State RegulationsNC specificDifficulty 3/5
An insured applies to reinstate a lapsed health policy, and the insurer issues a conditional receipt but does not approve the application. Under G.S. 58-51-15(a)(4), when does the reinstated coverage take effect and what does it cover?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under G.S. 58-51-15(a)(4), when a conditional receipt is issued the policy is reinstated upon approval or, absent approval, on the 45th day following the receipt unless disapproved in writing earlier. The reinstated policy covers accidents after reinstatement and sickness beginning more than 10 days after that date, and premiums accepted apply to periods not more than 60 days prior to reinstatement.
Why the other options are wrong
- A) The automatic effective day is the 45th, not the 30th, and sickness is covered only when it begins more than 10 days after reinstatement.
- B) Reinstatement is not instantaneous on filing; G.S. 58-51-15(a)(4) provides approval or the 45th-day mechanism.
- C) Without approval, coverage still attaches on the 45th day; written approval is not the only trigger.
Memory hook
45th day auto-hooks; sickness waits 10 more.