# Lesson Plan: Health Insurance

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1 Lesson Plan: Health Insurance Submitted by Marcia Allen, Murphysboro High School, Murphysboro, Illinois. Ms. Allen is a 2002 graduate of the Insurance Education Foundation (IEF), Insurance Education Institute at Illinois State University, Normal, Illinois. For more information on the Insurance Education Foundation, access the following Web Site: Subject: Consumer Economics Grade Level: Length: Objective: Materials: One Class Period Students will be able to apply their knowledge of health insurance definitions by taking scenarios and determining the cost to the consumer and the cost to the insurance company. Student - pen or pencil, page of scenarios and worksheets Teacher - copies of scenarios, transparency and overhead projector Background: Activities: Students will have completed health insurance vocabulary assignments found in most textbooks. The teacher will present an example of how deductibles, co-insurance, stop loss points, limits of policy, and exclusions are applied in a health insurance problem. Show-Me Standards: For more information access the MO Department of Elementary and Secondary Education website at: Knowledge Standards: Communication Arts (1, 2, 6) Health/Phys Ed. (6) Mathematics (1, 3) Science (8) Social Studies (4) Performance Standards: 1-5, 1-8, 1-10, 2-3, 2-7, 3-1, 3-2, 3-4, 3-5,3-6, 3-7, 3-8, 4-1, 4-5, 4-6

4 Scenario: Nathan has the following health insurance policy: \$250 deductible 80/20 co-insurance \$2,000 stop loss limit (amount to which insurance is applied) \$1,000,000 limit of policy Nathan had a skate boarding accident and the bill was \$40,250. How much did Jim pay? How much did the insurance company pay?

5 Break it down: Nathan Pays \$40,250 Cost of Accident Deductible \$40,000-2,000 Stop Loss Point \$38,000 \$2,000 Stop Loss Point x 0.20 Nathan's % \$400 \$2,000 Stop Loss Point x 0.80 Insurance Co.'s % \$1,600 Insurance Co. Pays \$250 Deductible \$0 \$400 Co-Insurance \$1,600 \$0 Stop Loss point met \$38,000 \$650 Total \$39,600

6 Scenario Worksheet: Directions: Determine what each person and each company will pay Case #1 Manuel has the following health insurance: Hometown Pride Insurance Company Includes: Basic health insurance (hospitalization, surgical, outpatient coverage, also known as physician expense). Major medical insurance with prescription coverage Excludes: Vision and dental coverage Insurance includes a \$500 deductible, 80/20 co-insurance, \$2,500 stop loss point, and a \$1 million maximum. Case #2 Tenisha has the following health insurance: Dazzler Insurance Company Includes: Basic health insurance Major medical insurance with prescription coverage Dental policy that covers two cleanings per year Vision coverage that covers one eye exam and 75% for glasses or contact lenses The basic health and major medical insurance includes a \$250 deductible, 80/20 coinsurance, up to \$500 preventative care paid at regular rate (no preventative care coverage over \$500), \$1,000 stop loss point, and \$1 million maximum. Case #3 Greta has the following health insurance: Crimson & Corn Insurance Company Includes: Basic health insurance Major medical insurance with a prescription card (\$15 generic, \$25 brand name) Excludes: Vision and dental coverage Insurance includes a \$1,000 deductible, 70/30 co-insurance, preventative care paid up to \$250 at 100% with no co-insurance or deductible applied (no preventative care coverage over \$250), \$5,000 stop loss point, and \$.5 million maximum. Manuel had the following bills throughout the year: Jan.: Office visit for sore throat (\$40); prescription, brand name (\$50) April: Office visit and allergy shot (\$60) May: Annual eye exam, replace broken eye glasses (\$250) June: Teeth cleaned (\$48) July: Broken arm x-rays, surgeon s fee, cast, etc. (\$4,000) Dec.: Teeth cleaned (\$48) Tenisha had the following bills throughout the year: Jan.: Teeth cleaned (\$48) March: Annual physical and office visit (\$300) June: Appendectomy (\$5,000) July: Teeth cleaned (\$48) Aug.: Eye exam (\$50) and new glasses (\$200) Sept.: Office visit (\$40) Greta had the following bills throughout the year: Feb.: Teeth cleaned (\$48) April: Annual physical and office visit (\$250) May: Office visit (\$40) June: Major skiing accident, hospitalized with intensive care, etc. (\$300,000) Sept.: Teeth cleaned (\$48) Oct.: Vision check and new contact lenses (\$200) Nov.: Sore throat, office visit (\$40); prescription, generic (\$35)

7 Case #1 Calculation Space: Office Visit (sore throat) \$40 Prescription 50 Office Visit (allergy shot) 60 Broken Arm + 4,000 Total medical expenses \$4,150 Deductible \$3,650 Stop Loss point - 2,500 \$1,150 Manuel Pays \$500 Deductible \$500 for co-insurance (20% of Stop Loss amount) \$96 for dental (not a covered expense) \$250 for vision (not a covered expense) Total: \$1,346 Hometown Pride Insurance Co. Pays \$2,000 for co-insurance (80% of Stop Loss Amount) \$1,150 Stop Loss Point Met Total: \$3,150 Case #2 Calculation Space: Physical \$300 Appendectomy 5,000 Office Visit + 40 Total Medical Expenses \$5,340 Deductible \$5,090 Stop Loss Point - 1,000 \$4,090 2 teeth cleanings covered at 100% \$96 Eye exam covered at 100% \$50 New glasses covered at 75% 200 x 0.75 \$150 Tenisha Pays \$250 Deductible \$200 for co-insurance (20% of Stop Loss Amount) \$50 (25% of new glasses) Total: \$500 Dazzler Insurance Pays \$800 (80% of Stop Loss Amount) \$4,090 Stop Loss Point met \$96 for dental \$50 for eye exam \$150 (75% of new glasses) Total: \$5,186 Case #3 Calculation Space: Office Visit \$40 Accident 300,000 Office Visit + 40 \$300,080 Deductible - 1,000 \$299,080-5,000 \$294,080 Greta Pays: \$1,000 Deductible \$1,500 for co-insurance (30% of Stop Loss Amount) \$96 for dental (not a covered expense) \$200 for vision check and contact lenses (not a covered expense) \$15 for generic prescription co-pay Total: \$2,811 Crimson & Corn Insurance Pays \$3,500 (70% of Stop Loss) \$294,080 Stop Loss Point met \$20 for generic prescription co-pay \$250 for annual physical Total: \$297,850

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