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Exam NY-Life-Accident-and-Health Topic 1 Question 62 Discussion
Actual exam question for Insurance Licensing's NY-Life-Accident-and-Health exam
Question #: 62
Topic #: 1
Question #: 62
Topic #: 1
In a health insurance policy, an insured has an out-of-pocket limit of $10,000, a deductible of $500, and an
80%/20% coinsurance. The insured incurs $50,000 of covered losses in an accident. How much will the insurer have to pay?
80%/20% coinsurance. The insured incurs $50,000 of covered losses in an accident. How much will the insurer have to pay?
Suggested Answer: B Vote an answer
The correct answer is $39,600 . To determine the insurer's payment, the deductible and coinsurance provisions must be applied to the total covered medical expenses. First, the insured must pay the $500 deductible . Subtracting this amount from the total covered losses of $50,000 leaves $49,500 of eligible expenses subject to coinsurance.
Under an 80/20 coinsurance arrangement , the insurer pays 80% of the covered expenses and the insured pays
20% . Applying the insurer's portion to the remaining amount:
80% × $49,500 = $39,600 .
Therefore, the insurer's payment equals $39,600 , while the insured would pay the deductible plus their coinsurance share. Although the policy mentions a $10,000 out-of-pocket limit , the insured's cost in this situation (the $500 deductible plus 20% of the remaining expenses) does not exceed that limit , so the limit does not affect the calculation.
Thus, after applying the deductible and coinsurance provisions, the insurer pays $39,600 , making Option B the correct answer.
Under an 80/20 coinsurance arrangement , the insurer pays 80% of the covered expenses and the insured pays
20% . Applying the insurer's portion to the remaining amount:
80% × $49,500 = $39,600 .
Therefore, the insurer's payment equals $39,600 , while the insured would pay the deductible plus their coinsurance share. Although the policy mentions a $10,000 out-of-pocket limit , the insured's cost in this situation (the $500 deductible plus 20% of the remaining expenses) does not exceed that limit , so the limit does not affect the calculation.
Thus, after applying the deductible and coinsurance provisions, the insurer pays $39,600 , making Option B the correct answer.
by Stephanie at Jul 10, 2026, 01:37 AM
Here are all the actual test exam dumps for IT exams. Most people prepare for the actual exams with our test dumps to pass their exams. So it's critical to choose and actual test pdf to succeed.
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