1. Michael Lim was seriously injured in a motorcycle accident that broke both his legs and arms. His medical expenses included 5 days of hospitalization at P1,000.00 per day, P162,000.00 in surgical fees, P43,000.00 in physician’s fees (including time in the hospital and eight follow-up visits), P15,200.00 in  prescription medications, and P21,000.00 for physical therapy treatments. All of  these charges will fall within customary and reasonable payment amounts. a) If Michael had an indemnity plan that pays 80% of his charges with a P5,000.00 deductible and a P5,000.00 stop-loss provision. How much would he have to pay out of pocket? b) What would Michael’s out-of-pocket expenses be if he belonged to an HMO with a P2,000.00 co-pay for office visits? c) Monthly premiums are at P1,550.00 for the indemnity plan and P2,500.00 for the HMO. If he had no other medical expenses this year, which plan would have provided more cost-effective coverage for Michael? What other factors should be considered when deciding between two plans?

Pfin (with Mindtap, 1 Term Printed Access Card) (mindtap Course List)
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ISBN:9780357033609
Author:Randall Billingsley, Lawrence J. Gitman, Michael D. Joehnk
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Chapter9: Insuring Your Health
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1. Michael Lim was seriously injured in a motorcycle accident that broke both his legs and arms. His medical expenses included 5 days of hospitalization at P1,000.00 per day, P162,000.00 in surgical fees, P43,000.00 in physician’s fees (including time in the hospital and eight follow-up visits), P15,200.00 in  prescription medications, and P21,000.00 for physical therapy treatments. All of  these charges will fall within customary and reasonable payment amounts.

a) If Michael had an indemnity plan that pays 80% of his charges with a P5,000.00 deductible and a P5,000.00 stop-loss provision. How much would he have to pay out of pocket?

b) What would Michael’s out-of-pocket expenses be if he belonged to an HMO with a P2,000.00 co-pay for office visits?


c) Monthly premiums are at P1,550.00 for the indemnity plan and P2,500.00 for the HMO. If he had no other medical expenses this year, which plan would have provided more cost-effective coverage for Michael? What other factors should be considered when deciding between two plans?

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