46. If an insured under a Major Medical Insurance policy with a $200 deductible and an 80% coinsurance clause incurred the following covered expenses: Hospital room and board $2,000; Surgeon's fee $1,500. How much would the policy pay?
Answer: C
The policy would pay $2,640.
To calculate the amount the policy pays, we first combine the hospital expenses and the surgeon's fee, which total $3,500. After applying the $200 deductible, the amount subject to coinsurance is $3,300. With the 80% coinsurance clause, the policy would cover $2,640 of the remaining expenses.
A) 2,480
This option incorrectly calculates the amount by subtracting the deductible from each expense separately instead of from the total. The correct method requires applying the deductible to the combined expenses before calculating coinsurance.
B) 2,600
This option incorrectly adds the deductible back into the final calculation, which does not align with how deductibles are applied in insurance policies. The deductible should be deducted from the total before applying the coinsurance percentage.
C) 2,640
This option correctly calculates the total covered expenses of $3,500, subtracts the $200 deductible to arrive at $3,300, and then applies the 80% coinsurance to yield a total payment of $2,640, which is accurate according to the policy terms.
D) 2,800
This option assumes that the deductible is not applied correctly to the total amount before calculating the coinsurance. It provides an overstated payment amount by not considering the deductible in the right context.
Conclusion
The correct answer is definitively C) 2,640, as it accurately reflects the application of the deductible and coinsurance according to the terms of the Major Medical Insurance policy. All other options miscalculate the total payment by incorrectly applying the deductible or coinsurance, leading to inaccurate figures.