Benefit Triggers
Activities of Daily Living (ADL) and cognitive disorder are considered types of benefit triggers, the term used to describe the factors that qualify a person 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 tub 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 receives long-term care because mental capacity has deteriorated, resulting in the inability to take care of oneself without assistance. Usually an individual with such a disorder needs supervision, protection and reminders to do everyday activities.
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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