'Triggers' are essentially the conditions necessary for
benefits to be payable. To make LTC claims for specific diseases or disorders
there are often a list of many possible triggers, with a set number necessary
to make a claim based upon that condition.
For instance, if one seeks long term care in a facility
based upon a struggle with dementia, usually two of 5 or 6 triggers are
required for the insurance company to deem payment of the claim to cover the
facilities costs necessary. These triggers are very specific, such as whether
or not the person needs 24 hour care, and if not whether or not they can
properly bathe or dress alone, and triggers such as eating without assistance. Assistance could mean standby or substantial
assistance. Standby assistance is much
easier to meet.
The reason this question comes up so often is that these
triggers, and the failure to prove them to insurance companies, can often lead
to a lack of payment for coverage that has been purchased and is, in fact,
owed. The difference between understanding the triggers in insurance plans
purchased, or to be purchased, can be the difference between many thousands of
dollars in payable claims each month.
My advice: seek professional help both when purchasing your
LTC plans and when it comes time to make a claim.
