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U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

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Insurance Services Programs

Federal Long Term Care Insurance Program

Advantages of the Federal Program

  • 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.

  • 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.