State RegulationsOH specificDifficulty 2/5
An insurer in Dayton is underwriting an application for long-term care insurance. Under Ohio's framework, which factor is most central to evaluating the applicant's likely need for LTC benefits?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Ohio builds LTC benefit eligibility around activities of daily living (ADLs) and cognitive impairment — OAC 3901-4-01(H)(7) identifies these as the measures of the need for long-term care. It follows that functional and cognitive status are the underwriting factors most directly predictive of future benefit use, and Ohio producers and insurers evaluate them when assessing LTC applications.
Why the other options are wrong
- A) Medicare Part B enrollment relates to Medicare eligibility, not private LTC underwriting risk.
- B) An employer's plan premiums have no bearing on the applicant's functional care needs.
- C) A driving record is irrelevant to long-term care benefit triggers under Ohio rules.
Memory hook
Underwrite what triggers: ADLs and cognition tell the LTC story.