Indiana State Life and Health Insurance Practice Exam

What is an important feature of a comprehensive major medical health insurance policy?

1. A maximum coverage limit for all expenses

2. Coverage for only catastrophic events

3. A provision for eligible expenses

4. A mandatory waiting period on claims

The correct answer is: A provision for eligible expenses

A comprehensive major medical health insurance policy is designed to cover a broad range of healthcare expenses, making it essential that it includes a provision for eligible expenses. This feature ensures that a wide array of medical services, treatments, and procedures are covered, providing policyholders with access to necessary healthcare without being limited to a narrow set of conditions or types of care. The inclusion of eligible expenses is a fundamental aspect of comprehensive plans, as it helps to protect individuals from high medical costs that could arise from both routine and unexpected health issues. In contrast, other features mentioned in the choices do not align with the essence of comprehensive coverage. For instance, a maximum coverage limit might restrict benefits and could lead to inadequate coverage in case of significant medical needs. Coverage exclusively for catastrophic events would imply that routine care and preventive services, which are essential parts of health insurance, would not be covered at all. A mandatory waiting period on claims can introduce barriers that deter timely access to healthcare services, which is generally contrary to the purpose of having a robust health insurance plan.