Florida 2-15 Life, Health and Variable Annuity AgentFlorida Laws and Regulations Specific to Health InsuranceHard
A Florida resident, aged 68, has been diagnosed with a serious illness and is unable to perform at least two Activities of Daily Living (ADLs). They are considering applying for a Long-Term Care (LTC) insurance policy. According to Florida law, what is the required benefit trigger for an LTC policy related to ADLs?
- AInability to perform all six ADLs.
- BInability to perform at least three ADLs.
- CInability to perform at least two ADLs.
- DInability to perform at least one ADL.
Show answer & explanationAnswer & explanation
Correct answer: C. Inability to perform at least two ADLs.
Under Florida law and federal standards, a qualified Long-Term Care insurance policy must define 'chronically ill' as being unable to perform at least two Activities of Daily Living (ADLs) without substantial assistance for at least 90 days due to a loss of functional capacity, or requiring substantial supervision due to severe cognitive impairment.
Why the other options are wrong
- A. Inability to perform all six ADLs is an extremely high threshold and not the standard trigger.
- B. Three ADLs is a more stringent requirement than typically mandated by state and federal law.
- D. One ADL is generally not sufficient to trigger LTC benefits.
LTC ADL Benefit Trigger (FL)
In Florida, Long-Term Care insurance policies require the inability to perform at least two Activities of Daily Living (ADLs) without substantial assistance as a benefit trigger for 'chronically ill' status.
- Inability to perform 2+ ADLs
- Must be for at least 90 days
- Due to loss of functional capacity or severe cognitive impairment
- ADLs: Bathing, Dressing, Eating, Toileting, Continence, Transferring
Memory trick: LTC: Two ADLs, Two Triggers (ADLs or Cognitive).