State RegulationsNC specificDifficulty 2/5
A North Carolina health insurer writes a claim-filing provision into its policies. Under G.S. 58-3-225(f), what is the shortest filing window the insurer may require?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under G.S. 58-3-225(f), insurers may require claims to be submitted within 180 days after the date of service (facility claims: 180 days after discharge), but they may not require fewer than 180 days. If late filing was not reasonably possible to avoid, the claim must still be accepted, never later than one year.
Why the other options are wrong
- B) Ninety days is shorter than the statutory floor; a policy requiring filing within 90 days would violate G.S. 58-3-225(f).
- C) Thirty days is far below the 180-day minimum the statute imposes on claim-filing requirements.
- D) Twenty days is likewise below the 180-day floor and would be an unenforceable filing window.
Memory hook
Insurers can demand 180 days but never a day less.