An Ohio long-term care policy takes effect on March 1. The insured was treated for a back condition 2 months before the effective date. Loss from that condition begins 7 months after the effective date. What may the insurer do?

Why D is correct

Under ORC 3923.44(B)(4), (B)(5) and (D), an Ohio LTC policy may exclude a preexisting condition only for losses or confinements beginning within 6 months following the effective date of coverage. Here the loss began 7 months after the effective date, outside the exclusion window, so the insurer must pay even though the condition was treated shortly before coverage began.

Why the other options are wrong

• A) Pre-effective-date treatment alone does not justify denial; the exclusion is bounded by the 6-month loss window.
• B) Twelve months is not a permissible measure; the relevant line is the 6-month window following the effective date.
• C) Ohio law does not permit partial payment as a compromise for an out-of-window preexisting loss.

Memory hook

Six months to exclude, then it's covered: month 7 means pay.