Today’s Lecture U of I Student Injury and Sickness Insurance - Undergraduate Plan 2007-2008Maximum Amount PayableIn-Hospital Expense BenefitIn-Hospital Expense Benefit ExampleIn-Hospital Expense Benefit Example 2Pre-Admission TestingSurgical Expense BenefitSurgical Expense Benefit - ExampleAssistant Surgeon Expense BenefitAssistant Surgeon Expense Benefit ExampleAnesthesia Expense BenefitAnesthesia Expense Benefit - ExampleIn-Hospital Physician’s Expense BenefitIn-Hospital Physician’s Expense Benefit - ExampleOutpatient BenefitsOutpatient Benefits (cont.)Outpatient Expense Benefit - ExampleOutpatient Expense Benefit – Example 2Ambulance Expense BenefitOutpatient Diagnostic ProceduresPsychiatric and Drug Abuse TreatmentPsychiatric and Drug Abuse Treatment - ExampleToday’s LectureU of I Student Injury and Sickness Insurance - Undergraduate Plan2007-2008CoverageDeductibles, Coinsurance and LimitsExamplesMaximum Amount PayableAggregate$200,000 for each Injury or SicknessPsychiatric and Substance Abuse Treatment $20,000 per lifetimeIntercollegiate, Club and Intramural Sports Injuries $75,000 per injuryIn-Hospital Expense Benefit$100 Deductible 80% of next $10,000100% of balance of room and board and other hospital expenses incurredIn-Hospital Expense BenefitExampleIn hospital for 10 days at $500 per day room and board.Total charge: 10 x $500 = $5000 Deductible 10080% of first $10,000 4900 = 3920Amount payable = $3920In-Hospital Expense BenefitExample 2In hospital for 30 days at $500 per day room and board. How much does the U of I Student Plan pay?A) 0B) 10,000C) 11,920D) 12,900E) None of the abovePre-Admission TestingIf testing is performed within 7 days of the surgery, it is included under Hospital Expense Benefit.Otherwise, it would be considered an Outpatient Miscellaneous Expense Benefit.Example:Tests performed on October 7Surgery on October 10Costs included in In-Hospital Expense BenefitIf no surgery was performed, or if it was performed after October 14, then it would be considered an Outpatient MiscellaneousExpenseSurgical Expense BenefitLower of:80% of Usual and Customary or80% of Actual ChargeSurgical Expense Benefit - ExampleYou have surgery and the surgeon charges you $10,000. The Usual and Customary fee is $12,000. How much does the U of I Student Plan pay?A) 0B) 8,000C) 9,600D) 10,000E) None of the aboveAssistant Surgeon Expense BenefitLower of:80% of Usual and Customary or80% of Actual ChargeAssistant Surgeon Expense Benefit ExampleYou have surgery and an assistant surgeon charges $3000 (Usual and Customary). How much does the U of I Student Plan pay?A) 0B) 2000C) 2400D) 2500E) None of the aboveAnesthesia Expense BenefitLower of:80% of Usual and Customary or80% of Actual ChargeAnesthesia Expense Benefit - ExampleDuring surgery, an anesthetist administers anesthesia. You are charged $6000. The Usual and Customary charge is $5000. How much does the U of I Student Plan pay?A) 0B) 4,000 C) 4,800D) 5,000E) None of the aboveIn-Hospital Physician’s Expense BenefitLower of:80% of Usual and Customary or80% of Actual ChargeLimited to 1 visit per dayIf in Intensive Care Unit, pays 50% (not 80%)In-Hospital Physician’s Expense Benefit - ExampleYou are hospitalized for 2 days; the doctor visits you once each day, charging $200 for each visit (U&C). How much does the U of I Student Plan pay?A) 0B) 160C) 200D) 320E) None of the aboveOutpatient BenefitsIncludes the following benefits (page 8):Surgical Expense BenefitDay Surgery MiscellaneousAssistant Surgeon Expense BenefitAnesthetistOutpatient ExpensesMedical EmergencyPhysician’s VisitsX-Rays/LaboratoryTests & ProceduresInjectionsPhysiotherapyChemotherapy and Radiation TherapyOutpatient Benefits (cont.)Outpatient Expenses BenefitStudents have a $150 Deductible per policy yearInsured Dependents have no deductibleMedical Emergency Room visits have extra $50 deductible per visitCoverage80% of Usual and Customary or 80% of the actual charge, whichever is less$900 maximum per policy year for Physiotherapy (chiropractic or physical therapy)Outpatient Expense Benefit - ExampleYou (a student) visit a doctor four times for treatment of mononucleosis. Each visit costs $100 (U&C). In addition, lab tests cost $250. How much does the U of I Student Plan pay?A) 0B) 80C) 400D) 520E) None of the aboveOutpatient Expense Benefit – Example 2You fall off a skateboard and skin your knee. You go to the emergency room to have it treated. You are billed $500 for the emergency room visit (U&C). How much does the U of I Student Plan pay?A) 0B) 240C) 280D) 300E) None of the aboveAmbulance Expense BenefitFor land ambulance or air ambulance (medical emergency only)80% of Usual and Customary or 80% of actual chargeOutpatient Diagnostic ProceduresFor illness or accidental bodily injury, plan pays 80% of lower of U & C or 80% of actual charge up to:CT scans $800MRI 1200Nuclear Imaging 782Psychiatric and Drug Abuse TreatmentInpatient Same as any other illness (but with $20,000 lifetime maximum)Outpatient50% of charge up to maximum of:$35 per day45 days per policy yearPsychiatric and Drug Abuse Treatment - ExampleYou visit a psychiatrist 50 times in one year. Each visit is a different day. Each visit costs $100. How much does the U of I Student Plan pay?A) 0B) 1575C) 1750D) 2500E) None of the