State RegulationsMA specificDifficulty 3/5
A Massachusetts long-term care insurer proposes to exclude coverage for care related to Alzheimer's disease and other forms of dementia from all of its long-term care policies. Under Massachusetts' long-term care rules, what is the problem with this proposal?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Severe cognitive impairment is one of the fundamental benefit triggers of long-term care insurance under 211 CMR 65.05(1), the Massachusetts Division of Insurance's trigger standard within 211 CMR 65.00. A product that excludes dementia-related care has stripped away the very scenario — extended custodial care for a cognitively impaired insured — that long-term care coverage exists to finance. The permissible exclusions under 211 CMR 65.05(3) are narrow conduct-based limits and cannot be stretched to swallow the product's central benefit.
Why the other options are wrong
- A) Dementia-related care sits at the heart of the severe cognitive impairment trigger under 211 CMR 65.05(1); it is not a free-standing excludable category.
- B) There is no premium-discount mechanism that licenses an exclusion of core cognitive-impairment coverage.
- D) Age-based carve-outs are not a recognized exclusion device under the Massachusetts long-term care rules.
Memory hook
Cognitive impairment is a trigger, not a taboo — LTC exists to cover it.