Just so you know, when I pass the test, I'm going to have to delete all educational material because I don't want to infringe on copyright. That will be in 4 days. Actually I'll probably just delete the whole story because let's face it, there's no point in it existing.

Medical Plan Concepts

Big Hero 6 plus Tadashi, Hiccup, Astrid, Finn, Adrianna, Erick, and Cliff remain seated on the couch, which must have stretched out because that's a heck of a big couch otherwise. Then again, Fred is rich so maybe he has giant couches. Or they're all on a giant version of the double decker couch from The Lego Movie. Doesn't matter.

BAYMAX: The next chapter is on Medical Plans. When this chapter concludes, there will be a brief break in which Overlord Katie reviews the other chapters leading up to chapter 12. Your patience will be appreciated.

FINN: Already boring.

BAYMAX: Let's get started. Medical Expense Insurance provides benefits for Medical Care. Even though there are many types of benefits offered, Medical Insurance is categorized as Basic Medical Expense and Major Medical Insurance.

TADASHI: Okay cool.

BAYMAX: Basic Medical Policies are identified by their low dollar limits and first dollar coverage. Basic policies do not provide protection for an individual or family against catastrophic Medical expenses. Any benefit for a miscellaneous Medical expense is generally expressed in a dollar amount.

HICCUP: Well that's already complicated. So what you're saying is that basic expenses are low and don't protect for catastrophes. Benefits are expressed in dollars.

BAYMAX: Correct. Basic Hospital Expense policies cover room and board, lab, x-ray, medicines, and any other miscellaneous costs associated with an insured's hospital stay.

ASTRID: Let me guess: the policy gives the insured a set amount each day and anything above the limit will be paid by the insured.

BAYMAX: That is correct. How did you know?

ASTRID: It sounded like all the other stuff that gets said here.

BAYMAX: Miscellaneous Hospital Expenses included in an insured's stay can either be charged a flat rate or be charged a certain limited amount.

HIRO: So... prescriptions?

BAYMAX: That would be included. Basic Medical Expense policies cover non-surgical hospital expenses.

ASTRID: And coverage is limited to amount per day, per doctor visit, or hospital stay without paying a deductible?

BAYMAX: Yes. Since the coverage is limited, the insured pays the rest of the covered amount.

HICCUP: You're really good at this.

ASTRID: I have to be good at something. DreamWorks almost never gives me anything substantial to do that isn't directly connected to you.

HICCUP: Word.

BAYMAX: Basic Surgical Expense Coverage pays for limited surgeon's fees, operating room expenses, and anesthesiologist services that are not covered by another policy.

WASABI: Would a surgeon's schedule be included in the policy, which also states the options?

BAYMAX: Yes. The schedule also includes the amount payable, the percentage of the amount covered, or a relative value for an operation. A relative value that is applied causes the operation to be assigned a number of points. The points assigned to a procedure are multiplied by a conversion factor. The conversion factor is the total amount that can be paid per point.

HONEY: Umm... what?

BAYMAX: For example, if a surgery has an assigned point value of 300 and the conversion factor is 10, then 300x10 equals $3,000 for the procedure.

HIRO: Ahh so points mean math.

GOGO: Just when we thought this couldn't get any worse.

BAYMAX: Fee for Service is a payment system to providers.

HIRO: They'd be paid for each service.

BAYMAX: Correct. A Prepaid Plan pays providers whether or not they provide a service but no additional compensation will be provided when services are rendered.

ADDIE: Okay so a prepaid plan is prepaid, regardless of the services rendered. Like a prepaid cellphone.

FINN: Or mobile phone, for our friends across the pond.

ADDIE: Yeah and you pay for the service whether or not you use it. Like a certain number of minutes or amount of data.

CLIFF: Unlimited text, yo.

ERICK: Yeah, can you maybe not keep texting me pictures of your lunch?

CLIFF: I just do that because you told me my burger looked suspect once.

ERICK: That was ONE TIME.

CLIFF: It wasn't suspect. He thought the lettuce was the bun.

ERICK: This was back when we all used flip phones.

ADDIE: Still, that's an embarrassing mistake.

ERICK: Oh quiet, you.

ADDIE: Make me.

ERICK: I'd have to kiss you and we all know what insanity that would cause among the readers.

HIRO: Okay gag. Let's get back to insurance.

BAYMAX: The two basic types of Health Care coverage plans for Federal Civilian employees are Fee-for-Service and Prepaid plans. Policies that limit coverage to one particular illness are specified Coverage Policies.

TADASHI: Like cancer policies?

WASABI: Maybe Dental Plans?

BAYMAX: Right. Policies that provide a comprehensive package of Health Care services, like an HMO, are Comprehensive Policies.

TADASHI: Like physicals?

HICCUP: Immunizations?

BAYMAX: Those are included, yes. A Benefit Schedule is contained in some Medical Expense Plans, which vary directly in accordance with what is covered and paid for in the plan.

ASTRID: So it tells you what kind of treatments there are and how much they have to pay?

BAYMAX: Essentially, yes. If it is stated that a payment will be made for a given procedure based upon the average charge for a procedure in a specific area, it is termed as a Usual-Reasonable and Customary coverage.

HIRO: So that means the the procedure's cost is based on the average for the area.

BAYMAX: Correct. Most traditional reimbursement type Comprehensive Medical Expense Plans provide for an insured to be treated by any physician of their choice.

HICCUP: Not under the ACA.

ASTRID: Yes but that was a cleverly written lie to the American public.

HIRO: What are you talking about?

HICCUP: Obamacare.

HONEY: Oh. That's outlawed in this universe.

TADASHI: Yeah, they discovered that it was a load of baloney and tossed it.

GOGO: Great, now this story has a political agenda.

ADDIE: You think this is a political agenda? Just you wait until the next story in my series.

BAYMAX: Before we get into an argument about why conservative and libertarian policies are the logically superior policies to anything leftist or liberal, let us get back to the topic at hand. Limited Choice Providers, such as HMOs, are specific regarding the physicians and Health Care Centers that can and must be used by an insured.

HICCUP: Ahh. Taking away free choice. Sounds communist to me.

ASTRID: Good gods, Hiccup, this is was never meant to be a political rant and since when are you a libertarian?

HICCUP: That would be the logical political stance based on my characterization. I prefer a leadership style that gives people the freedom to do what they do best without interference as long as no one gets hurt. Maximum liberty!

FRED: CAPITALISM, YEAH!

OVERLORD KATIE: I cannot wait to see the reviews on this.

BAYMAX: Insureds/Participants are people that receive benefits. Subscribers are individuals whose name is on the issued contract and are responsible for making its premium payments.

HIRO: So they can be different people.

HICCUP: Yeah, like the taxpayers are the subscribers because they pay the bills for the lazy insured/participants who cheat the system.

FINN: Okay, dad, stop.

HICCUP: Snickers. Now I'm just being annoying on purpose.

CLIFF: A man after my own heart.

HICCUP: Way to make it awkward, Cliff.

BAYMAX: This concludes the section.

Sorry not sorry for the political slant. All meant as a joke. I am a libertarian/conservative in real life but I just thought I'd have fun with that.

~KateMarie999