Which type of care is MOST likely to be excluded from coverage under a typical major medical expense policy?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Major medical policies typically exclude custodial care — assistance with bathing, dressing, feeding, and other activities of daily living that does not require skilled medical services. Such care is viewed as maintenance rather than treatment of a covered sickness or injury. By contrast, medically necessary hospital care, surgery, and physician-ordered home health care are core covered benefits under standard major medical plans. This is one of the standard exclusions tested under the exclusions and limitations objectives for medical expense insurance.
Why the other options are wrong
- B) Physician-ordered hospitalization for a covered sickness is a primary benefit of major medical coverage, not an exclusion.
- C) Surgery required after an accidental injury is a covered expense under standard major medical plans.
- D) Home health care ordered by a physician following surgery is typically covered as medically necessary care.
Memory hook
Custodial = comfort care, not a cure. The policy pays to treat you, not to wipe your brow and hand you a fork.