An Ohio issuer is drafting the preexisting-condition provisions of its Medicare supplement policy. Which statement correctly pairs the limits Ohio law imposes on preexisting-condition terms?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Ohio law confines both halves of the preexisting-condition term. Under ORC 3923.332(B) and OAC 3901-8-08(N)(3), a Medicare supplement policy may not exclude or limit benefits for losses incurred more than 6 months from the effective date of coverage, and 'preexisting condition' may not be defined more restrictively than a condition for which medical advice was given or treatment was recommended or received within 6 months before the effective date. A draft that pairs a longer or shorter exclusion window with a broader definition violates both limits, so issuers must align the exclusion period and the definition to the same 6-month standards.
Why the other options are wrong
- A) The 30-day exclusion window is not the Ohio standard for Medicare supplement policies; the statutory maximum exclusion period is 6 months from the effective date.
- B) A 63-day window belongs to guaranteed-issue enrollment windows, not the preexisting-condition exclusion period, and the definition may not extend its lookback beyond 6 months before the effective date.
- D) Ohio does permit a preexisting-condition exclusion; it only caps that exclusion at losses incurred within 6 months after the effective date, so a no-exclusion statement misstates the rule.
Memory hook
Six months to exclude, six months to define — Med supp pre-x runs on twin sixes.