State RegulationsOH specificDifficulty 2/5
An applicant in Dayton enrolls in a Medicare supplement policy during the open enrollment period and has 6 months of prior creditable coverage. What effect does that creditable coverage have on preexisting-condition exclusions?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
OAC 3901-8-08(N)(2) provides that during open enrollment, creditable coverage of at least 6 months eliminates preexisting-condition exclusions entirely; a shorter period of creditable coverage reduces the exclusion period proportionately. Because this applicant has exactly 6 months of creditable coverage, no preexisting-condition exclusion may be imposed.
Why the other options are wrong
- A) A full exclusion cannot survive 6 months of creditable coverage; the rule eliminates the exclusion at that threshold.
- B) The rule eliminates the exclusion at 6 months of creditable coverage rather than fixing a 3-month remainder.
- C) Creditable coverage is the very mechanism the rule uses to reduce or eliminate preexisting-condition exclusions.
Memory hook
Six months of creditable coverage wipes out the pre-x exclusion.