CMFAS HI Medical Expense & Group H&S Insurance question: insurer's total payout for the year (2)

CMFAS HIMedical Expense & Group H&S Insurance

Mr Faisal's policy carries a per-disability (per-claim) deductible of S$800 and 10% co-insurance. In the same policy year he made two separate, unrelated claims of S$5,000 and S$2,500. What is the insurer's total payout for the year?

A S$5,310
B S$6,030
C S$6,750
D S$5,900

Show the answer and explanation

Answer: A. S$5,310

A per-disability (per-claim) deductible is borne separately for each claim. Claim 1: S$5,000 - S$800 = S$4,200, less 10% co-insurance (S$420) = S$3,780. Claim 2: S$2,500 - S$800 = S$1,700, less 10% co-insurance (S$170) = S$1,530. Total = S$3,780 + S$1,530 = S$5,310.

Common mistake

Treating it as a per-annum deductible (one S$800 across both claims: (S$7,500 - S$800) x 0.9 = S$6,030) is wrong; the deductible resets on every claim. S$5,900 forgets the co-insurance.

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