31. What condition MUST be satisfied for a totally disabled employee to continue coverage under the extension of benefits provision in a medical expense plan?
Answer: D
The disability must result from an illness or accident occurring while the employee was under the plan.
For a totally disabled employee to continue coverage under the extension of benefits provision in a medical expense plan, the disability must result from an illness or accident that occurred while the employee was covered by the plan.
A) The employee must be undergoing treatment for disability when the plan ends
This option is incorrect because the requirement is not solely about the employee receiving treatment at the time of the plan's termination, but rather that the disability itself must arise from an illness or accident that occurred during the coverage period.
B) Claims relating to the disability must be fully incurred prior to plan termination
This option is also incorrect. While claims must generally be incurred during the coverage period, the critical factor for continuing coverage is that the disability itself must have resulted from an incident that occurred while the employee was covered by the plan.
C) The total disability must be permanent
This option does not satisfy the requirement either. The plan does not specify that the total disability must be permanent; rather, it focuses on the origin of the disability being linked to an event that happened while the employee was covered under the plan.
D) The disability must result from an illness or accident occurring while the employee was under the plan
This option is correct as it directly addresses the requirement for a disabled employee to maintain coverage under the extension of benefits provision. The provision explicitly states that the origin of the disability must align with the time frame of the employee’s coverage.
Conclusion
The correct answer is D because it aligns with the specific requirement that the disability must originate from an event during the time the employee was covered under the plan. Options A, B, and C fail to address the essential condition regarding the timing and cause of the disability, making D the only accurate choice.