State RegulationsIL specificDifficulty 2/5
Under Illinois Medicare supplement standards, how may an insurer handle preexisting conditions on a policy sold outside the open enrollment period?
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Outside open enrollment, Illinois Medicare supplement standards cap the preexisting-condition device at two limits: the insurer may look back no more than 6 months into the applicant's health records to define a preexisting condition, and it may impose a waiting period of up to 6 months for such conditions. Credit for prior creditable coverage reduces or eliminates the waiting period. These limits flow from the 215 ILCS 5/363 statutory family and the Illinois SHIP guidance administered with the Illinois Department of Insurance rules.
Why the other options are wrong
- A) The look-back is capped at 6 months of health records; an unlimited look-back into the applicant's history is not permitted.
- C) A mandatory first-year exclusion regardless of prior coverage exceeds the 6-month waiting period maximum and ignores creditable-coverage credit.
- D) Disclosure of a preexisting condition does not permit outright denial outside open enrollment; the statute allows a limited waiting period, not rejection.
Memory hook
Six to look, six to wait — and prior coverage wipes the wait.