What Is the Definition of Major Medical Insurance

Tamsen Butler
Learn about medical insurance.
Learn about medical insurance.

What is the definition of major medical insurance? While policies differ, the simple definition of this type of insurance is a policy that covers routine and emergency medical expenses after the preset deductible has been met by the policyholder.


A major medical insurance policy is not a "bare bones" policy that only covers a limited range of medical expenses. Instead, this type of medical insurance policy is designed to be comprehensive coverage that adequately covers policyholders for a broad range of medical issues.

Major medical insurance may not cover everything. Commonly, extra coverage - also known as insurance "riders" - must be purchased separately or as an additional policy. Examples of coverage that are usually not included in a major medical insurance policy and that must be purchased as an additional policy include vision insurance and some dental coverage. Coverage for these categories usually depends on the nature of the medical need. For example, while routine dental examinations may not be covered, a dental emergency as a result of an injury may be covered by a major medical insurance policy.

What Is the Definition of Major Medical Insurance

Since medical insurance policies differ, there is no absolute answer to the question "What is the definition of major medical insurance" that is suitable for all policies. Instead, this term generally refers to policies that provide coverage for most health-related expenses that can be incurred.

Coverage included in a major medical insurance policy usually includes:

  • Prescription drugs
  • Casts and other necessary equipment needed for bone breaks or fractures
  • X-rays
  • Both outpatient and inpatient services as a result of required medical care
  • Diagnostic tests and examinations
  • Ambulance services
  • Necessary medical supplies
  • Necessary medical therapies

Other procedures are covered depending upon the details of the policy. A major medical insurance policy, by definition, is supposed to cover almost everything you may need from your health insurance policy.

Cosmetic medical procedures are not usually covered under this type of policy unless they are deemed necessary by a physician. For example, a breast augmentation would not generally be covered under a major medical policy if the patient wants it solely for cosmetic purposes, but if the same patient experienced severe burns across her chest in an accident, this procedure may be considered reconstructive and therefore covered by the policy. Contact your insurance company with questions regarding coverage provided by your particular policy.

Deductibles and Other Expenses

Keep in mind that most major medical insurance policies include deductibles, so even though something like prescription drugs are covered by the policy, the policyholder must first pay for any deductibles that are required by the policy. For this reason, major medical insurance should not be considered an all-inclusive policy that will never result in out of pocket expenses for the policyholder.

  • Deductible: This is the amount of money that the policyholder must pay before the insurance coverage kicks in to pay the remainder of the bill. The amount of money for a deductible varies. Policyholders usually have a say in how much of a deductible they are willing to pay, which will in turn affect the amount of money paid monthly for the policy premiums.
  • Co-Pay: This is the amount of money that must be paid by the policyholder according to the amount already established by the insurance company. For example, a policyholder may have a $25 co-pay fee for every visit to the doctor, or a $5 co-pay for prescription medicines. This means that every time the policyholder visits any doctor, a $25 co-pay must be paid regardless of what kind of appointment it is.

Varying Policies

Major medical insurance is important because it covers most medical expenses. While some people choose to select a cheaper policy, the expenses related to a major medical health insurance policy can easily be worth the expenses in the long run.

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What Is the Definition of Major Medical Insurance