Under Virginia's long-term care regulation, what kinds of conditions may a long-term care policy use to trigger payment of benefits?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Virginia's long-term care benefit-trigger standards under 14 VAC 5-200-187 center eligibility for benefits on chronic need: functional incapacity measured by the inability to perform activities of daily living without substantial assistance, or severe cognitive impairment requiring substantial supervision. These triggers define when the insured's need for long-term care services — institutional, home health, or community-based — becomes payable. Acute or temporary illness, hospitalization history, or insurer-drafted diagnosis schedules are not the regulatory basis for triggering LTC benefits.
Why the other options are wrong
- B) Short-term, temporary illness is not an LTC trigger; the product responds to chronic, ongoing care needs.
- C) An insurer-defined diagnosis schedule cannot substitute for the regulatory trigger standards.
- D) Hospitalization history, acute or chronic, is not itself the measure of benefit eligibility.
Memory hook
LTC pays for chronic need: can't do the daily activities, or the mind needs watching.