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). A trigger at 1 of the 6 ADLs or any physician's written referral would be too easy a trigger. The 3-of-6 trigger with annual recertification is incorrect — the federal standard is 2 of 6. Requiring all 6 of the 6 ADLs with no cognitive-impairment alternative 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.