State RegulationsOH specificDifficulty 2/5
An Ohio long-term care policy pays benefits only after the insured is institutionalized. Under Ohio rules, what is the longest prior institutional stay the policy may require before benefits become payable?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under ORC 3923.44 and OAC 3901-4-01, a long-term care policy that provides benefits only after institutionalization may not require a prior institutional stay of more than 30 days. This prevents insurers from using extended prior-stay requirements to delay or avoid paying otherwise covered confinement benefits. The Ohio Department of Insurance enforces this limit as a core consumer protection in LTC policy design.
Why the other options are wrong
- A) 90 days exceeds the maximum prior-stay requirement Ohio permits for institutionalization-only benefits.
- B) 6 months is far beyond the statutory ceiling and would unlawfully delay benefits.
- C) 10 days describes neither a required nor a maximum prior stay; the limit is expressed as a maximum of 30 days.
Memory hook
Prior stay cap: 30 days, no more — institutional-only policies must keep the door open.