A condition for which medical advice, diagnosis, care, or treatment was recommended or received during the 6 months immediately preceding the effective date of group health coverage is
Apreexisting conditionis defined in health insurance as a medical condition for which advice, diagnosis, care, or treatment was recommended or received within a specified period (commonly 6 months) before the effective date of coverage. In Oklahoma, group health insurance policies often include provisions limiting or excluding coverage for preexisting conditions for a certain period, as regulated by federal and state laws, including the Health Insurance Portability and Accountability Act (HIPAA).
Option A: Incorrect. An elimination period is the waiting period before benefits begin, typically in disability or long-term care policies, not related to preexisting conditions.
Option B: Incorrect. An affiliation period is a waiting period for late enrollees in HMOs under HIPAA, not tied to medical conditions.
Option C: Incorrect. A diagnosed condition is not a standard insurance term; it does not specifically denote the timeframe of prior treatment like a preexisting condition.
Option D: Correct. A preexisting condition matches the definition provided, as per Oklahoma and federal regulations.
This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers health insurance exclusions and limitations.
[:, Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section: General Knowledge – Accident and Health Insurance)., Oklahoma Insurance Department, Title 36 O.S. § 6060.4 (preexisting condition provisions)., HIPAA, 45 CFR § 144.103 (definition of preexisting condition)., ]
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