State RegulationsOH specificDifficulty 3/5
An Ohio long-term care policy lapsed for nonpayment. The insured's family demonstrates that the insured was cognitively impaired before the grace period expired, and requests reinstatement 4 months after the termination. What must the insurer do?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
OAC 3901-4-01(G) requires the insurer to offer reinstatement of a lapsed LTC policy if the insured shows that cognitive impairment or loss of functional capacity existed before the end of the grace period, provided the request for reinstatement is made within 5 months after termination. A request at 4 months, supported by evidence of pre-grace cognitive impairment, falls squarely within this protection.
Why the other options are wrong
- A) No new physical examination may be substituted for the statutory reinstatement right; the showing required is the impairment evidence.
- B) The 30-day figure is not the reinstatement deadline; the request window runs 5 months after termination.
- D) Permanent exclusion of treated conditions is not a permitted condition of this reinstatement.
Memory hook
Impaired before the grace ran out? Ask within 5 months and the policy comes back.