California Property & Casualty Broker-AgentHealth InsuranceMedium
A client is considering purchasing a Long-Term Care (LTC) insurance policy. They want to ensure that the policy will cover a wide range of services, including assistance with daily living activities. Which benefit trigger is commonly used in LTC policies to determine eligibility for benefits related to assistance with daily living?
- AAcute illness requiring hospitalization
- BInability to perform Activities of Daily Living (ADLs)
- CNeed for skilled nursing care only
- DDiagnosis of a terminal illness
Show answer & explanationAnswer & explanation
Correct answer: B. Inability to perform Activities of Daily Living (ADLs)
LTC policies typically trigger benefits when the insured is unable to perform a certain number of Activities of Daily Living (ADLs), such as bathing, dressing, eating, toileting, and transferring, or has severe cognitive impairment.
Why the other options are wrong
- A. Acute illness is generally covered by standard medical insurance, not primarily LTC.
- C. While LTC can cover skilled nursing, 'only' skilled nursing is too restrictive; LTC covers a broader range of care levels.
- D. Terminal illness triggers life insurance accelerated benefits or hospice care, not standard LTC benefits.
LTC Benefit Triggers
Conditions or criteria that must be met for a Long-Term Care insurance policy to begin paying benefits.
- Most common are inability to perform ADLs or cognitive impairment.
- Medical necessity is often a secondary requirement.
- A licensed health professional typically certifies the need.
Memory trick: ADLs are your daily 'Activities' that trigger LTC.