Medical expense policies generally exclude coverage for:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Standard medical expense policies exclude losses caused by intentional, self-inflicted injury because such injuries are not fortuitous and would create a serious moral hazard. If the policy paid for deliberately self-inflicted harm, insureds would have an incentive to collect benefits by injuring themselves. Intentional self-harm is a common exclusion alongside war, military service, and illegal activity, all of which are likewise excluded because they involve predictable or volitional losses. The fortuity principle is fundamental to insurance: coverage responds to accidental, unintended events, not to losses the insured deliberately brings about.
Why the other options are wrong
- B) Hospital services are the core benefit of medical expense coverage. Excluding them would defeat the very purpose of a policy that exists to pay hospital and surgical bills.
- C) Medically necessary surgery is a covered benefit when it falls within the policy's terms. Policies generally exclude only unnecessary, experimental, or cosmetic procedures, not necessary treatment.
- D) Covered prescription drugs for a chronic illness are a benefit under the policy, subject to its pharmacy provisions. They are not an excluded loss of the intentional-injury type.
Memory hook
Insurance pays for accidents, not for deliberate harm you do to yourself.