In a comprehensive major medical policy, which service is typically not covered under Eligible Expenses, i.e., considered an exception?

• A. Hospital room and board
• B. Doctor visits
• C. Prescription drugs
• D. Experimental and investigative services

Answer: (D)

In major medical plans, the expenses that get reimbursed are typically those tied to standard, medically necessary care. Hospital room and board and doctor visits are classic examples of covered services because they represent established elements of medical treatment. Prescription drugs are also commonly covered, subject to the plan’s formulary and rules.

The thing that’s usually excluded from eligible expenses is experimental and investigative services. These are not considered proven to be safe or effective or a standard part of care, so insurers generally don’t reimburse them as part of the policy benefits. Some plans may offer limited coverage for clinical trials under specific riders, but in general, experimental and investigative services fall outside standard coverage.