State RegulationsNY specificDifficulty 1/5
A New York long-term care policy contains a preexisting condition limitation. Under Reg 62 (11 NYCRR Part 52), for how long after the effective date of coverage may benefits for a preexisting condition be excluded?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under Reg 62 (11 NYCRR Part 52), specifically Part 52.25(b)(2), the only permissible preexisting condition limitation in a long-term care policy excludes coverage for no more than 6 months after the effective date of coverage, and only for a condition for which medical advice was given or treatment was recommended or received within 6 months before the effective date. Many insurers forgo the limitation entirely and rely on underwriting alone.
Why the other options are wrong
- A) 12 months is double the maximum exclusion period Reg 62 permits.
- B) 24 months is far beyond the 6-month maximum the regulation allows.
- C) 60 months would bar coverage for years and is plainly outside the regulation's limit.
Memory hook
LTC preexisting rule: look back 6 months, lock out at most 6 months.