Consider an example where your:
- Insurance coverage is $8,000,000
- Deductible is $250 per certificate period
- Coinsurance for claims incurred inside US and in the PPO: After the deductible, 90% of first $5,000 and then 100% to the policy limit
- Your claims for medical expenses is $24,850
Below is a simple calculation showing how much the plan/insurance company pays you:
- Subtract the deductible from claims amount - $24,850 minus $250 equals $24,600. Insured bears $250
- Apply 90% coinsurance for first $5,000 of $24,600. i.e. $5,000*0.90 equals $4500. Insurance Company will pay upto $5,000. Insured bears $500
- Plan/insurance company pays: $24,600 minus $500 equals $24,100 and insured bears $750