Which expense would a typical major medical expense policy exclude because another source of payment applies?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Major medical policies commonly contain an other-insurance exclusion for medical expenses that are payable under a workers' compensation law. Because the employer's workers' compensation coverage is statutorily responsible for on-the-job injuries, the major medical policy steps aside to avoid duplicate payment — the two coverages never pay twice for the same bill. Surgery after an accidental injury, hospitalization for a covered illness, and physician-ordered outpatient testing are all ordinary covered benefits with no other compulsory payer. Coordination with workers' compensation is handled by an other-insurance provision so the claimant receives full reimbursement of covered expenses from a single responsible source and the two policies do not pay the same bill twice.
Why the other options are wrong
- B) Surgery required after an accidental injury is a standard covered benefit of major medical insurance.
- C) Hospitalization for a covered illness is the core function of a major medical policy.
- D) Outpatient diagnostic testing ordered by a physician is a covered medical expense, not a compensated other-payer situation.
Memory hook
On-the-job injury? Workers' comp owns that bill. Major medical steps aside when another payer is required to step up.