AD Banker Comprehensive Practice Exam

For nonroutine treatments, a comprehensive policy generally pays:

1. A specified percentage of the reasonable and customary charges

2. For catastrophic health losses only

3. 100% of the medical expenses

4. For inpatient hospital treatment only

The correct answer is: A specified percentage of the reasonable and customary charges

A comprehensive policy is designed to cover a wide range of healthcare services, including both routine and nonroutine treatments. When it comes to nonroutine treatments, which often involve specialized care or procedures that are not typically covered by basic health insurance plans, the comprehensive policy usually pays a specified percentage of the reasonable and customary charges. This means that the policy will reimburse a certain percentage of the costs that are considered standard or acceptable for a given treatment in a specific geographical area, ensuring that the insured person has coverage for their medical expenses while also helping to manage costs. In contrast, policies that provide coverage only for catastrophic health losses limit their scope, focusing primarily on severe and high-cost conditions, and wouldn't address nonroutine treatments comprehensively. Coverage of 100% of medical expenses might seem attractive; however, it typically does not apply universally and can lead to higher premiums. Coverage restrictions to inpatient hospital treatment overlook other essential medical services that may fall under the nonroutine category, like outpatient surgeries or specialized therapies. Thus, the correct choice reflects the standard coverage model typically found in comprehensive health policies, facilitating access to care while balancing cost management.