Medical Expense Insurance Practice Exam

In medical expense insurance, when is a claim considered incurred?

The service or charge is billed for and received by the insured; typically the date of service. The claim is approved by the insurer. The policy is in force. The provider is in-network.

Correct Answer:

The service or charge is billed for and received by the insured; typically the date of service.

Explanation:

The date of service is the moment incurrence occurs—the service is performed and billed to the insured. Incurrence means the insured becomes liable for the expense, which usually happens when the medical service is provided and the bill is issued, so the claim is considered incurred at that time. Approval by the insurer happens after the service and does not define when the expense was incurred. The policy being in force is a prerequisite for coverage, but it doesn’t establish the incurrence date. Whether the provider is in-network affects cost-sharing and networked payment amounts, not when the claim is incurred.

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