State RegulationsNC specificDifficulty 2/5
A North Carolina health insurer is drafting the claim-filing provision of its policy. Under G.S. 58-3-225(f), what is the shortest claim-filing deadline the insurer may require after the date of service?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under G.S. 58-3-225(f), an insurer may require claims to be submitted within 180 days after the date of service, with facility claims running 180 days after discharge, but the insurer may not require fewer than 180 days. Late filing must still be accepted when not reasonably possible, and in no event later than 1 year, so 180 days is both the standard and the statutory floor.
Why the other options are wrong
- A) 60 days is the waiting period before a legal action on an accident and health claim under G.S. 58-51-15(a)(11), not a filing floor.
- B) 90 days is the model-act figure; North Carolina's statutory floor under G.S. 58-3-225(f) is 180 days.
- C) 1 year is the outside limit for accepting late filings under G.S. 58-3-225(f), not the minimum window an insurer may impose.
Memory hook
Insurers cannot cut below 180 - one-eighty is the claim filing floor.