State RegulationsOH specificDifficulty 1/5
Beyond the permitted preexisting-condition waiting period, may an Ohio long-term care policy exclude a specifically named disease or condition by waiver or rider?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under ORC 3923.44(B)(4), (B)(5) and (D), together with OAC 3901-4-01, an Ohio LTC policy may exclude a preexisting condition only for losses beginning within the permitted waiting period measured from the effective date. Once that period passes, the insurer may not use a waiver or rider to permanently exclude specifically named preexisting diseases or conditions. The Ohio Department of Insurance treats such open-ended exclusions as unlawful policy provisions.
Why the other options are wrong
- A) Disclosure on the application does not license a permanent exclusion; exclusions are confined to the statutory waiting period.
- C) A claim-time waiver cannot create an exclusion the statute forbids at issue.
- D) Age 80 confers no special exclusion authority on insurers under Ohio LTC law.
Memory hook
Named diseases can hide during the wait — but not forever; the exclusion clock runs out.