Hospital Scenarios Under HIP PPO

Figuring out exactly how hospital bills are paid under the HIP PPO plans can be a bit confusing. We've provided a few sample scenarios below to help explain how it works.

Note: These scenarios highlight the effects of the in-network deductible and co-insurance for individual coverage with respect to inpatient/outpatient hospital bills. (Please note that bills for specialty diagnostic services, such as MRI's and CAT scans, etc. will work the same way). In-network doctor visits or emergency room visits are covered in full by HIP (you just pay a small co-pay). All out-of-network services are subject to the out-of-network deductible and co-insurance amounts.

In-Network Facilities
Full Year's Hospital Bills You Pay HIP Pays Why?
$1,000 $1,000 - Since $1,000 is less than the $3,000 deductible, you are responsible for the full amount.
$5,000 $2,600 $2,400 You pay the first $2,000 (since that's your deductible), and then 20% of the remaining $3,000 (another $600)
$10,000 $3,600 $6,400 You pay the first $2,000 (since that's your deductible), and then 20% of the remaining $8,000 (another $1,600).
$75,000 $5,000 $70,000 You pay the first $2,000 (since that's your deductible), and then 20% of next $15,000 (another $3,000), at which point you reach the out-of-pocket maximum for the year of $5,000.
Out-of-Network Facilities
Full Year's Hospital Bills You Pay HIP Pays Why?
$1,000 $1,000 - Since $1,000 is less than the $4,000 deductible, you are responsible for the full amount.
$10,000 $6,400 $3,600 You pay the first $4,000 (since that's your deductible), and then 40% of the remaining $6,000 (another $2,400).
$25,000 $10,000 $15,000 You pay the first $4,000 (since that's your deductible), and then 40% of the next $15,000 (another $6,000) at which point you reach the out-of-pocket maximum for the year of $10,000.
$75,000 $10,000 $65,000 You pay the first $4,000 (since that's your deductible), and then 40% of next $15,000 (another $6,000), at which point you reach the out-of-pocket maximum for the year of $10,000.