State RegulationsMI specificDifficulty 2/5
Under Michigan long-term care insurance, when does an insured become eligible to receive policy benefits?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Michigan's long-term care framework, M.C.L. 500.3901-.3955 as administered with DIFS shopper's-guide disclosures, keys benefit eligibility to the policy's defined benefit triggers: the insured must need the covered level of care, such as substantial assistance with activities of daily living, as those terms are defined in the policy. Hospitalization, a permanence certification, or a Social Security disability finding does not by itself trigger LTC benefits.
Why the other options are wrong
- A) A hospital admission is not an LTC benefit trigger; eligibility turns on the need for covered care.
- B) A physician's permanence certification is not the trigger the policy defines for paying benefits.
- D) Social Security disability determinations govern federal benefits, not eligibility under a Michigan LTC policy.
Memory hook
LTC pays on care needs: the policy's triggers, not a hospital stay or a disability ruling.