Under a California tax-qualified long-term care insurance policy, benefits are triggered when the insured cannot perform without substantial assistance how many of the six Activities of Daily Living (ADLs)?
Explanation
Under HIPAA's federal definition adopted by California (Insurance Code §10232.92), a tax-qualified LTC policy is triggered when a licensed health care practitioner certifies that the insured is 'chronically ill' — meaning unable to perform without substantial assistance at least 2 of 6 ADLs (eating, bathing, dressing, toileting, transferring, continence) for at least 90 days, OR has a severe cognitive impairment requiring substantial supervision (e.g., Alzheimer's disease). Option A would be too easy a trigger. Option B (3 of 6) is incorrect — the federal standard is 2 of 6. Option D would make the benefit nearly impossible to reach. The cognitive-impairment alternative is critical: an Alzheimer's patient may be physically capable of all 6 ADLs but still need LTC.
Law Reference: Cal. Ins. Code §10232.92 (LTC benefit triggers)Practice all 315 questions free — no signup required.
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