What is a common rule regarding cosmetic or elective surgery?

What is a common rule regarding cosmetic or elective surgery?

• A. Always fully covered.
• B. Not covered unless medically necessary or resulting from injury; policy-specific.
• C. Covered for cosmetic procedures only if there is medical necessity.
• D. Never covered.

Answer: (B)

Cosmetic and elective procedures are generally not treated as essential medical care in medical expense insurance. The typical rule is that coverage is denied for cosmetic or elective surgery unless there is medical necessity or the procedure results from an injury, and even then what’s covered can depend on the specific policy. This captures the common practice that procedures done purely for appearance are not routinely paid for, while reconstructive or necessary treatments after injury may be covered, subject to policy terms and any riders.

Cosmetic and elective procedures are generally not treated as essential medical care in medical expense insurance. The typical rule is that coverage is denied for cosmetic or elective surgery unless there is medical necessity or the procedure results from an injury, and even then what’s covered can depend on the specific policy. This captures the common practice that procedures done purely for appearance are not routinely paid for, while reconstructive or necessary treatments after injury may be covered, subject to policy terms and any riders.