State RegulationsNC specificDifficulty 2/5
An individual health policy issued in North Carolina contains a preexisting condition exclusion. The insured received treatment for the condition several months before the policy's effective date. Under G.S. 58-51-15(a)(2)b, for how long after the effective date may the policy exclude this condition at most?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under G.S. 58-51-15(a)(2)b, a preexisting condition exclusion may not extend beyond one year after the policy's effective date. The look-back window for defining a preexisting condition covers advice, diagnosis, care, or treatment received or recommended within the one-year period before the effective date, so the earlier treatment falls inside it - but the exclusion itself still may not run past one year. Credit for prior creditable coverage applies under G.S. 58-51-17.
Why the other options are wrong
- A) Ninety days understates the cap; the statute permits an exclusion of up to one year.
- C) Eighteen months exceeds the maximum exclusion period allowed by G.S. 58-51-15(a)(2)b.
- D) Twenty-four months doubles the lawful limit; no preexisting exclusion may extend beyond one year.
Memory hook
Look back one year, exclude no more than one year.