SOLUTION: Josh will use Primary Care Physicians and retail network pharmacies for their medical care needs. He will also use brand-name prescriptions only when there are no generic equivalen
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Question 1042449: Josh will use Primary Care Physicians and retail network pharmacies for their medical care needs. He will also use brand-name prescriptions only when there are no generic equivalents available. Josh is generally healthy except for the occasional injury, and Josh Greenfield is a non-smoker. Last year (which was a representative year) Josh had a general physical ($300) and went to the doctor 3 times for minor ailments ($75 per visit). Josh Greenfield also went to the emergency room once for a sprained ankle ($450). Josh had X-rays ($250) but did not have to stay overnight. During the year, Josh had 8 prescriptions filled (at an average cost of $30 per prescription); all of the prescriptions were generic. Josh feels that this medical history is a good indicator of the upcoming year. How much would Josh have to pay out-of -pocket for covered expenses for the current plan? Is that number greater than his current budget? Assume he has not met the deductible for the calendar year. (Note: you need to show the amount Josh pay on each expense)
Benefit Description Member’s Copayment
Physicians and Lab Services
Physician Office Visit Primary Care Physician $30
Specialist Office Visit $40
Routine physicals-One per plan year for adults; periodic for children, or as
directed by the primary care physician $30 or $40
Diagnostic x-rays, mammography, and lab tests No copayment
Family planning $40
Vasectomy & tubal ligation No copayment
Infertility benefits 50%
Hospital Services
Inpatient hospital-Semi-private room & board or intensive care units
$100 per day copayment per admission, 5 day max. $1500 max. per person per year
Outpatient day surgery$100
Emergency care - In-area and out-of-area covered at listed copayment. If hospitalized, copayment is waived $100
Urgent care - Includes physician's after-hours care or at an urgent care facility $50
Prescription Drugs
Plan Year Deductible
If a Brand Name medication is dispensed when a Generic is available, member shall be responsible for the Generic Copayment plus the cost difference between the Generic and the Brand Name medication $50
