State RegulationsNY specificDifficulty 2/5
A New York long-term care insurer wants to exclude benefits for mental, emotional, and nervous disorders. Which statement describes what Reg 62 allows?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under Reg 62 (11 NYCRR Part 52), Part 52.25(b)(2) permits an exclusion or limitation for mental, emotional, or nervous disorders, but the policy may not exclude or limit benefits on the basis of Alzheimer's disease, senile dementia, or demonstrable organic brain disease. Those cognitive disorders must remain covered even though other mental and emotional conditions may be limited.
Why the other options are wrong
- B) Disclosure cannot save an exclusion the regulation forbids; organic brain disease and Alzheimer's must be covered.
- C) The preexisting condition limitation does not create an exception for Alzheimer's; coverage for cognitive disease cannot be timed out.
- D) The regulation does permit exclusions for mental and emotional disorders generally; only the listed cognitive conditions are protected.
Memory hook
The LTC mental exclusion stops cold at Alzheimer's, dementia, and organic brain disease.