Life License Qualification Program (LLQP) Practice Exam

Which type of health care service is typically NOT covered under a comprehensive major medical health insurance policy?

1. Hospital charges

2. Nursing services

3. Experimental and investigative services

4. Physician fees

The correct answer is: Experimental and investigative services

Comprehensive major medical health insurance policies are designed to cover a wide range of medical services to help individuals manage their health care costs effectively. However, one of the significant exclusions in many of these policies is coverage for experimental and investigative services. These types of services often involve new treatments or procedures that have not yet been widely accepted or proven effective through rigorous clinical trials. As a result, insurance companies may choose not to cover them due to the uncertainty regarding their efficacy and safety. By excluding these experimental services, insurers protect themselves from the financial risk associated with covering treatments that are not yet validated by conventional medical standards. On the other hand, typical services that are usually covered include hospital charges, nursing services, and physician fees, as they are part of standard medical care that is established and recognized within the healthcare system. Therefore, excluding experimental and investigative services aligns with the objective of the policy to cover necessary and conventional health care, rather than treatments that are still under evaluation.