State RegulationsVA specificDifficulty 2/5
An application for a long-term care policy in Virginia discloses a condition that was treated during the look-back window. Under Va. Code § 38.2-5204, what limits apply to how the policy may treat that preexisting condition?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Va. Code § 38.2-5204 confines long-term care preexisting-condition provisions in Virginia to a 6-month look-back and a 6-month exclusion period: the insurer may look back only 6 months for conditions for which advice or treatment was received or recommended, and may exclude those conditions only for the first 6 months of coverage. Both halves are capped, so the condition becomes fully covered once the policy has been in force for 6 months. Permanent exclusions and longer windows exceed what the statute allows.
Why the other options are wrong
- B) A permanent exclusion exceeds the statutory cap; the exclusion period can run no longer than 6 months.
- C) The statute permits a limited preexisting-condition exclusion; it does not mandate day-one coverage of every prior condition.
- D) A 12-month exclusion period would exceed the 6-month maximum regardless of disclosure.
Memory hook
Six to look, six to exclude — after that, the preexisting condition is covered.