In North Carolina, what is the shortest claim-filing window a health insurer is permitted to require in its policy?

Why B is correct

G.S. 58-3-225(f) lets insurers require health claims to be filed within 180 days after the date of service — or 180 days after discharge for facility claims — but prohibits requiring fewer than 180 days. Filing after the window is still allowed when it was not reasonably possible to file sooner, and in no event later than 1 year after the deadline.

Why the other options are wrong

• A) Ninety days is the NAIC-model proof-of-loss figure that North Carolina does not adopt; G.S. 58-3-225(f) sets the floor at 180 days.
• C) One year is the outside limit for late filing under G.S. 58-3-225(f), not the minimum window a policy may impose.
• D) Sixty days is the provider claim-status reporting trigger in G.S. 58-3-225(g); the claim-filing floor is 180 days.

Memory hook

Policies can demand 180 days but never a day less.

Why D is correct

Under G.S. 58-3-225(f), an insurer may require claims to be submitted within 180 days after the date of service, with facility claims running 180 days after discharge, but the insurer may not require fewer than 180 days. Late filing must still be accepted when not reasonably possible, and in no event later than 1 year, so 180 days is both the standard and the statutory floor.

Why the other options are wrong

• A) 60 days is the waiting period before a legal action on an accident and health claim under G.S. 58-51-15(a)(11), not a filing floor.
• B) 90 days is the model-act figure; North Carolina's statutory floor under G.S. 58-3-225(f) is 180 days.
• C) 1 year is the outside limit for accepting late filings under G.S. 58-3-225(f), not the minimum window an insurer may impose.

Memory hook

Insurers cannot cut below 180 - one-eighty is the claim filing floor.