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Benefit Triggers

Quick Answer

A benefit trigger is a requirement that must be met before accessing Long-Term Care Insurance benefits. Once someone meets the benefit trigger requirements, they can file a claim and receive their benefits.

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Detailed Answer

Benefit triggers allow policyholders to access their Long-Term Care Insurance benefits. Every tax-qualified Long-Term Care Insurance policy has federally regulated benefit triggers requirements. These requirements are the same regardless of policy or company. 

Most policies have two benefit triggers. You can access benefits when you meet at least one of these requirements:

  1. Your health care professional determines you need hands-on or stand-by help with two or more activities of daily living.
  2. Your health care professional confirms the need for supervision due to cognitive decline or impairment.

Once you have met one of these requirements, you can file a claim. After you file a claim and the claim is approved, you may need to start an elimination period. Your policy will provide benefits for your long-term care needs once the elimination period ends.

Some Long-Term Care Insurance policies do not meet federal regulations. Unregulated policies may have different rules for benefit triggers. These policies may make it difficult to access benefits. Some of these policies require individuals to have a terminal condition before accessing their benefits. Most people who need long-term health care are not terminally ill.

Every qualified policy will list its benefit triggers in the policy booklet. You can either talk to a professional or read your policy booklet to determine your policy's benefit triggers.

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