State RegulationsNC specificDifficulty 1/5
A North Carolina health insurer drafts its claim submission rules. What is the shortest proof-of-loss filing deadline it may require of claimants?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under G.S. 58-3-225(f), insurers may require claims to be submitted within 180 days after the date of service, or for facility claims within 180 days after discharge, but they may NOT require a shorter period. Late filing is still allowed when not reasonably possible, never later than 1 year, so 180 days is the statutory floor insurers must respect.
Why the other options are wrong
- A) Ninety days is the NAIC-model proof-of-loss figure that North Carolina deliberately departs from; it is shorter than the statutory floor.
- C) One year is the outside limit for late filing when circumstances make timely filing not reasonably possible, not the minimum required window.
- D) Sixty days has no role in the claim filing rule; facility claims get 180 days measured from discharge.
Memory hook
One-eighty is the floor: insurers can't demand faster filing.