State RegulationsOH specificDifficulty 1/5
Under Ohio's long-term care rules, what measures are used to determine whether an insured qualifies for benefits, and where must they be described?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
OAC 3901-4-01(H)(7) requires that activities of daily living (ADLs) and cognitive impairment — the measures used to decide when long-term care benefits are payable — be described in a separate paragraph titled "Eligibility for the Payment of Benefits." This disclosure lets consumers see in advance exactly what triggers coverage under their Ohio LTC policy.
Why the other options are wrong
- B) Income and net worth are suitability-disclosure items, not benefit triggers, and they do not appear in an eligibility paragraph.
- C) Terminal-illness certification is not the measure of long-term care need under Ohio rules.
- D) Medicare benefit periods govern Medicare coverage, not private LTC benefit eligibility in Ohio.
Memory hook
ADLs + cognition = the LTC trigger duo, spelled out in the eligibility paragraph.