State RegulationsTX specific✓ Verified · outline & fact-checked · Sep 2026Difficulty 1/5
Under the Texas long-term care insurance rules adopted by TDI, eligibility for benefits under a long-term care policy must be based on:
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under the Texas long-term care rules at 28 TAC 3.3804 and 3.3818, benefit eligibility is tied to the insured's functional or cognitive status, meaning the inability to perform activities of daily living or a severe cognitive impairment. It cannot rest on age alone, on a hospital admission, or on an unstructured physician recommendation. This is why the policy's definitions and benefit triggers are the most important part of the contract for a consumer to understand before buying.
Why the other options are wrong
- A) A prior hospital stay is not a permissible gatekeeping condition, since many long-term care claimants are never hospitalized.
- B) A physician's recommendation must be supported by the objective functional or cognitive criteria the policy sets out.
- D) Age alone is not a lawful benefit trigger; the insured must meet the functional or cognitive criteria in the policy.
Memory hook
Long-term care pays on function and cognition, not on age or a hospital stay.