State RegulationsMI specificDifficulty 2/5
A Michigan Medicare supplement policy takes effect, and the insured began treatment for a heart condition 2 months before the effective date. Which claims may the insurer lawfully deny during the preexisting-condition waiting period?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
M.C.L. 500.3819(2)(a) defines a preexisting condition as one for which medical advice, diagnosis, care, or treatment was received within 6 months before the effective date, and limits denial of claims for such conditions to losses incurred within 6 months after the effective date. The heart condition qualifies as preexisting, so related claims are deniable only during the first 6 months; losses incurred later must be paid.
Why the other options are wrong
- A) The permissible limitation runs 6 months, not a full policy year.
- B) The statute looks to treatment received before the effective date, not the insured's expectations.
- C) That is the reverse of the rule: once 6 months have passed after the effective date, the insurer may not deny claims for the preexisting condition.
Memory hook
Look back 6 months to define preexisting; look forward 6 months to limit claims.