Maintenance Care
Care at the level a patient's condition has plateaued at, often limited or excluded in medical and disability policies that pay only while improvement is occurring.
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Practice This Concept
An elderly insured needs help with bathing, dressing, and meal preparation at home, but requires no medical care. Under a typical major medical expense policy, this care is MOST likely to be:
Excluded because it is custodial care, not medically necessary treatment — Major medical policies cover medically necessary treatment and exclude custodial care — assistance with activities of daily living such as bathing, dressing, and feeding that does not require skilled medical services. A physician's order does not convert custodial care into a covered benefit, because the policy pays for treatment of sickness or injury, not for maintenance care. This exclusion is one reason long-term care insurance exists: major medical stops where custodial care begins. Agents must therefore distinguish skilled care, which major medical covers, from custodial maintenance, which it does not, when counseling older clients about their coverage needs.
National insurance concept
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