<
 
 
 
 
?
>
hide
You are viewing a Web site, archived on 17:39:30 Oct 31, 2004. It is now a Federal record managed by the National Archives and Records Administration.
External links, forms, and search boxes may not function within this collection.
Click here to skip navigationNew User About the Agency | What's New | Quick Index | Operating Status
Link to the United States Office of Personnel Management Home Page
Strategic Management of Human Capital Employment and Benefits Career Opportunities

You are here: Home > insure> ltc> faq

Working for America


Federal Long Term Care Insurance Program Frequently Asked Questions
Other FAQ Topics  |   Search  |   FLTCIP Home
You are here: OPM Home > Insurance > FLTCIP > FAQ > Eligibility

Eligibility FAQ
Who Can Apply for This Insurance?



These FAQs talk about who is eligible to APPLY for this insurance, not who is eligible to be ENROLLED in this insurance. There is a difference.

Unlike some other insurance products, long term care insurance under the Federal Program is something you must apply for, and pass a medical screening (called underwriting), in order to be enrolled. Certain medical conditions, or combinations of conditions, will prevent some people from being approved for coverage. You may also want to read the FAQs on Applying for Coverage.

General

Employees

Uniformed Services

Annuitants and Compensationers

Qualified Relatives

Continuing the Insurance After Leaving an Eligible Group

General

Q. Who is eligible to apply for the insurance?
A. As specified in the law, individuals eligible to apply for this insurance coverage are:

  • Employees
    • Most Federal and U.S. Postal Service employees
    • Active members of the uniformed services
    • Employees of the Tennessee Valley Authority
    • D.C. Government employees who were first employed by the D.C. Government before October 1, 1987
    • Employees of the D.C. Courts
    • Navy Personnel Command (also known as BUPERS) employees

    For Federal and Postal employees, in general if you are in a position that conveys eligiblity for FEHB coverage, you are eligible for this program (whether enrolled in FEHB or not - the key is ELIGIBILITY).

  • Annuitants
    • Most Federal and U.S. Postal Service annuitants, including survivor annuitants and deferred annuitants
    • Retired members of the uniformed services
    • Compensationers (individuals receiving compensation from the Department of Labor who are separated from the Federal service)
    • Retired military reservists
    • Retired "grey" reservists, even if they are not receiving their retired pay yet
    • Former Federal and U.S. Postal Service employees who separated from service with title to a deferred annuity
    • Retired employees of the Tennessee Valley Authority
    • Retired D.C. Government employees who were first employed by the D.C. Government before October 1, 1987
    • Retired employees of the D.C. Courts
    • Retired employees of the Navy Personnel Command (also known as BUPERS)
    • Surviving spouses. To be considered eligible to apply for this insurance, surviving spouses must be receiving a Federal survivor annuity. They must be a surviving spouse of a deceased person in one of the following groups:
      • Federal and Postal employees or annuitants
      • D.C. Government employees or annuitants who were first employed by the D.C. Government before October 1, 1987, or
      • D.C. Courts employees or annuitants.

    Surviving spouses of deceased active or retired members of the uniformed services who are receiving a Federal survivor annuity and surviving spouses of deceased active or retired Navy Personnel Command (BUPERS) employees are also eligible. However, they are considered eligible as qualified relatives, rather than as annuitants.

  • Qualified Relatives -

    • Current Spouses of employees and annuitants (including surviving spouses of members and retired members of the uniformed services who are receiving a survivor annuity).
    • Adult children (at least 18 years old, including natural children, adopted children and stepchildren) of living employees and annuitants. Foster children are not eligible.
    • Parents, parents-in-law, and stepparents of living employees (but those of annuitants are not eligible).

    People who fall into one of those groups are eligible to apply for the insurance. Whether someone's application will be approved and he/she will be enrolled in the insurance will depend on the results of the medical underwriting. Not everyone who applies for this insurance will be approved for it.

Q. Is there an upper age limit for who can apply for this insurance?
A. No.

Q. Is there a minimum age for applying?
A. Yes. You must be at least 18 years old at the time you submit your application.

Q. Do I have to already have FEGLI, FEHB, Medicaid or other health or life insurance coverage to be eligible for the Federal Long Term Care Insurance Program?
A. No. The new Federal Long Term Care Insurance Program is totally separate and independent. You do not need to be enrolled in the Federal Employees' Group Life Insurance (FEGLI) Program, the Federal Employees Health Benefits (FEHB) Program, TRICARE or any other program to apply for this Program. However, someone currently receiving Medicaid assistance should probably not be purchasing long term care insurance.

Q. I live overseas. Am I eligible to apply for this insurance and can I use the benefits overseas?
A. As long as you are in one of the groups eligible to apply for this insurance, you can apply, even if you live overseas. Benefits are payable for covered services received outside the United States, its territories and possessions. However, the coverage does have some limitations that you may want to review before you decide whether to apply. Take a look at our International Coverage section.


Employees

Q. Can you give more specifics on who is included as an "employee"?
A. Here are the details (you can read the specifics in the law):

INCLUDED:

  • Full-time Federal employees
  • Part-time Federal employees
  • Active members of the uniformed services
  • Employees of the U.S. Postal Service
  • Employees of the Tennessee Valley Authority
  • Employees of the D.C. Courts
  • D.C. Government employees who were first employed by the D.C. Government before October 1, 1987
  • Members of Congress
  • Congressional employees
  • The President
  • Employees of Gallaudet College
  • An individual employed by a county committee established under section 590h(b) of title 16, United States Code;
  • An individual appointed to a position on the office staff of a former President or Vice President (see section 8901, U.S.C., for details related to this category)
  • Employees serving under interim appointments under the Whistleblower Act
  • Employees of the Navy Personnel Command (also known as BUPERS)
NOT INCLUDED:
  • Employees of the District of Columbia Government who do not fit into one of the categories listed above
  • An employee of a corporation supervised by the Farm Credit Administration if private interests elect or appoint a member of the board of directors;
  • An individual who is not a citizen or national of the United States and whose permanent duty station is outside the United States, unless the individual was an employee for the purpose of this chapter on September 30, 1979, by reason of service in an Executive agency, the United States Postal Service, or the Smithsonian Institution in the area which was then known as the Canal Zone;
  • An employee who is serving under an appointment limited to 1 year or less AND who has not completed 1 year of current continuous employment, excluding any break in service of 5 days or less.
    • BUT the following employees ARE covered, even if they are serving on a temporary appointment: An acting postmaster, a Presidential appointee appointed to fill an unexpired term, and an appointee that meets other special conditions (see 890.102 in the regs)
  • An employee who is expected to work less than 6 months in each year
    • BUT the following employees ARE covered, even if they are expected to work less than 6 months in each year: employees who are employed under an OPM approved career-related work-study program under Schedule B of at least 1 year's duration and who are expected to be in a pay status for at least one-third of the total period of time from the date of the first appointment to the completion of the work-study program
  • An intermittent employee (a non-full-time employee without a prearranged regular tour of duty)
  • A beneficiary or patient employee in a Government hospital or home
  • An employee paid on a contract or fee basis
    • BUT, the following employees ARE covered, even if paid on a contract or fee basis: employees who are citizens of the United States and are appointed by a contract between the employee and the Federal employing authority which requires their personal service and is paid on the basis of units of time.
  • An employee paid on a piecework basis, except one whose schedule provides for full-time service or part-time service with a regular tour of duty.

Q. Can Non-appropriated Fund (NAF) employees apply for the insurance?
A. Public Law No. 107-314 provides that NAF entities MAY be covered under the Federal Long Term Care Insurance Program. However, this is NOT automatic. The Secretary of Defense has the authority to determine that employees of a nonappropriated fund instrumentality of the Department of Defense are eligible to apply for the Federal Long Term Care Insurance Program OR may determine that they are covered under an alternative long term care insurance program. As of December 29, 2003, Navy Personnel Command (BUPERS) employees and retirees, and their qualified relatives, became eligible to apply for insurance under this authority.

Q. What if I have questions about my eligibility to apply for this Program?
A. You should talk to someone in your human resources office at your agency. If you are a Federal or Postal employee and are in a position that conveys eligibility for the Federal Employees Health Benefits Program, in general you are eligible for this Program. Your H.R. office should be able to tell you (or you probably already know) if you are eligible for the FEHB Program. This doesn't mean that you need to be enrolled in FEHB, just that your current position conveys eligibility for FEHB coverage.

Some employees are no longer Federal employees, but are now working for a private entity, and yet they still have eligibility for FEHB. Those employees are NOT eligible to apply for the Federal Long Term Care Insurance Program (FLTCIP). In order to be eligible to apply for the FLTCIP as an employee, you must be a current Federal or Postal employee. Employees who used to be Federal employees but are now private sector employees with a grandfathered right to certain Title 5 Federal benefits are NOT eligible to apply for the FLTCIP.

Q. Can DC Government employees apply for the insurance?
A. Some are eligible to apply and others are not. D.C. Government employees who were first employed by the D.C. Government before October 1, 1987, and employees of the D.C. Courts are eligible to apply for this insurance. Other DC Government employees are not eligible.

Q. What about DC Government employees who retire (or are already retired) and are eligible for the Federal health benefits and/or the Federal life insurance program?
A. Retired D.C. Government employees who were first employed by the D.C. Government before October 1, 1987, and retired employees of the D.C. Courts are eligible to apply for the insurance. Other DC Government retirees are not eligible.

Q. Are employees of the D.C. Government who were hired on or after October 1, 1987, eligible to apply for the insurance?
A. No, unless they are employees of the D.C. Courts.

Q. I am a Secret Service Agent covered under the D.C. (Government) Police and Firefighters Retirement System. Am I eligible to apply?
A. YES, if you are in a position that conveys eligibility for the Federal Employees Health Benefits (FEHB) Program. Some Secret Service Agents and U.S. Park Police are covered under the D.C. (Government) Police and Firefighters Retirement System. This does NOT mean they are D.C. Government employees or D.C. Government retirees. They are Federal employees or Federal annuitants. Therefore, assuming they meet the other eligibility requirements, they are part of the Federal Family eligible to apply for insurance coverage under the Federal Long Term Care Insurance Program. However, they cannot pay premiums through deduction from their annuity that comes from the D.C. Government.

Uniformed Services

Q. Who is eligible to apply for the insurance in the Uniformed Services?
A.

  • Members on active duty or full-time National Guard duty for more than 30 days
  • Members of the Selected Reserve
  • Members on retirement or retainer pay
  • Retired members of the Selected Reserve, including grey reservists
Q. Those in the "Selected Reserve" are eligible to apply for this insurance. Who does that include?
A. The Selected Reserve consists of those uniformed services members who are required to routinely train and are the first category liable for mobilization under the statutes governing mobilization. The Selected Reserve consists of Drilling Reservists and Guard members assigned to Reserve Component Units; all Individual Mobilization Augmentees who are Reservists assigned to Reserve Component billets in Active Component units (they may perform duty in a pay or non-pay status); and Active Guard and Reserve members who are full-time Reserve members on full-time National Guard duty or active duty in support of the National Guard or Reserves.

Reservists who are assigned to a Voluntary Training Unit in the Naval Reserve and Category E in the Air Force Reserve (although they may perform inactive duty training (drills) in a non-pay status) are not members of the Selected Reserve and therefore are not eligible. They are members of the Individual Ready Reserve.

Q. I was in the military years ago, but I didn't retire. I am not receiving any retirement or retainer pay. I simply completed my tour of duty and returned to civilian life. Am I eligible to apply for this insurance?
A. No you are not, based on what you've said. But of course if you are currently on active duty or full-time National Guard duty and have been for more than 30 days, or you're in the Selected Reserve (members in the Individual Ready Reserve are not eligible), then you would be eligible to apply.

Q. Are grey reservists eligible to apply for this insurance?
A. Yes, they are eligible to apply for this insurance at any time. They do NOT need to wait until they are actually in receipt of their annuity.

Q. Are surviving spouses who receive Dependency Indemnity Compensation (DIC) payments from the Department of Veterans Affairs eligible to apply for this insurance?
A. Yes. A DIC payment is a survivor annuity.

Q. I'm receiving a "variable separation incentive" from the uniformed services. I was an officer and my position was eliminated. I was offered and accepted a variable separation incentive equal to two times my service time. Am I eligible to apply for this Program?
A. No, you are not. A variable separation incentive payment does not qualify as retired or retainer pay for purposes of the Long-Term Care Security Act. You do not have retirement status that would qualify you to apply for this Program.

Q. I'm a former member of the uniformed services receiving a medical annuity. Am I eligible to apply for insurance under this Program?
A. Yes, if that medical annuity is retired pay or retainer pay. If it is a benefit provided under statutes administered by the Department of Veterans Affairs (VA), you are not eligible. However, there is one exception -- if indeed you are qualified for retired pay from the uniformed services and voluntarily chose to receive a VA benefit instead, you are still eligible to apply.

Q. I'm receiving payments under the SBP (Survivor Benefit Plan). Does that qualify as a survivor annuity?
A. Yes it does. You are eligible to apply for insurance coverage in this Program, using the full underwriting application.

Q. I'm on leave without pay from my Federal/Postal position, because Iím on active duty with the reserves. How can I meet the actively at work requirement if I'm on leave without pay?
A. You simply need to meet the actively at work requirement for members of the uniformed services. For members of the uniformed services, actively at work means that you are on active duty and are physically able to perform the duties of your position.


Annuitants and Compensationers

Q. I'm retired from the military but am also a retired Federal employee, receiving a Federal annuity. Does it matter whether I apply as one or the other?
A. No it doesn't matter, because all annuitants (whether uniformed services, Federal or Postal) will need to answer the same questions about their health.

Q. I'm retired from the Federal Government, but am also a Federal employee. Are my parents eligible to apply?
A. Yes, they are since you are an active employee.

Q. Are Federal deferred annuitants eligible to apply for the insurance?
A. Yes, they are. Federal/Postal employees who separate from service with title to a deferred annuity can apply for this insurance at any time. They do NOT need to wait until they are actually receiving their deferred annuity.

Q. Are disability annuitants eligible to apply for the insurance?
A. Yes, but like all annuitants, they must undergo full underwriting.

Q. Are compensationers eligible to apply for the insurance?
A. Yes, compensationers (Federal employees or former employees who are receiving monthly compensation from the U.S. Department of Labor and whom the Secretary of Labor determines are unable to return to duty) are eligible to apply for the insurance.

Q. I separated on an MRA+10. Am I eligible to apply?
A. Yes you are. Employees who separate from service with title to an annuity under the Federal Employees Retirement System's Minimum Retirement Age plus 10 years service provision (FERS MRA+10) are eligible to apply for this Program. This is true even if they decide to postpone receipt of their annuity.

Q. What D.C. Government retirees are eligible to apply for this insurance?
A. D.C. Government employees who retire and who were first employed by the D.C. Government before October 1, 1987, and employees of the District of Columbia Courts who retire are eligible to apply for this insurance.

Qualified Relatives

Q.Who is a "qualified relative"?
A. There are three categories of qualified relatives under the law:

  • Current spouses of living employees and annuitants (surviving spouses of deceased members and retired members of the uniformed services who are receiving a survivor annuity are eligible as "spouses")
  • Adult children (at least 18 years old, including natural children, adopted children and stepchildren) of living employees and annuitants
  • Parents, parents-in-law, and stepparents of living employees (but not of annuitants)

See the FAQ on eligible employees and annuitants for more details on who is included as an employee or annuitant.

Q. Can my 10 year old son who is disabled sign up for this program?
A. No. Only adult children (age 18 and over) are eligible to apply for coverage. And they must pass full underwriting.

Q. Can I sign up my eligible family members?
A. No. If you are eligible to apply for the insurance (whether or not you actually apply), your qualified relatives can apply. But you cannot "sign them up". There is no self and family coverage.

Q. Do I have to apply in order for my spouse to be eligible?
A. No. Each eligible person in the "Federal Family" has an independent right to apply for the insurance. The person they are related to need not apply.

Q. Can I enroll in self and family to cover all my qualified relatives?
A. No. There is no self and family coverage in this program. Each eligible person applies in his/her own right.

Q. Can survivors of Federal employees who are receiving a survivor annuity and survivors of Federal annuitants who are receiving a survivor annuity apply for the insurance?
A. Yes, they can.

Q. I'm a widow(er) of a Federal annuitant who never elected a survivor annuity. Am I eligible to apply for this insurance?
A. Unfortunately, you are not eligible to apply. In order for a surviving spouse of a Federal employee or a surviving spouse of a Federal annuitant to be eligible to apply for this insurance, he/she must be receiving a Federal survivor annuity. We are updating our CSRS and FERS retirement applications to make it clear that this is another item to consider when deciding whether to elect a Federal survivor annuity.

Of course, if you had enrolled while your spouse was alive, you would keep the coverage as long as you continued to pay premiums - even if your Federal annuitant spouse later died without electing a survivor annuity.

Q. Are surviving spouses of deceased members or retired members of the uniformed services eligible to apply for this insurance?
A. Yes, they are eligible if they are receiving a survivor annuity.

Q. I'm a surviving spouse of a deceased member or retired member of the uniformed services and I'm NOT receiving a survivor annuity. Am I eligible?
A. No, you are not eligible because you are not receiving a survivor annuity.

Q. I'm a surviving spouse of a deceased member or retired member of the uniformed services, am NOT receiving a survivor annuity, but I AM eligible for military health benefits. Am I eligible?
A. No, you are not eligible because you are not receiving a survivor annuity.

Q. I'm a former spouse of a person who is eligible to apply for this insurance. Am I eligible too? Would I be eligible if I were receiving a survivor annuity?
A. No. Former spouses who are not eligible in their own right (for example, as an employee or retiree) are not eligible to apply for this insurance, even if they are receiving a survivor annuity.

Q. I'm a former spouse with a Qualified Domestic Relations Order (QUADRO) which entitles me to half of my ex-spouse's benefits. So wouldn't I be eligible for this Program too?
A. No. Former spouses who are not eligible in their own right (for example, as an employee or retiree) are not eligible to apply for this insurance, even if they have a QUADRO.

Q. How does the Program define stepparent?
A. A stepparent is the person who is currently married to the employee/memberís parent, or if the parent is dead, the person who was married to the employee/memberís parent at the time of his/her parentís death.

Q. My mom was married to my stepfather for 25 years. My stepfather raised me and is the only father I've ever known. However, he divorced Mom last year. Is he eligible to apply for this insurance?
A. No, he is not.

Q. My stepmother was married to my natural father for years. Dad died last year. Is my stepmother eligible to apply for this insurance?
A. Yes, she is. She is your current stepparent, regardless of whether your natural parent is still alive.

Q. I'm an eligible employee. Does "parent-in-law" include my spouse's parents, even though my spouse is no longer alive?
A. Yes, as long as you have not remarried. Parents-in-law include the parents of a deceased spouse, as long as the employee or member of the uniformed services has not remarried.

Q. Is OPM considering adding any additional qualified relative groups other than those mentioned in the law (for example, grandparents, brothers and sisters, foster children, etc)?
A. Not at this time. The law makes a limited set of qualified relatives eligible to apply for the long term care insurance (spouses and adult children of both employee and retiree groups, and parents/parents-in-law/stepparents of the employee groups). While the law provides us with a limited amount of discretionary authority to designate other groups as qualified relatives, we decided not to add any additional groups beyond those specified by Congress. Given the size of the program and the education and communication challenges, we did not want to increase the risk of a successful program launch by making coverage provisions more complex.

We are certain we will identify areas that could be improved for the future. We will carefully review all areas that come to our attention with an eye toward making the program even more successful.

Q. Can common law spouses of eligible individuals apply for the insurance?
A. Yes, a common law spouse is eligible to apply, if the common law marriage is recognized by the state in which the couple lives or previously lived.

So this means that IF you:

  • currently live or lived at some point in a state that recognizes common law marriages, AND
  • met that state's requirements for a common law marriage at that time
THEN you are eligible to apply for insurance coverage under the Federal Long Term Care Insurance Program. If you have any questions about the validity of your marriage, please consult someone who specializes in marital law.

Continuing the Insurance After Leaving an Eligible Group

Q. If I've already enrolled and my insurance coverage is effective, what happens to it if I leave my eligible group (e.g., I move from the Selected Reserve to the Individual Ready Reserve, or I resign from the Federal Government, or I divorce my Federal spouse)?
A. Your insurance coverage continues. It is fully portable. As long as you continue paying premiums, your insurance coverage will continue. If you were paying premiums by payroll deduction and you leave the Government, you'll have to make arrangements with LTC Partners to start paying premiums directly or by automatic debit from your bank account. But you get to keep the insurance at the same premiums as if you never left the eligible group.

Q. My qualified relatives are eligible to apply for this insurance. But what happens to their eligibility if I am no longer in an eligible group?
A. They are qualified relatives as long as you are in one of the groups eligible to apply for this insurance. And if they enroll while you are eligible (whether you enroll or not), they will keep the coverage even if you leave an eligible group. However, once you leave an eligible group, they can no longer apply for the insurance.

For example, when you are a Federal employee, your mother is eligible to apply for this program. If she applies, and gets coverage, she'll keep the insurance even if you quit working for the Federal government. BUT, if she does not apply while you are a Federal employee, she is NOT eligible to apply after you quit working for the Federal government. Remember that parents of retirees are not qualified relatives.

Q. Let's say I apply for this insurance as a member of one of the eligible groups, and I get the insurance coverage. I understand my coverage will continue (is portable) after I leave the eligible group. But does this portability extend to my qualified relatives' eligibility too? As long as I have the coverage and leave an eligible group, do I also retain THEIR eligibility to apply?
A. No. Please see the answer to the previous question. If you are no longer in any of the eligible groups, your qualified relatives are no longer eligible to apply for this insurance. But if they had the insurance before you left the eligible group, they get to keep it as long as they continue paying premiums.

Q. What happens if I apply while I am in an eligible group, but then I leave the eligible group before my insurance is effective? Will my insurance still become effective?
A. It depends. You must be in an eligible group on the date you apply for the insurance and on the date the insurance is supposed to become effective. Generally, if you leave the eligible group during this time period, your insurance will not become effective. But there are some exceptions. If you apply as an employee and are involuntarily separated before your coverage is effective, it will still become effective as if you hadn't separated.

If you apply as an employee using the full underwriting application but are retired before your coverage becomes effective, it will still become effective on the scheduled effective date, as long as you meet the other requirements (such as needing to let LTC Partners know if you've had a significant change in health since you completed your application).

If you apply as an employee using the abbreviated underwriting application but are retired before your coverage becomes effective, it will not become effective. You will have to reapply using the full underwriting application.

Q. Is there a "five-year rule" for continuing coverage into retirement like there is with the Federal Employees Health Benefits Program?
A. No. Coverage is fully portable. If, for instance, you retire, you keep your coverage as long as you pay your premiums. You do not have to be enrolled for any minimum length of time before retiring. Even one day is ok!


Other FAQ Topics:   Active Duty Service   |    Application Questions on Health   |    Applying for Coverage   |    Basics   |    Benefits   |    Consumer Protections   |    The Contract   |    Cost   |    FSA Program   |    Miscellaneous   |    Tax Benefits   |    Transferring with Credit

SEARCH   |   Site Index   |   Publications   |   Home   |   Contact Us   |   Privacy Policy   |   Accessibility Statement

Page updated November 25, 2003