A major medical policy denies a claim for care provided primarily to help an elderly member bathe, dress, and eat, with no skilled treatment being given. This denial is generally valid because major medical plans:

Why A is correct

Major medical insurance covers medically necessary care for injury or illness. Custodial care — assistance with activities of daily living such as bathing, dressing, and eating — does not require skilled medical treatment and is a standard exclusion from these policies. Such care is addressed by long-term care insurance or, after a spend-down of assets, by Medi-Cal. Agents should explain this limitation so customers understand the scope of what their major medical policy will pay.

Why the other options are wrong

• B) Custodial care is not covered merely because it happens in a hospital; the test is whether skilled, medically necessary treatment is being provided.
• C) Medically necessary home health care such as skilled nursing or therapy is often covered; the exclusion targets non-skilled custodial assistance.
• D) A 90-day elimination period is a disability income concept, not a route to custodial coverage under major medical.

Memory hook

Custodial care = help with daily living, not skilled treatment — and not covered by major medical.