer 1

• enhanced medical + hospital care on top of government care (i.e massage therapy, ambulatory care)
• dental care
• vision care
• accidental death + dismemberment (ad&d)

Question 2

EHP Deductibles

Answer 2

deductibles could be:

• per claim
• single
• family

Question 3

EHP per claim deductible

Answer 3

• i.e insured pays $15 DISPENSING FEE FOR EACH PRESCRIPTION

Question 4

EHP Single Deductible

Answer 4

• i.e dental plan: insured pays $100, all other cover up till annual max

so, insured pays deductible the 1st time, then doesnt have to pay again for the year

Question 5

EHP family deductibles

Answer 5

• family deductble === TOTAL family deductible

i.e: policy has $100 single deductible / $300 FAMILY deductible, so if each family member had $500 claim for the year :
person 1: 500 claim - 100 deductible
person 2: 500 claims - 100 deductible
person 3: 500 claim - 100 deductible
»» $300 family deductible MET«<
person 4: 500 claim- 0 deductible —> no more deductible BC family deductible MET

Question 6

EHP co insurance

Answer 6

co insurance: % of claim ins co will pay subject to policy limits

Question 7

EHP Policy w co-ins + Deductible

Answer 7

example:

• coverage up to $1500
• 80% co ins
• $100 deductible

1st claim: $800

step 1:
insurance co reimbursement:
» always deduct the deductible 1st«
800 claim - $100 DEDUCTIBLE= 700

step 2:
co ins: $700 x co ins 80%= $560 reimbursed