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If you have a long-term care insurance policy or are thinking about it for the future, it is important to know under what circumstances the policy will pay benefits. Although each policy is unique in its features and coverage amounts, many insurance companies establish benefit triggers based on the insured’s ability to conduct activities of daily living (ADL). For instance, your policy might stipulate that a claim for benefits will be honored only if you are unable to perform two of the six commonly recognized activities of daily living for yourself.

 

Without some standardization of the definition of activities of daily living, insurance companies might be able to deny claims. Thankfully, the National Association of Insurance Commissioners (NAIC) has established clear definitions that most insurers abide by. Below are the six activities of daily living as defined by the NAIC in their booklet “A Shopper’s Guide to Long-term Care Insurance.”

 

Six activities of daily living commonly recognized by long-term care policies

 

  1. Bathing : Washing oneself by sponge bath, in either a tub or shower. This activity includes the task of getting into or out of the tub or shower.
  2. Continence: The ability to maintain control of bowel and bladder function; or when unable to maintain control of these functions, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag).
  3. Dressing: Putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs.
  4. Eating: Feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table).
  5. Toileting: Getting to and from the toilet, getting on and off the toilet and doing related personal hygiene.
  6. Transferring: Moving into and out of a bed, chair or wheelchair.

 

You hope you never need to use a long-term care policy, but if you do, it helps to know about benefit triggers in case you ever have to file a claim. Many insurance companies adhere to the definitions of activities of daily living spelled out by the NAIC. It’s important to understand how many of the ADLs you must be unable to perform before your policy will pay benefits. If you are unsure about the policy you own or are considering, ask the insurance company for clear definitions of what self-care limitations qualify for claims under policy terms.

 

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