What Are The Benefit Triggers?


The term usually used to describe the way insurance companies decide when to pay benefits is "Benefit Triggers". Criteria used to evaluate when you are eligible for benefits, and the conditions you must meet to receive benefits. This is an important part of a long term care insurance policy.

Types of Benefit Triggers

Activities of Daily Living (ADLs): The inability to do activities of daily living is the most common way insurance companies decide when you are eligible for benefits. They are:

  • Bathing
  • Continence
  • Dressing
  • Eating
  • Toileting
  • Transferring

Typically, a policy pays benefits when you can't do a certain number of the ADLs, such as two of six or three of six. The greater the number of ADLs required, the harder it will be to become eligible. Tax-Qualified policies are required to use the inability to perform two of the six ADLs as a benefit trigger.

Cognitive Impairment: Most long-term care policies also pay benefits for "cognitive impairment". Coverage of cognitive impairment is especially important if you develop Alzheimer's disease or other dementia. If your policy only uses ADLs as a trigger, it may not pay benefits if you have Alzheimer's disease because you may still be able perform your ADLs on your own.


Disclaimer: Insurance products are offered through insurance companies with which we have sales arrangements. Not all products/features may be available in your state. Check with your Accountant or Tax professional on the tax issues associated with Long-Term Care insurance purchase and benefits. Associates of Clifton Park are not a part of Raymond James & Associates. Securities offered through Raymond James & Associates, Inc. Member FINRA/SIPC

Raymond James financial advisors may only conduct business with residents of states and/or jurisdictions for which they are properly registered. Therefore, a response to a request for information may be delayed. Please note that not all of the investments and services mentioned are available in every state. Investors outside of the United States are subject to securities and tax regulations within their applicable jurisdictions that are addressed on this site. Contact your local Raymond James office for information and availability.