E. Triggers for Benefits

Long-term care policies which intend to be federally tax-qualified (benefits received not subject to income tax), and to provide benefits for care received in a person's home or other community-based setting, will qualify an insured for benefits if the insured is determined to be a chronically ill individual who is impaired in at least 2 of the activities of daily living (ADLs) or if the person has a severe cognitive impairment. To be considered a chronically ill individual or to have a severe cognitive impairment, a person's condition must be assessed by a health care practitioner who is not an employee of the insurer.

The 6 defined activities of daily living (ADLs) are the following:

1. Eating — taking in food and feeding oneself;
2. Bathing — bathing without assistance;
3. Continence — bowel and bladder control;
4. Dressing — clothing oneself;
5. Toileting — personal cleansing and grooming; and
6. Transferring — mobility, being able to move from one place to another in the home.

A cognitive impairment is an organic process (or the result of an accident) which results in a person's inability to understand or appreciate the nature of their surroundings and the danger the person presents to himself/herself or others. Impaired means that the individual requires either substantial supervision (stand-by assistance) or actual hands-on assistance with ADLs.