Question

Which of the following most accurately describes the criteria required for an insured to qualify for long-term care benefits for a qualified plan under the health insurance portability and accountability act?

A) the insured is unable to perform two of the six ADLs for 90 days
B) the insured has substantial cognitive impairment requiring substantial assistance
C) the insured must meet both a and b
D) the insured may qualify by meeting either a or b

Answer 1

The insured qualifies for long-term care benefits under HIPAA if they cannot perform two of the six ADLs for 90 days or if they have substantial cognitive impairment requiring assistance. Criteria A or B, when met individually, are sufficient for qualification.

Step-by-step explanation:

The question pertains to long-term care benefits under a qualified plan according to the Health Insurance Portability and Accountability Act (HIPAA). To qualify for these benefits, an insured must meet specific criteria. If the insured is unable to perform at least two out of the six Activities of Daily Living (ADLs) for at least 90 days, they would meet one such criterion. ADLs typically include basic self-care tasks such as bathing, dressing, eating, transferring/mobility, toileting, and continence. Alternatively, if the insured has a substantial cognitive impairment, such as severe dementia or Alzheimer's disease, that requires substantial supervision or assistance to protect themselves from threats to health and safety, they could also qualify for long-term care benefits.

Therefore, the answer to the student's question is D) the insured may qualify by meeting either A or B. This means the insured doesn't need to fulfill both the inability to perform ADLs and have substantial cognitive impairment; meeting one of these criteria is sufficient to qualify.