What determines the claim M is eligible for under a basic Hospital/Surgical Expense policy?

The eligibility of a claim under a basic Hospital/Surgical Expense policy is primarily determined by the terms of the policy itself. This means that the specific provisions, limitations, covered procedures, and benefits outlined in the policy dictate what types of claims can be filed and what expenses will be reimbursed.

These policies typically have predefined coverage levels, limits on the types of services covered, deductibles, and co-pays that detail what the insurer will pay for hospital and surgical expenses. As a result, policyholders must review their specific coverage terms to understand the claim process and any limitations that apply to their circumstances.

The other options do not directly influence the eligibility of a claim in the same way. While the experience of the surgeon, the age of the insured, and the charges from the hospital may affect the amount reimbursed or the providers included in a network, they do not establish the fundamental eligibility criteria for claims as defined by the policy terms.