Benefit TriggersActivities of Daily Living (ADL) and
cognitive disorder are considered types of "benefit triggers",
the term used to describe the factors that qualify an individual for eligibility of benefits under a long-term care insurance policy. This is an important part of the policy. The policy usually outlines the benefit triggers.
Activities of Daily Living (ADL) is the most common gauge insurance companies use to decide if an individual is eligible for benefits. Long-term care is generally needed when an individual is unable to perform two to three of the following activities.
- Bathing
the ability to sponge bathe or to get in and out
of the bathtub or shower.
- Eating
the ability to feed oneself by getting food into
the body or by a feeding tube.
- Continence
the ability to maintain control of bowel and
bladder functions.
- Toileting
the ability to get to and from the toilet and
perform associated personal hygiene.
- Dressing
the ability to put on and remove all items of
clothing and any braces or artificial limbs.
- Transferring the ability to get in and out of bed, a chair or wheelchair.
Cognitive Disorder
The policy usually pays benefits when an individual needs care because their mental capacity has deteriorated.They may or may not need assistance with the activities of daily living, but may need to have someone nearby to supervise their activities or remind them to do everyday activities. Costs for this stand by care are usually covered under a long-term care insurance policy.
Different policies may use different benefit triggers. Some states require certain benefit triggers. Check with your state insurance department to learn what your state requires.
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