Maryland Life and Health Insurance License Practice Exam

If an insured under a Major Medical plan with a zero deductible and 80/20 coinsurance files a $1,000 claim, what is the insured's responsibility?

1. $800

2. $200

3. $1,000

4. $400

The correct answer is: $200

In a Major Medical plan with a zero deductible and an 80/20 coinsurance, the insured is responsible for a percentage of the covered medical expenses after any applicable deductible is met. Since the deductible in this scenario is zero, the entire claim amount of $1,000 is considered for coinsurance calculations. With an 80/20 coinsurance arrangement, the insurer pays 80% of the covered expenses, while the insured is responsible for 20%. To determine the insured's responsibility for a $1,000 claim, you simply calculate 20% of that amount. 20% of $1,000 is $200. This is the amount the insured will need to pay out-of-pocket, making the insured's responsibility $200. The remaining 80% ($800) would be covered by the insurance provider. Thus, the correct response reflects the insured's share of the expenses based on the terms of the insurance plan.