State RegulationsPA specificDifficulty 2/5
An insured's accident and health policy is reinstated. He develops a sickness a few days after the reinstatement date and seeks coverage. Under 40 P.S. § 753(A)(4), what is the outcome?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
40 P.S. § 753(A)(4) imposes a short guard band after reinstatement: sickness is covered only if it begins more than 10 days after the reinstatement date. A sickness arising within that window is not covered. The same provision also bars applying reinstated premiums to periods more than 60 days before reinstatement, closing both the coverage and premium loopholes after a lapse.
Why the other options are wrong
- A) Reinstatement does not reach back over the 10-day sickness window; the statute expressly withholds coverage for sickness beginning inside it.
- B) There is no supplemental endorsement mechanism in 40 P.S. § 753(A)(4); the 10-day rule applies to the reinstatement itself.
- C) The rule is binary, not a reduction: sickness beginning more than 10 days after reinstatement is covered, and sickness beginning inside the window is not.
Memory hook
Ten days of quarantine after reinstatement — early sickness waits outside the door.