State RegulationsFL specificDifficulty 2/5
A long-term care policy issued in Florida contains a preexisting condition exclusion. Under Fla. Stat. 627.9407(4)(a) and (b), what is the maximum lookback and the maximum exclusion period the policy may apply?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under Fla. Stat. 627.9407(4)(a) and (b), a Florida long-term care policy may look back no more than 6 months from the effective date of coverage for preexisting conditions and may exclude a preexisting condition for no more than 6 months. This prevents insurers from using health history to gut coverage: once the 6-month exclusion runs, a condition that existed before issue must be covered like any other claim.
Why the other options are wrong
- A) 30 days is the cap on a required prior hospital or nursing facility stay, not the preexisting condition lookback or exclusion period.
- C) 180 days belongs to the elimination period cap, and no multi-year exclusion is permitted for a Florida LTC policy.
- D) A 2-year lookback with a life-of-the-policy exclusion far exceeds what Fla. Stat. 627.9407 allows.
Memory hook
Six and six: look back 6 months, exclude 6 months.