Ins 3.46(16)(c)1.1. To determine whether the applicant meets the standards developed by the insurer, the agent and insurer shall develop procedures that take the following into consideration: Ins 3.46(16)(c)1.a.a. The ability to pay for the proposed coverage and other pertinent financial information related to the purchase of the coverage. Ins 3.46(16)(c)1.b.b. The applicant’s goals or needs with respect to long-term care and the advantages and disadvantages of insurance to meet these goals or needs. Ins 3.46(16)(c)1.c.c. The values, benefits and costs of the applicant’s existing insurance, if any, when compared to the values, benefits and costs of the recommended purchase or replacement. Ins 3.46(16)(c)2.2. The insurer, and where an agent is involved, the agent shall make reasonable efforts to obtain the information set out in subd. 1. The efforts shall include presentation to the applicant, at or prior to application, the “Long-Term Care Insurance Personal Worksheet.” The personal worksheet used by the insurer shall contain, at a minimum, the information in the format contained in Appendix 2, in not less than 12 point type. The insurer may request the applicant to provide additional information to comply with its suitability standards. A copy of the insurer’s personal worksheet shall be filed with the commissioner. Ins 3.46(16)(c)3.3. A completed personal worksheet shall be returned to the insurer prior to the insurer’s consideration of the applicant for coverage, except the personal worksheet need not be returned for sales of employer group long-term care insurance to employees and their spouses. Ins 3.46(16)(c)4.4. The sale or dissemination outside the company or agency by the insurer or agent of information obtained through the personal worksheet in Appendix 2 is prohibited. Ins 3.46(16)(d)(d) The insurer shall use the suitability standards it has developed pursuant to this section in determining whether issuing long-term care insurance coverage to an applicant is appropriate. Ins 3.46(16)(e)(e) Agents shall use the suitability standards developed by the insurer in marketing long-term care insurance. Ins 3.46(16)(f)(f) At the same time as the personal worksheet is provided to the applicant, the disclosure form entitled “Things You Should Know Before You Buy Long-Term Care Insurance” shall be provided. The form shall be in the format contained in Appendix 3, in not less than 12 point type. Ins 3.46(16)(g)(g) If the insurer determines that the applicant does not meet its financial suitability standards, or if the applicant has declined to provide the information, the insurer may reject the application. In the alternative, the insurer shall send the applicant a letter similar to the sample letter in Appendix 4. However, if the applicant has declined to provide financial information, the insurer may use some other method to verify the applicant’s intent. Either the applicant’s returned letter or a record of the alternative method of verification shall be made part of the applicant’s file. Ins 3.46(16)(h)(h) The insurer shall maintain and have available for review by the commissioner the total number of applications received from residents of this state, the number of those who declined to provide information on the personal worksheet, the number of applicants who did not meet the suitability standards, and the number of those who, after receiving a suitability letter, indicated that the insurer should resume processing the application. Ins 3.46(17)(17) Standards for benefit triggers; long-term care, nursing home and home health care policies. Ins 3.46(17)(a)1.1. “Activities of daily living” includes at least bathing, continence, dressing, eating, toileting, and transferring. Ins 3.46(17)(a)2.2. “Bathing” means washing oneself by sponge bath; or in either a tub or shower, including the task of getting into or out of the tub or shower. Ins 3.46(17)(a)3.3. “Cognitive impairment” means a deficiency in a person’s short- or long-term memory, orientation as to person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness. Ins 3.46(17)(a)4.4. “Continence” means the ability to maintain control of bowel and bladder function; or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene, including caring for catheter or colostomy bag. Ins 3.46(17)(a)5.5. “Dressing” means putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs. Ins 3.46(17)(a)6.6. “Eating” means feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table) or by a feeding tube or intravenously. Ins 3.46(17)(a)7.7. “Hands-on assistance” means physical assistance, either minimal, moderate or maximal, without which the individual would not be able to perform the activity of daily living. Ins 3.46(17)(a)8.8. “Toileting” means getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene. Ins 3.46(17)(a)9.9. “Transferring” means moving into or out of a bed, chair or wheelchair. Ins 3.46(17)(b)(b) A long-term care, nursing home only and home health care only policy or certificate shall condition the payment of benefits on a determination of the insured’s ability to perform activities of daily living and on cognitive impairment. Eligibility for the payment of benefits may not be more restrictive than requiring either a deficiency in the ability to perform not more than 3 of the activities of daily living or the presence of cognitive impairment. Ins 3.46(17)(c)1.1. Activities of daily living shall include at least those contained in the definition in par. (a). Ins 3.46(17)(c)2.2. Insurers may use deficiencies to perform activities of daily living to determine when covered benefits are payable in addition to those contained in par. (a) as long as they are defined in the policy. Ins 3.46(17)(d)(d) An insurer may use additional provisions for the determination of when benefits are payable under a policy or certificate; however, the provisions may not restrict, and are not in lieu of, the requirements contained in pars. (b) and (c).