Activities of daily living and cognitive impairment shall be used to measure an insured’s need for long-term care and shall be described in the policy or certificate in a separate section that shall be labeled “Eligibility for the Payment of Benefits.” Additional benefit triggers, if any, shall also be explained in this section. If the triggers differ for different benefits, explanation of the trigger shall accompany each benefit description. If an attending physician or other specified person is required to certify a certain level of functional dependency in order to be eligible for benefits, this requirement shall be specified.

SOURCE: Final Rulemaking published at 52 DCR 10902 (December 16, 2005); as amended by Final Rulemaking published at 55 DCR 3759 (April 11, 2008).