A typical individual medical expense policy is MOST likely to exclude which of the following?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Individual medical expense policies routinely exclude injuries that are intentionally self-inflicted, along with other standard exclusions such as war, experimental treatment, and non-medically-necessary cosmetic procedures. Insurance is designed for fortuitous losses, and intentionally self-inflicted harm is neither accidental nor fortuitous. By contrast, emergency treatment of an accidental injury, hospitalization for a covered sickness, and physician-ordered home health care are core covered benefits of a major medical policy. The rationale is that insurance is built on fortuitous loss; a deliberately caused injury presents a moral hazard that the contract refuses to assume, and covering it would invite abuse.
Why the other options are wrong
- B) Emergency treatment of an accidental injury is a standard covered benefit; accidental injuries are exactly the losses major medical insurance exists to pay.
- C) Hospitalization for a covered sickness is the primary purpose of major medical coverage and is routinely covered.
- D) Home health care ordered by a physician is a typical covered benefit under modern major medical plans.
Memory hook
Insurance pays for accidents, not intentions. Intentionally self-inflicted harm is the one wound no policy opens its wallet for.