Florida 2-15 Life, Health and Variable Annuity AgentGeneral Knowledge of Health InsuranceMedium
A client is considering a long-term care (LTC) policy. Which of the following is a key factor in determining the policy's benefit eligibility and the insured's ability to perform daily self-care?
- ACognitive Impairment Index (CII)
- BInstrumental Activities of Daily Living (IADLs)
- CActivities of Daily Living (ADLs)
- DMedical Necessity Review (MNR)
Show answer & explanationAnswer & explanation
Correct answer: C. Activities of Daily Living (ADLs)
Activities of Daily Living (ADLs) are fundamental to personal care and are a primary trigger for benefits in most long-term care insurance policies. The inability to perform a certain number of ADLs (typically two or more) often makes an individual eligible for benefits.
Why the other options are wrong
- A. Cognitive Impairment is a separate, but equally important, trigger for LTC benefits, not an index.
- B. IADLs are more complex activities and are secondary to ADLs for benefit triggers.
- D. Medical Necessity Review is a process for determining if a service is medically appropriate, not an eligibility trigger itself.
Activities of Daily Living (ADLs)
Fundamental personal care tasks that individuals perform on a daily basis, used as a primary eligibility trigger for long-term care insurance benefits.
- Six standard ADLs: bathing, dressing, eating, toileting, continence, transferring.
- Inability to perform a certain number (e.g., 2 out of 6) triggers LTC benefits.
- Assesses an individual's functional ability to care for themselves.
Memory trick: LTC needs a trigger to unlock care!