CMFAS HI Medical Expense & Group H&S Insurance question: Arjun's plan entitles

CMFAS HIMedical Expense & Group H&S Insurance

Mr Arjun's plan entitles him to a Class B1 ward, but he is admitted to a private hospital. The pro-ration factor is 55%, his 'as charged' bill is S$32,000, the annual deductible is S$3,500 and co-insurance is 10%. How much does the insurer pay?

A S$25,650
B S$17,600
C S$12,690
D S$14,100

Show the answer and explanation

Answer: C. S$12,690

Apply the pro-ration factor first: 55% x S$32,000 = S$17,600 of covered charges. Deduct the deductible: S$17,600 - S$3,500 = S$14,100. Apply 10% co-insurance on that balance: 10% x S$14,100 = S$1,410 (borne by Mr Arjun). Insurer pays S$14,100 - S$1,410 = S$12,690.

Common mistake

Skipping pro-ration and working from S$32,000 gives S$25,650; S$17,600 (pro-rated) and S$14,100 (after deductible) are intermediate figures, not the final payment.

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