Health insurance-Question?

Question

.Me and My wife is having a health insurance(USA) which is having the following details..My wife is pregnant now and estimated cost is $10000.Can some one tell me how I can calculate the amount that needs to be paid from my pocket.I don't have any other insurance other than this..

1.Calendar year deductibe/Person $100

2.Calendar year deductibe/Family $300

Coinsurance 90% after deductible

Annual out of pocket limit/individual $1100 per indi

Annual out of pocket limit/famiy $3300 per family

Deductibe included in out of pocket Yes

Preganancy and Maternity care 90% after deductible(global fees apply)

Hospitalization for childbirth 90% after deductible

Answer 1

Easy:  The MOST you will have to pay out of you pocket is $1100.  After you have paid $1100 out of your pocket,  your insurance pays 100%.

Answer 2

Someone mentioned that the most you'd have to pay out of pocket is $1,100, which isn't entirely true.

Both your wife and your baby will have medical charges resulting from the birth.  Therefore, you could potentially incur deductible and coinsurance charges for both your wife and the baby.  So, you have to look at the family maximums vs. the individual maximums.

This means that you could potentially be liable for up to $3,300 in covered charges.  Assuming a normal pregnancy/delivery with no complications, I wouldn't actually expecct that you'll owe that much.  (Not with 90% coverage, anyhow.  And, of course, services for other family members during the year would also count towards that family out of pocket limit.)

However, its still good to know what's the "most" you'll potentially have to pay for covered services, and that amount for you is $3,300.  (Non-covered services, of course, would be fully your responsibility also, if applicable.)

Answer 3

If you have already paid your deductible for the year, you will be required to pay $1000 for your wife's hospitalization.

Breakdown:

If you have already paid the $100 for her prenatal care and doctor's visits then you are responsible for 10% of her hospitalization expenses for the labor and delivery which you have stated is $10000. If the insurance company pays 90% that leaves a balance of $1000. Which you are responsible for. After that $1000 is paid, from your information that insurance covers 100%.