State RegulationsNC specificDifficulty 3/5
An applicant who received medical care shortly before applying is issued an individual health policy containing a preexisting-condition exclusion. Which limitation does North Carolina law place on that exclusion?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under G.S. 58-51-15(a)(2)b, a preexisting-condition exclusion may not extend beyond 12 months after the policy's effective date, and the look-back is limited to advice, diagnosis, care, or treatment within the 1-year period preceding that date. Credit for prior creditable coverage applies under G.S. 58-51-17, shortening or eliminating the exclusion.
Why the other options are wrong
- B) The statute caps the exclusion at 12 months after the effective date; it cannot run indefinitely with the condition.
- C) Exclusions are permitted; the law regulates their maximum length and look-back rather than banning them outright.
- D) The 12-month clock runs from the effective date of the policy, not from the first premium payment.
Memory hook
12 months exclusion, 1-year look-back - and prior coverage credit trims it.