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Case Study #1 Answers

The insured pays the deductible first ($500), then the insurance company and the insured split the remainder (80%/20%), up to the stop-loss limit of the insured ($5,000). The breakdown of payments for covered medical expenses are as follows:

 

Total expenses   $10,500 
Insurer pays Steven pays
Deductible $500 $0 $500
Remaining $10,000    
80/20 split   $8,000 $2,000
Total payments $10,500 $8,000 $2,500

 



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