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Applying for Coverage Under the Program FAQ
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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 will prevent some people from being approved for coverage. You may also want to read the FAQs on Eligibility.
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General
Underwriting
Who Can Use Abbreviated Underwriting?
Actively at Work Requirement
Coverage Exclusions
Alternative Insurance Plan and Service Package
Increasing and Decreasing Coverage
Miscellaneous
General
Q. I didn't apply during Open Season. Can I still apply now? How do I get an application?
A.
YES, you can apply now if you are in one of the groups
eligible to apply for coverage! Go to
www.ltcfeds.com to view or order an Information Kit with application, or call 1-800-LTC-FEDS (1-800-582-3337) (TTY: 1-800-843-3557).
Q. What are the advantages of the Federal Program? Why should I consider applying?
A. There are numerous advantages, such as:
- OPM Oversight -- The Office of Personnel Management (OPM) stands behind the Federal Program and is on the enrollees' side. We are making sure the Program stays contemporary and covers new modes of care as they arise (such as robotic care). We're only a phone call or email away.
- Payment of Benefits -- The Federal Program bases its benefit reimbursement on the actual cost of an enrollee's care, instead of reimbursing at "usual, customary and reasonable" rates as some other insurance policies do. Make sure you're comparing identical benefits.
- No Mental/Nervous Exclusion -- Some other programs deny benefits to enrollees who trigger benefits due to a mental or nervous condition (although all will pay benefits if you trigger due to Alzheimer's). The Federal Program does not have a mental/nervous condition exclusion from benefits.
- No War Exclusion -- Many/most other programs have a war exclusion, denying benefits if you trigger them due to war or an act of war. The Federal Program does not. We have a catastrophic coverage limitation, which is much narrower. If a catastrophe caused such a large number of Program enrollees to be eligible for benefits that payment of their benefits would seriously affect the financial stability of the Program, we would reduce the benefit period for those affected enrollees. The chances of such a thing happening are very remote, and decrease with time.
- International Coverage -- We have very generous International coverage (payment for care received outside the U.S., its territories and possessions).
- Premiums vs. Underwriting -- Some other programs may have lower premiums. But they may also have much stricter underwriting. There is obviously a direct correlation - the more people excluded from coverage, the lower premiums can be. Make sure you know for certain whether you can even qualify for coverage elsewhere before comparing premiums.
- Rate Stability -- Our plan is one of the first to use the National Association of Insurance Commissioners' rating guidelines, which are designed to produce stable premiums. Many lower-priced plans have not set premiums according to these guidelines, and may therefore be more likely to experience a premium increase in the future.
- Care Coordination -- Care coordination is included in the Federal Program, and available to enrollees' uninsured qualified relatives too. And the use of the care coordination doesn't count against your maximum lifetime benefit (pool of money). Other programs may limit access to care coordination, or charge you for it by reducing your benefits.
- Informal Care -- The Federal Program has a very generous informal care benefit - you can receive care from friends, neighbors, other non-licensed caregivers including family members who don't normally live with you. Other programs may require you to receive home care from only licensed providers.
- Disputed Claims -- The Federal Program provides enrollees with a right to a review disputed claims where benefits have been denied or eligibility for benefits has been denied. An independent third party whose decision is binding on Long Term Care Partners performs the review. What other plans have that benefit?
- Negotiated Profit -- Under the Federal Program, the insurance carriers' annual profit is negotiated with OPM, and part of it depends solely on performance. That gives OPM the leverage to demand high quality customer service and administration of claims.
BOTTOM LINE - you can't just compare apples to apples - you need to get below the surface and compare details. Don't be fooled by other plans claiming to be the Federal program.
Q.
I've applied already. When will I hear a decision about my application?
A. If you applied using the abbreviated underwriting application, you should receive a decision on your application within a few weeks. If you applied using the full underwriting application, it will take longer, perhaps a month or more, depending on whether it was necessary to request copies of your medical records and whether it was necessary to schedule an interview with a nurse.
Q. How can I check on the status of my application?
A. Call Long Term Care Partners at 1-800-LTC FEDS (1-800-582-3337) (TTY 1-800-843-3557) and press option #3 to speak to a Customer Service Representative.
Q. If I apply and I'm approved for coverage, when will my coverage be effective?
A. The scheduled effective date will be the first day of the first month after your application is approved. You'll receive a letter from Long Term Care Partners containing your scheduled effective date and what might change that date.
Q. Who makes insurability decisions?
A. LTC Partners makes all insurability decisions, and those decisions cannot be appealed to OPM. However, an applicant may ask LTC Partners to reconsider its insurability decision. If you apply and are denied coverage, you can find out how to request a reconsideration by reading the information in the letter you received from LTC Partners that explains why your application was not approved.
Q. Where should I mail my application?
A. Please mail your application to Long Term Care Partners, P.O. Box 9170, Boston, MA 02117-9995, EVEN IF there is a different address listed on your application.
Q. Can I send two applications in the same envelope?
A. Yes.
Q. Do I need to send two voided checks to Long Term Care Partners if my spouse and I are applying at the same time and we both select automatic bank withdrawal?
A. Yes. Each application is reviewed separately and even if you mail the two applications in the same envelope (which is okay), they will not remain together for processing. Therefore, you must each submit the required documentation (a blank voided check or a deposit slip) for automatic bank withdrawal. And, if the account is a joint account, please be sure that you both sign each other's application.
Q. When is the next open season?
A. This program does not have annual open seasons. We do not know how frequently we will have them and when the next one will be. So you really can't count on a future open season at any time soon. AND — there is no guarantee that any future open season will offer abbreviated underwriting. BUT — you do NOT need to wait for an open season! If youre in an
eligible group, you can apply at any time, using the full underwriting application. Please visit
www.ltcfeds.com for an application.
Underwriting
A. Yes. There are two levels of underwriting - full underwriting and abbreviated underwriting.
Q. What is Underwriting?
A.
Underwriting is the process of reviewing medical and
health-related information furnished in an insurance application process to determine if the applicant presents an acceptable level of risk and is insurable.
Q. What is Full Underwriting?
A.
Everyone eligible for the Program who does not qualify for abbreviated underwriting is subject to full underwriting. This means that they will have to answer numerous
health-related questions. It may also include a review of medical records and possibly an interview with a nurse. This is the same level of underwriting that those who purchase individual policies in the private market undergo.
Q. What is Abbreviated Underwriting?
A.
Abbreviated underwriting has fewer health-related questions than full underwriting. The application has several health-related questions designed to determine who may be immediately eligible for benefits, or eligible for benefits within a short period of time.
Employees who are eligible for abbreviated underwriting and apply for the 3 year or 5 year benefit period answer seven questions about their health. Spouses of employees who are eligible for abbreviated underwriting answer nine questions, and may need to authorize access to their medical records. They may also have an interview with a nurse.
Q. Who can apply using the abbreviated underwriting application?
A. The following groups can apply using the abbreviated underwriting application within 60 days of becoming eligible:
- New and newly eligible employees.
- Federal or U.S. Postal Service employees first returning from nonpay status after November 2, 2002, who were also in nonpay status at any age at least three months between July 1 and December 31, 2002.
- Spouses of persons in one of the above groups, and
- Newly married spouses of employees.
Q. Who must use the full underwriting application to apply?
A. Anyone who does not qualify to use the abbreviated underwriting application. This includes:
- New and newly eligible employees who are NOT applying within 60 days of their hire or eligibility date,
- Federal or U.S. Postal Service employees first returning from nonpay status after November 2, 2002, who were also in nonpay status at least three months between July 1 and December 31, 2002, who are NOT applying within 60 days of their return,
- Spouses of employees who are NOT applying within 60 days of marriage,
- Annuitants, including retired members of the uniformed services
- Qualified relatives.
Who Can Use Abbreviated Underwriting?
Q. Can employees newly hired or newly eligible for coverage apply with abbreviated underwriting, even outside an open season?
A. Yes, they can. New or newly eligible
employees and their spouses can apply for insurance under the Program using the abbreviated underwriting application within 60 days of becoming eligible. After that time, they can still apply, but will have to use the full underwriting application.
Q. I'm an
employee. If I get married, can my new spouse apply using the abbreviated application form?
A.
Yes, your spouse can apply using the abbreviated underwriting application within 60 days of your marriage. After that time, he/she can still apply, but will have to use the full underwriting application. You would not get this 60 day window unless you are a new or newly eligible employee, because you already had an opportunity to apply using the abbreviated underwriting application.
Q. How do you define a new employee?
A. A new
employee is someone who is part of the employee group
eligible to apply for this insurance and was hired or began their position on/after November 2, 2002. Those with prior Federal service must have had a break in service of at least 180 days. New District of Columbia employees (except for D.C. Courts employees) are not eligible to apply for this insurance.
Q. How do you define a newly eligible employee?
A. A newly eligible
employee is someone entering a
position that conveys eligibility for this Program, from a position which did not convey eligibility. For example, someone who was an intermittent employee and then moved to a full-time permanent position without a break in service would be a "newly eligible employee". Here's another example - a member of the Individual Ready Reserve moves into the Selected Reserve.
Q. I just began my job with the Federal Government, but I also worked for the Federal Government back in 1998. Am I still considered a new or newly eligible employee?
A. You're considered a new employee, because the time between your Federal jobs (your "break in service") is greater than 180 days. You may apply for the Program using the abbreviated underwriting application within 60 days of starting your new job.
Q. I just began my job with the Federal Government in January 2003, but I also worked for the U.S. Postal Service until September 2002. Am I still considered a new or newly eligible employee?
A. No, you're not, because the time between your Postal position and current new Federal position is less than 180 days. If you apply for coverage under the Program, you must use the full underwriting application.
Q. I'm an
employee and just got married. Can I apply using the abbreviated underwriting application?
A. No, because you have already had an opportunity to apply using the abbreviated underwriting application (either during the Open Season that was held in 2002 or when you first became eligible). But your new spouse can apply within 60 days of your marriage using the abbreviated underwriting application. You can apply using the full underwriting application.
Q. I was in nonpay status during July and August 2002. Then I went back into nonpay status on December 20th, 2002. I'm now returning from nonpay status in 2003. Can I apply using the abbreviated underwriting application?
A. No, because you were in pay status for at least three months during the 2002 Open Season (July 1 - December 31, 2002). You may apply using the full underwriting application.
Q. I am a Federal (or Postal) employee. I was in nonpay status for most of the Open Season. During that time I was called up to active duty in the military. Will I get an opportunity to apply using abbreviated underwriting upon my return from nonpay status?
A. Yes, you will, because you were in nonpay status in your Federal/Postal position for at least half of the Open Season.
Q. I am a Federal (or Postal) employee. I was NOT in nonpay status for most of the Open Season. I'll be going into nonpay status soon because I'm in the reserves and am being called up for active duty in the military. Will I get an opportunity to apply using abbreviated underwriting upon my return from nonpay status?
A. No, you will not. The opportunity to apply with abbreviated underwriting within 60 days of returning from nonpay status is for employees who were in nonpay status for at least one-half of the Open Season. You could have applied with abbreviated underwriting during Open Season, and so you don't get another opportunity. But assuming you're in an
eligible position, you can apply using the full underwriting application.
Q. I am a Federal (or Postal) employee and currently have the insurance under this Program. I was NOT in nonpay status for most of the Open Season. Ill be going into nonpay status soon because I'm in the reserves and am being called up for active duty in the military. I'm thinking about canceling my insurance for now, since my active duty pay will be less than my current pay. Can I apply with abbreviated underwriting again when I return to pay status in my Federal/Postal position?
A. You are certainly free to cancel your coverage if you'd like to. But you will not have an opportunity to apply with abbreviated underwriting again when you return to pay status (
see FAQ above). You will be able to reapply for the insurance using the full underwriting application. Depending on your health, that may not make a difference to you. But perhaps it might. You may want to review the applications at
www.ltcfeds.com before you cancel your insurance.
Q. If I'm currently on leave without pay to work for the union, will I be able to apply for this insurance using the abbreviated underwriting application within 60 days of returning to my eligible Federal position?
A. Yes you will. You can also apply after that 60 day period, using the full underwriting application.
Q. I was in an intermittent position that didn't convey eligibility for the FEHB Program. Therefore I wasn't eligible to apply for this Program. But in August 2002 I transferred to a new, full-time position that conveyed eligibility for the FEHB Program and this Program. Can I now apply for this Program using the abbreviated underwriting application?
A. No, you cannot, because it is more than 60 days after you began that new position. You do not meet the definition of either a new or newly eligible employee. You may apply using the full underwriting application.
Q. I am a new
employee. But I am also the spouse of an eligible employee. Do I have to answer questions 8 and 9 on the abbreviated underwriting application?
A. No.
Q. I qualify to apply using the abbreviated underwriting application. I know I have to answer more health questions if I want the unlimited benefit period (vs. if I apply for the 3 or 5 year benefit period). If I apply for the unlimited but am not approved for it, do I have to submit another application in order to get the 3 or 5 year benefit period?
A. If you are not approved for the unlimited, but you ARE approved for the 3 and 5 year benefit periods, you'll automatically receive the 5 year benefit period. You do not need to submit another application. If you don't want the 5 year benefit period, simply call Long Term Care Partners when you receive their letter and tell them to change your coverage to the 3 year benefit period, or cancel the coverage altogether.
Actively At Work Requirement
Q. Who needs to be actively at work in order for their coverage to become effective?
A. Employees who apply with the abbreviated underwriting application must be actively at work for at least one-half of their regularly scheduled work hours on the date their coverage is scheduled to take effect, otherwise it will not take effect that day.
Q. What does it mean to be "actively at work"?
A. For employees (other than members of the uniformed services) applying with the abbreviated underwriting application, it means:
- You are reporting for work at your usual place of employment or other location to which government business requires you to travel; and
- You are able to perform all the usual and customary duties of your employment on your regular work-schedule; and
- You are not absent from work due to sickness, injury, annual leave, sick leave or any other leave (for employees working an alternative work schedule, an "AWS" day off counts as a day you are Actively at Work).
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.
Q. I'm eligible to apply with the abbreviated underwriting application. What happens if I'm NOT actively at work on the original effective date of my coverage?
A. If you do not meet the actively at work definition on your original effective date, you must contact LTC Partners with that information. LTC Partners will then issue a revised effective date, which is the first day of the month after the date you return to being actively at work.
However, for coverage to become effective on the revised effective date, you must meet the actively at work requirement on that date as well. Your coverage will not become effective until you meet the actively at work requirement on the coverage effective date issued by LTC Partners. If LTC Partners discovers that you were not actively at work on the "effective" date of your coverage, benefits will never be paid because your coverage never went into effect.
Q. But what if my original scheduled effective date is on a weekend or holiday?
A. Then you must meet the actively at work requirement on the last workday before that date.
Q. What if I work other than a full-time schedule, and my original scheduled effective date falls on a date I am not scheduled to be at work?
A. Then you must meet the actively at work requirement on your closest workday before that original effective date.
Q. I'm a new employee applying with the abbreviated underwriting application. WHY do I have to be actively at work for my coverage to be effective? It affects my vacation plans.
A. We negotiated premiums with Long Term Care Partners with the understanding that employees and members of the uniformed services using the abbreviated underwriting application would receive this more limited underwriting as long as there was also an actively at work requirement. An actively at work requirement is standard industry practice for employer-sponsored group long term care insurance. The reasoning is that being actively at work absolutely speaks volumes about someone's health. You can look at it as a proxy for asking additional questions about health. Being on sick or annual leave means you're not actively at work. Chances are that the reason you're not at work is not related to a reason that would make you uninsurable, but it could be. And people take annual leave if they're sick and vice-versa. There's no policing of that. So both are excluded from being actively at work.
It is important to realize that without this requirement, employees would have been subject to FULL underwriting ALWAYS (even when new or newly eligible). Having only abbreviated underwriting for new and newly eligible employees is a huge advantage and allows many more employees to qualify for the insurance. Having to be actively at work (or else postponing the effective date) is a small price to pay for this advantage. And, keep in mind that the actively at work requirement is only for of your regularly scheduled tour of duty for that day.
Q. I'm an employee applying after open season using the full underwriting application. Do I still have to be actively at work in order for my coverage to become effective?
A. No. The actively at work requirement applies ONLY with the abbreviated underwriting application.
Q. I'm the new spouse of an employee. Does the employee I'm related to have to be actively at work in order for my coverage to become effective?
A. No. The actively at work requirement applies only to
employees who are applying for coverage using the abbreviated underwriting application.
Q. I'm the new spouse of an employee and am applying using the abbreviated underwriting application. I have a non-Federal job. Do I have to be actively at work at that job in order for my coverage to become effective?
A. No. The actively at work requirement applies only to
employees who are applying for coverage using the abbreviated underwriting application.
Q. I'm on leave without pay to work for the union. I understand that if I qualify to apply with the abbreviated underwriting application, I must be actively at work on my scheduled effective date, otherwise my coverage will not become effective. But how can I meet the actively at work requirement if I'm not at my Federal job?
A. If you are on leave without pay from your eligible Federal position:
- to work full-time for an employee organization (e.g., union), or
- to work on a detail to an international organization, or
- to work on a temporary assignment to a State, local, or Indian tribal government, institution of higher education, or
- to work at any other organization eligible under the Intergovernmental Personnel Act of 1970
then you do not have to be actively at work with your Federal agency on your scheduled effective date. Instead, you must be actively at work at your current employment site on your scheduled effective date in order for your coverage to become effective.
Q. I'm a new employee and work a flexible work schedule (one type of alternate work schedule) and earn "credit hours". I earn credit hours when I work more than my basic work requirement for that day. I elect to work longer on some days than others, and then I carry forward those "credit" hours to use later. When I'm using my earned credit hours, am I considered to be actively at work for purposes of my effective date of coverage, the same as if I take an AWS day (which is considered an actively at work day)?
A. Yes. An employee using credit hours earned as part of an alternate/flexible work schedule is considered to be actively at work during those hours.
Q. I'm a new employee and I'm also in the Reserves. I'm going to be activated very soon. My coverage is scheduled to go into effect on the first of the month. Your other FAQs say that if I'm in a leave status, I'm not actively at work. But what if I'm on leave without pay from my Federal job and instead on active duty in the uniformed services on that date -- will my coverage still become effective on my scheduled effective date?
A. YES, it will, assuming your health hasn't changed in such a way to change the answers to any questions on your application.
Coverage Exclusions
Q. The applications deny coverage to people who use a wheelchair. How can
this be allowed? Isn't such outright discrimination against the law,
specifically the Americans with Disabilities Act?
A. The Americans with Disabilities Act (ADA) does not cover
the underwriting practices of insurance companies. Insurance companies can
legally underwrite their coverage to identify people who do not present
acceptable risks to be insured. It is not against the law for insurance
companies to deny insurance to classes of people with same/similar
conditions.
Standard industry practice denies long term care insurance coverage to
people in wheelchairs, people who use some other medical devices and/or
have certain medical conditions or diseases. That's because people in
those categories have a higher than average chance of needing long term
care services. Without a government subsidy toward premiums, accepting
such risks would increase the price of the insurance considerably,
resulting in adverse selection (the healthy would purchase coverage
elsewhere) and the eventual demise of the Program. The Federal Long Term
Care Insurance Program, however, does offer an alternative insurance plan
to employees, members of the uniformed services, and their spouses who are
denied the standard insurance, and a service package to everyone denied
coverage, including annuitants.
The Long-Term Care Security Act which established the Federal Long Term
Care Insurance Program recognized that underwriting would be necessary. It
states: "Nothing in this chapter shall be considered to require that
long-term care insurance coverage be guaranteed to an eligible individual."
Q. Can someone with disabilities enroll?
A.
Anyone in an
eligible group can apply for coverage. There are a range of disabilities, of course. So as with all applicants, some people with disabilities will have their applications approved and others won't. As with all other applicants, acceptance or denial of a disabled person's application will depend on whether the person can meet the
underwriting requirements . And, depending on their answers to the underwriting questions, they may be offered other options.
Federal/Postal employees, members of the uniformed services and their spouses who are eligible to apply with abbreviated underwriting and who are declined coverage will be offered either an alternative insurance plan and/or a service package. Everyone else who applies with full underwriting and is declined coverage will be offered a service package.
The Federal government has distinguished itself as a leader in recruiting individuals with disabilities. As a result, we have significantly more employees with disabilities than many private sector employers. Without some form of underwriting (questions about health status), we could not offer attractive and affordable long term care insurance.
Q. Part B, Question 4 of the Full Underwriting Application indicates that "cancer within the past 2 years" would make me automatically ineligible for the insurance coverage. Does that exclusion include a minor type of cancer, such as skin cancer?
A. No it was not intended to exclude people from the insurance coverage if all they had was basal cell or squamous cell cancers of the skin. If you have had either of these two types of cancers, but no other type of cancer and no other listed excluded condition, you should answer NO to Question 4 in Part B of the full underwriting application.
Q. How can you say this is an important employee benefit when not all employees can enroll in the standard insurance coverage? Why can't the Government set an example by using its purchasing power to make this insurance available to all who want it without regard to state of health - like the health insurance program?
A. It is a very important benefit. All employees who apply will be offered some form of benefit. However, due to health reasons, a small minority will be offered
alternative insurance or a
service package. These individuals would probably not be able to receive any long term care benefits from the private sector.
Because over 90% of eligible employees have health insurance, the added costs of those in poor health can be spread over many, many others. The percentage of employees who typically purchase long term care insurance is less than five percent. So it wouldn't take many in poor health to drive up the costs (premiums) for the others. If we guaranteed standard insurance to all employees who applied, our insurance carriers would have added the expected costs of those in poor health to the premium. With no Government contribution, many healthier employees who could pass underwriting would find less expensive premiums and purchase coverage elsewhere. Our program would then be left with only those who couldn't purchase private insurance, requiring even higher premiums to cover the risks of those remaining in our program. That kind of cycle would almost guarantee that the program would fail.
Q. Is there an exclusion for pre-existing conditions?
A. Pre-existing conditions may prevent you from obtaining the long term
care insurance coverage in the first place, but if you qualify for
coverage, they won't affect your eligibility for benefits. You have to pass
underwriting to enroll in this insurance (
answering health
questions, possibly authorizing access to medical records, possibly being interviewed by a registered nurse).
If your application is approved, and you become eligible for benefits,
it doesn't matter whether a pre-existing condition is the reason you
became eligible. This is a definite advantage to our Program. There are
indeed private policies out there that limit access to benefits based on
pre-existing conditions.
As noted earlier, your pre-existing condition may prevent you from being
approved for the insurance in the first place. In that case, there are
possible alternatives for you -- an alternative insurance plan
and/or a service package.
Alternative Insurance Plan and Service Package
Q. Can you tell me more about the alternative insurance plan and the service package?
A. The Alternative Insurance Plan is an innovative plan developed by OPM and Long Term Care Partners. Some employees, members of the uniformed services and their spouses who apply using the abbreviated underwriting application and are not approved to enroll in the insurance they originally applied for will be offered the Alternative Insurance Plan. It offers nursing home only coverage with a 180 day waiting period and 2 year benefit period. The Alternative Insurance Plan also has higher premiums. This plan is not available to those who use the full underwriting application.
If you apply for and are denied the standard insurance and are not offered the Alternative Insurance Plan, you will be offered a Service Package. This is true for everyone who applies - those using the abbreviated underwriting application AND those using the full underwriting application. The Service Package is not insurance. It is a package of services, including access to a care coordinator, general information and referral services, and access to a discounted network of long term care providers and services. It costs $59 per year, for an individual or a couple.
Everyone who is denied standard coverage will receive information from Long Term Care Partners to review at no obligation. The information will describe what is available in lieu of the standard insurance - either the Alternative Insurance Plan and/or the Service Package. Individuals who are offered both can decide which, if any, they wish to purchase.
Here's a table summarizing this information:
New or newly eligible employee or member of the uniformed services | No | No | N/A |
Standard
insurance |
New or newly eligible employee or member of the uniformed services | No | Yes | N/A |
Choice of either:
Alternative Insurance Plan or
Service Package |
New or newly eligible employee or member of the uniformed services | Yes | N/A | N/A |
Service
Package |
Newly eligible spouse of either an employee or member of the uniformed services | No | No | No |
Standard
insurance |
Newly eligible spouse of either an employee or member of the uniformed services | No | No | Yes |
Possibly Standard insurance.
If denied standard insurance, choice of either:
Alternative Insurance Plan or
Service Package |
Newly eligible spouse of either an employee or member of the uniformed services | No | Yes | N/A |
Choice of either:
Alternative Insurance Plan or
Service Package |
Newly eligible spouse of either an employee or member of the uniformed services | Yes | N/A | N/A |
Service
Package |
Everyone using the full underwriting application who is denied standard insurance | N/A | Service Package |
Q. Is the Alternative Insurance Plan available to employees, members of the uniformed services, and their spouses who submit a full underwriting application and are not approved to enroll in the insurance they applied for?
A. No, it is not. The Alternative Insurance Plan is ONLY offered in conjunction with the abbreviated underwriting application (NOT the full underwriting application).
Increasing and Decreasing Coverage
Q. Can I increase coverage?
A. At any time, you may request an increase (upgrade) in your coverage by contacting LTC Partners. In order to receive approval of a request for an increase outside of open season, you must provide, at your expense, evidence of your good health that is satisfactory to LTC Partners. They'll guide you through the process. The amount of an increase is subject to what's then available under the Program (for example, you couldn't increase to a $350 daily benefit amount if the highest we offer is $300).
If you request and Long Term Care Partners approves an increase in your daily benefit amount (not counting an increase due to your inflation protection option), your additional premium will be based on your age and the premium rates in effect at the time the increase takes effect. Other coverage increases you request that LTC Partners approves will cause your entire premium to be based on your age and the premium rates in effect at the time the increase takes effect.
Q. Can I decrease my coverage?
A. Yes. You can request a decrease in your coverage at any time. You can decrease to anything that is available under the Program, and your premiums (which will be based on your original age) will also decrease. For example, if you have the 5 year benefit period, you can decrease to a 3 year benefit period. But you could not decrease to a 2 year benefit period, because a 2 year benefit period is not available under our Program. You do not have to undergo new underwriting in order to decrease your coverage.
Q. If I decrease my coverage, can I ever get paid-up benefits, since I've already paid for higher benefits for a long time?
A. No, our Program does not offer paid-up benefits. At the time you paid for your higher benefits, you were insured for those higher benefits and received that protection for all the years you held the old policy. Just because you didn't use them doesn't mean they didn't have a cost from an insurance point of view. But your premiums will decrease when your benefits decrease.
Miscellaneous
Q. Can I buy insurance under the Federal Program from an insurance agent?
A. No. The Federal Program does not use insurance agents or brokers to sell or market this insurance or to provide information about its features. The only way to apply is to submit an application directly to Long Term Care Partners. You can obtain an application at
www.ltcfeds.com or by calling 1-800-LTC-FEDS (1-800-582-3337, TTY: 1-800-843-3557).
Q. If I stop paying premiums, will I still have benefits based on what I've already paid in premiums?
A. No, our Program does not offer paid-up benefits. If you stop paying premiums, and you're not in an approved claim status, your coverage will end.
Q. I'm a Federal employee caring for my mother who has Alzheimer's. How can this program help me? Her?
A. If you apply and are approved for coverage, the program can help you coordinate care for your mother, receive discounts on certain long term care services or supplies, and provide advice and support for you as caregiver. However, this is an insurance program and anyone who applies must be insurable based on the underwriting criteria for the program. Employees' qualified relatives who already need long term care services, such as your mother, will not qualify for this insurance.
However, as noted earlier, the care coordination program will be of substantial assistance to caregivers, such as yourself, who enroll in the program.
Q. I've been waiting for this program ever since my father was diagnosed with dementia last year. I heard that your program will provide retroactive benefits to anyone whose need for long term care began on/after September 19, 2000, when the President signed the law. Is that true?
A. No, that is not true. There are no provisions for retroactive benefits. Anyone who already needs long term care services is not going to qualify for this insurance.
