Which statement is true about Basic Medical Expense exclusions?

• A. They exclude all experimental procedures
• B. They cover elective cosmetic surgery
• C. They require coinsurance for all services
• D. They include a universal prescription drug benefit

Answer: (A)

Basic Medical Expense exclusions define what the policy will not pay for in that portion of coverage. A common and important exclusion is for experimental or investigational procedures, because these have not been proven safe and effective. That’s why saying that all experimental procedures are excluded is the true statement.

Cosmetic surgery, especially when done purely for appearance, is typically not covered under basic medical expenses, so the idea that elective cosmetic surgery is covered is not correct. Coinsurance describes how much of the cost you pay for covered services and is a cost-sharing feature rather than an exclusion, so it doesn’t define exclusions. There isn’t a standard universal prescription drug benefit embedded in basic medical expense exclusions; prescription drugs may be covered if the policy includes a drug benefit, but that isn’t part of the exclusion concept itself.