State RegulationsNY specificDifficulty 3/5
Elena's New York long-term care policy is issued after she received treatment for a heart condition within the look-back period. Under Reg 62, what is the maximum period for which the insurer may exclude coverage for that preexisting condition?
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under Reg 62 (11 NYCRR Part 52 (Reg 62)), a preexisting condition may be excluded for no more than 6 months after the policy's effective date, and the exclusion period must be reduced by the amount of the insured's uninterrupted prior coverage. So even though Elena's heart condition falls within the look-back, the insurer's exclusion window is capped at 6 months and shrinks further to the extent her prior coverage was continuous.
Why the other options are wrong
- B) A lifetime exclusion for a disclosed preexisting condition is prohibited; the exclusion window is strictly time-limited.
- C) 12 months is double the maximum exclusion Reg 62 allows, and uninterrupted prior coverage must always reduce the period.
- D) Some exclusion of a look-back condition is permitted; the protection is the 6-month cap, not a total ban on exclusions.
Memory hook
Preexisting exclusion: 6 months max, minus continuous prior coverage.