Under a Hospital/Surgical Expense policy with a deductible of $500 and four deductibles per calendar year, if two claims in 2013 each exceed the deductible, what is the 2013 out-of-pocket?

Under a Hospital/Surgical Expense policy with a deductible of $500 and four deductibles per calendar year, if two claims in 2013 each exceed the deductible, what is the 2013 out-of-pocket?

• A. $500
• B. $1,000
• C. $1,500
• D. $2,000

Answer: (B)

The deductible is applied per eligible claim, with a limit of four deductible payments per year. If two claims in the year each exceed the deductible, you pay the deductible for each claim. So you would have two deductible payments of 500 dollars, totaling 1,000 dollars out-of-pocket for the year. The remaining costs for those claims would be covered by the insurer according to the policy’s coinsurance and limits.

The deductible is applied per eligible claim, with a limit of four deductible payments per year. If two claims in the year each exceed the deductible, you pay the deductible for each claim. So you would have two deductible payments of 500 dollars, totaling 1,000 dollars out-of-pocket for the year. The remaining costs for those claims would be covered by the insurer according to the policy’s coinsurance and limits.