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LONG TERM DENTAL INSURANCE

When Will Long-Term Care Insurance Begin Paying Benefits?

All long-term care policies require that your physical or mental abilities be limited under one of three standards before benefits will be paid. These standards are often called Benefit Triggers. Many policies also require that additional conditions be met before you will receive payment. These “conditions” are events that must occur (or documents you must submit) after you meet the “benefit triggers” and before benefits will be paid.

The 3 Benefit Triggers permitted in long-term care insurance policies in California are:

1. Impairment in Activities of Daily Living (ADLs).

For deciding whether you get qualified for benefits, "Activities of Daily Living" are used for computing your physical abilities and suppose if you are impaired, then the law requires tax-qualified policies in case of paying benefits in 2 out of the following 6 ADL's such as bathing, dressing, transferring, eating, toileting and continence. But for non-tax qualified policies, the requirement is for 2 out of the following 7 ADLs: ambulating, bathing, dressing, transferring, eating, toileting and continence. Moreover, note down all the extra ADL's required for tax qualified policies and are ambulating.

Regardless of the use of a cane, crutches or braces, only two ADLs will be required before benefits will be paid for nursing home care, RCFE care, or home care in policies that are sold after October 1, 2001.

If you require human assistance or continual supervision for performing an Activity of Daily Living, "Impairment" is facilitated. Policies that trigger benefits when you have to meet one of the ADLs may begin paying benefits earlier in your disability than if you have to meet two. Your premiums will be even higher than before and the policy will not be tax qualified.

2. Impairment in Cognitive Ability (or Cognitive Impairment).

"Impairment in Cognitive Ability" means that you need supervision and assistance to take care for yourself or others because of the fact that the mental deterioration caused by Alzheimer's disease. Depending on the clinical evidence and also by the use of standardized tests, a doctor used to diagnose cognitive impairment.

3. Medical Necessity

Normally "Medical Necessity" means if you do not receive the care recommended, your doctor has certified that your medical condition will also get depreciated. An insurer is not permitted to require that your benefits also be "medically necessary" before the company will pay under California law. Federal law also prohibits the use of a medical necessity trigger in tax-qualified long-term care insurance policies.

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