Note: The Plan Year for all Plans is Jan 1 - Dec 31.	PLANS
	ABC	DEF	GHI	JKL	MNO	PQR
Plan Type	PPO	HMO	POS	PPO	HMO	PPO
Category	Group	Individual	Group	Group	Group	Individual
% Premium Paid by Employer	100	N/A	80	50	90	N/A
Annual Single Premium	$3,341.10	N/A	$5,200.20	$5,608.52	$4,782.95	$6,680.35
Annual Family Premium	N/A	$7,151.05	$10,451.48	$12,000.00	N/A	$14,024.00
Stop Gap?	YES	NO	YES	NO	NO	YES
Annual Deductible	$1,300.00	$-	$1,400.00	$1,500.00	$400.00	$2,500.00
Deductible Counts Toward Stop Gap?	NO	N/A	YES	N/A	N/A	YES
Copayments Count Toward Stop Gap?	YES	N/A	YES*	N/A	N/A	YES*
Copayment (PCP/Specialist/ED)	$55/$80/$375	$0/$0/$400	$35/$60/$500	$50/$75/$450	$0/$0/$425	$40/$65/$500
Coinsurance - Hospital	25%	15%	40%	35%	5%	33%
Coinsurance - Laboratory	33%	0%	35%	45%	20%	55%
Maximum Out-of-Pocket	$4,000.00	N/A	$4,500.00	N/A	N/A	$3,750.00
Out of Network Coverage?	YES	NO	YES	NO	NO	YES
Prescription Drug Benefit	YES	YES	YES	YES	YES	YES
Prescription Drug Co-Payments
Tier 1	$20.00	$10.00	$25.00	$15.00	$10.00	$20.00
Tier 2	$45.50	$20.00	$35.50	$30.00	$16.00	$28.50
Tier 3	$75.00	$50.00	$85.00	$75.00	$40.00	$100.00
Tier 4	$125.00	$75.00	$140.00	$130.00	$55.00	$150.00

In general, POS plans are more restrictive than HMOs. __True __False

2. How much would an insured pay in premiums for Plan DEF in one year? $_________________

3. How much would an insured pay in premiums for Plan JKL in one year for family coverage? $______________

4. If out-of-pocket costs for premiums is the only important factor for an individual seeking single coverage,

assuming that he/she would select one of the six plans on the list, which of the plans should that individual

choose? ABC DEF GHI JKL MNO PQR

5. If out-of-pocket costs for an applicable deductible is the only important factor for an individual seeking

either individual or family coverage, assuming that he/she would select one of the six plan on the list, which of

plans would be the likely choice of the person shopping for a plan? ABC DEF GHI JKL MNO PQR

6. What is the average annual deductible for

a. the PPO Plans $__________

b. the HMO Plans $__________

7. Which plan has the highest PCP copaymentfor office visits? ______

Which plan has the lowest non zero PCP copaymentfor office visits? ______

8. An emergency room visit will cost an insured with Plan _____ the most in terms of emergency room copayments.

On average, in terms of copayments, an emergency room visit will cost insureds with PPO plans $ ___________.

Such visits, on average, in terms of copayments, will cost insureds with HMO plans $ __________.

9. Rank the plans in terms of hospital coinsurance ratesfrom lowest to highest Assign a rank of 1 to the plan with the lowest hospital coinsurance rate and a rank of 2 to the plan with the next lowest hospital coinsurance rate and so forth. List the Plans: 1 _____ 2 _____ 3 _____ 4 ______ 5 _____ 6 _____

10. When it comes to laboratory services, insureds covered by one of these six plans pay an average of _________% for their laboratory services.

If laboratory services are the only important plan benefits for an insured, which of the plans would be the most preferredbased on the coinsurance rate for laboratory services? List the plan ______

Which plan would be the least preferred? List the plan. ______

11. What is the impact of a plan having a maximum out-of-pocket liability for an insured?

12. All six of the plans offer a prescription drug benefit. In light of this fact, and considering the different copayments for these drugs, which plan would seem to be the most logical choice for an insured if she has one prescription drug that costs $3,500 for a 45 day supply (assume the drug would be in Tier 4 for all of the plans)?

List the plan. ______

What would her copayment be for her prescription if she chooses this plan? $__________