Long Term Care Insurance Policy Benefit Triggers
|Long term care insurance policies may have different benefit triggers
for home health care coverage than for nursing home care. Review
you long term care policy for specifics.
Activities of Daily Living (ADL)
The inability to do daily living activities is one way
long term care insurance companies decide when you are eligible
benefits. Activities of daily living most companies use are bathing,
continence, dressing, eating, toileting, and transferring. More
on these triggers can be found in your long term care policy. Typically
the policy pays benefits when you can't do a certain number of ADLs,
such as two of the six or three of the six for a certain period of
Be sure you understand the specific rules of ADLs. Policies may
define ADLs and may require you to have hands-on
assistance with the ADL. Specifying hands-on assistance may make
for benefits than if only standby assistance is required.
Using a test of your mental ability is also one of the benefit triggers.
This trigger usually requires that you cannot
pass certain mental function tests. Not all policies use this as
a benefit trigger.
Doctor Certification of Medical Necessity
Some long term care insurance policies will start paying benefits
if your doctor orders the care as medically necessary. Tax-qualified
policies do not use this benefit trigger.
Policies sold today do not require prior hospitalization to
start benefits. However, Medicare still requires a three-day hospital
stay to be eligible for Medicare payment of skilled nursing facility