An individual medical expense policy typically lists standard exclusions. Which exclusion is commonly found in these policies?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Most individual medical expense policies exclude losses that are already covered by workers' compensation or employer liability laws. If an on-the-job injury is compensable under the employer's workers' compensation plan, the medical expense policy will not make a duplicate payment, consistent with the indemnity principle of avoiding overpayment. Other standard exclusions include war, self-inflicted injury, injury during illegal acts, and cosmetic or experimental treatment. Preventive care and emergency treatment are core covered services, and newborn coverage is typically provided and often required by state law.
Why the other options are wrong
- B) Preventive services such as annual exams are covered, and under the ACA non-grandfathered plans must cover recommended preventive care with no cost sharing.
- C) Emergency room treatment for a sudden injury is a covered benefit; the exclusion targets injuries already payable by workers' compensation.
- D) Newborns are generally covered from birth, and state and federal rules usually require dependent coverage to include newborn children.
Memory hook
Already paid by workers' comp = already out of the medical policy. No double-dipping.