Under Pennsylvania's long-term care statute (40 P.S. § 991.1105(c)), how may a long-term care policy treat pre-existing conditions?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Pennsylvania's long-term care statute, 40 P.S. § 991.1105(c), defines a pre-existing condition by reference to a bounded look-back: conditions for which advice, diagnosis, care, or treatment was received or recommended within the statutory window. The policy may exclude such conditions, but only for the limited exclusion period the statute allows, and the companion provision, 40 P.S. § 991.1107, confines how these limitations are applied. The Pennsylvania Insurance Department enforces this structure so that pre-existing-condition language operates as a bounded underwriting tool, not a lifetime denial device.
Why the other options are wrong
- A) A denial right with no time boundary would swallow the statute; the look-back and exclusion period bound what the insurer may reach.
- B) The exclusion is temporary within the limits Pennsylvania sets; permanent exclusion of pre-existing conditions is not permitted.
- D) The insurer applies its own statutory framework under 40 P.S. § 991.1105(c); no determination from the federal Medicare program is part of the test.
Memory hook
Look-back bounded, exclusion limited — pre-existing rules have fences on both sides.