State RegulationsOH specificDifficulty 1/5
Under Ohio's long-term care rules, which measures are used to determine whether an insured qualifies for benefits and must be described in a separate 'Eligibility for the Payment of Benefits' paragraph?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
OAC 3901-4-01(H)(7) requires long-term care policies to use activities of daily living and cognitive impairment as the measures of the need for long-term care, and to describe them in a separate paragraph titled 'Eligibility for the Payment of Benefits.' These functional measures, rather than financial or demographic screens, control when benefits are payable under an Ohio long-term care policy.
Why the other options are wrong
- A) Hospital days and physician certifications are not the statutory benefit triggers for long-term care eligibility.
- C) Income and assets drive Medicaid eligibility, not eligibility for private long-term care policy benefits.
- D) Age and Medicare status determine Medicare enrollment, not long-term care benefit triggers.
Memory hook
LTC triggers: ADLs plus cognitive impairment.