State RegulationsTX specific✓ Verified · outline & fact-checked · Sep 2026Difficulty 2/5
A Texas long-term care policy pays benefits only once the insured satisfies the policy's benefit trigger. What does that benefit trigger measure?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under the Texas long-term care rules at 28 TAC 3.3804 and 3.3818, benefit eligibility is tied to functional and cognitive status: the insured's inability to perform activities of daily living without substantial assistance, or severe cognitive impairment, rather than age, a particular diagnosis, or institutional confinement alone. The practical consequence is that an insured who needs substantial hands-on help with daily activities can be benefit eligible while still living at home.
Why the other options are wrong
- B) Attaining a stated age is not the benefit trigger; the trigger is functional or cognitive inability, not a birthday.
- C) The trigger is not limited to nursing facility confinement, and benefits may be payable for care delivered at home or in the community.
- D) Eligibility does not depend on a single listed diagnosis; it depends on functional limitation or cognitive impairment.
Memory hook
Long-term care pays for function, not for birthdays.