A New Benefit for Federal Employees is Here!!

NEW-->  Long Term Care Handbook

How do I apply?

Information Kits with materials are available on the LTC Partners, Inc. website www.ltcfeds.com. At this website, you may select from a variety of brochures: Outline of Plan Proposals, Coverage, Payroll/Annuity Deduction Instruction Guide, Plan Proposals, Planning for Your Retirement, just to name a few. If you prefer a hard copy, you can request an Information Kit and application by calling 1-800-LTC-FEDS (1-800-582-3337) (TDD: 1-800-843-3557).

You may download an Abbreviated Underwriting Application or a Full Underwriting Application.

You may apply on-line or mail your application directly to LTC Partners. It is not sent through your servicing personnel or payroll office.

How do I pay for the insurance?

There are three options listed on the application form:
1. Automatic bank withdrawal; or
2. Payroll/annuity deduction; or
3. Direct billing

If you choose payroll/annuity deduction, you must provide a payroll/annuity office identifier. LTC Partners will use that payroll/annuity office identifier to map back to the servicing payroll office to initiate the applicant's payroll/annuity deduction. LTC Partners will have a listing of payroll identifiers and where to locate it on your leave and earning statement.

How do I learn more about LTC?

If you have additional questions, there are several ways you can obtain information.

You can access the Long Term Care Insurance website www.ltcfeds.com. This website provides valuable information about long term care insurance, e.g., what is it, what does it pay for, brochures, application, and premium calculator.

The Office of Personnel Management (OPM) has a Frequently Asked Questions section for the Federal Long Term Care Insurance Program that is regularly updated.

You may also speak to a Long Term Care Insurance Consultant by calling 1-800-LTC-FEDS (1-800-582-3337) (TTY: 1-800-843-3557), Eastern Time 8:00am - 7:00pm Monday through Friday.

Lastly, you may email Long Term Care partners at info@ltcpartners.com.

What is underwriting?

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.

What is abbreviated underwriting?

In this type of underwriting, the application has several health-related questions designed to determine who may be immediately eligible for benefits, or likely to be eligible for benefits within a relatively short period of time. Employees and members of the uniformed services who apply for the insurance coverage will answer seven questions, and their spouses who apply will answer nine. Those applying for the unlimited benefit period will have to answer a few additional questions, sign a release giving access to medical records, and perhaps have an interview with a nurse.

The following groups are eligible to use the abbreviated underwriting application within 60 days of becoming eligible:

• new or newly eligible employees
• Federal civilian or U.S. Postal Service employees first returning from non-pay satus after November 2, 2002, who were in non-pay status for at least three months during the Open Season held July 1 - December 31, 2002, and their current spouses.
• newly married spouses of employees

After those 60 days, members of these groups must use the full underwriting application to apply for coverage under the Program.

What is full underwriting?

In this type of underwriting, there are quite a few more health-related questions. It may also include a review of medical records and perhaps an interview with a nurse. This is the same level of underwriting that those who purchase individual policies in the private market undergo.

All applicants, other than those listed above, will be subject to full underwriting and must use the Full Underwriting Application.

There is an alternative insurance plan for some employees and spouses who are denied the coverage they applied for.

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.

The service package is for all who are declined insurance coverage (access to care coordination services and provider discounts for a small annual fee).

Will there be annual Open Seasons?

No, the Office of Personnel Management (OPM) will not hold annual Open Seasons. OPM will hold future Open Seasons, but not on a regular or frequent basis. OPM does not know when the next one will be.

Who is eligible to apply for coverage in the FLTCIP?

Federal Civilian and Postal employees

Federal civilian and Postal employees are eligible to apply for FLTCIP coverage if they are in a position that conveys eligibility for FEHB coverage. An employee does not need to be enrolled in FEHB, just eligible to enroll. There are two exceptions: Tennessee Valley Authority employees and retirees are eligible to apply for insurance coverage under the FLTCIP, even though they may not be eligible for FEHB.

District of Columbia Government employees who were first employed by the District of Columbia Government before October 1, 1987, and employees of the District of Columbia Courts are also eligible to apply for FLTCIP. Other DC Government employees are not eligible.

Temporary employees are eligible to apply for FLTCIP coverage under the same rules as FEHB. Once a temporary employee has completed one year of continuous current employment, he/she has 60 days from the date of first eligibility to apply for coverage using an abbreviated underwriting application.

Non-Federal employees with FEHB eligibility. Some employees are no longer Federal employees, but are now working for a private entity, and yet they still have eligibility for FEHB. For example, this applies to some employees of the Metropolitan Washington Airports Authority, and certain of the financial institutions. Those employees are not eligible to apply for FLTCIP. In order to be eligible to apply for the FLTCIP as Federal civilian employees, they must be current Federal or Postal employees in a position that conveys eligibility for the FEHB Program.

Non-appropriated fund (NAF) employees may be eligible to apply for FLTCIP coverage. Public Law No. 107-314 provides that NAF entities MAY be covered under the FLTCIP. 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 FLTCIP 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.

Members of the uniformed services

Members of the uniformed services are eligible to apply for coverage when they are on active duty or full-time National Guard duty for more than a 30-day period. Members of the Selected Reserve are eligible to apply. This consists of:

Drilling Reservists and Guardsmembers assigned to Reserve Component Units;

Individual Mobilization Augmentees who are Reservists assigned to Reserve component billets in Active Component units (performing duty in a pay or nonpay status);

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.

Members of the Individual Ready Reserve are not eligible to apply for coverage. This includes Reservists who are assigned to a Voluntary Training Unit in the Naval Reserve and Category E in the Air Force Reserve.

Annuitants and retired members of the uniformed services

Federal civilian annuitants, including surviving spouses, other survivor annuitants, FERS MRA+10 annuitants, deferred annuitants (when they are receiving annuities), and compensationers, are eligible to apply for the insurance coverage. There is no "five-year rule" for the FLTCIP, as there is for the FEHB Program. You do not have to be enrolled for any minimum length of time before retiring. Even one day is okay!

Retired members of the uniformed services are eligible when they are entitled to retired or retainer pay (including disability retirement pay). Retired ("gray") reservists are eligible even if they are not receiving their retired pay yet. Retired military reservists are eligible for FLTCIP.

What qualified relatives are eligible to apply?

The current spouse of an eligible person noted above may apply for coverage. This includes a surviving spouse of a member or retired member of the uniformed services who is receiving a survivor annuity. Receipt of Dependency and Indemnity Compensation (DIC) from the Department of Veterans Affairs qualifies as a survivor annuity.

A former spouse is not eligible, even if he/she is eligible for FEHB coverage and/or is eligible for or receiving an apportionment of a survivor annuity.

The parents, parents-in-law, and stepparents of living employees or living members of the uniformed services are eligible to apply (but those of annuitants and retired members of the uniformed services are not). Parents-in-law include the parents of a deceased spouse, as long as the employee or member of the uniformed services has not remarried. A stepparent is the person who is currently married to the employee's parent, or if the parent is dead, the person who was married to the employee's parent at the time of his/her parent's death.

The adult children (age 18 or over) of living employees, living annuitants, or living members or living retired members of the uniformed services are eligible to apply. This includes natural children, adopted children and stepchildren. Foster children are not eligible to apply.

There are no self and family enrollments in the FLTCIP. Each person must submit his/her own application and pass underwriting on their own. However, payment of premiums can be consolidated (e.g., employees may choose to pay the premiums for their spouses by payroll deduction).

Qualified relatives may apply even if the employee, annuitant, member or retired member of the uniformed services to whom they are related does not apply or applies and is not approved for coverage.

How does someone show eligibility?

The FLTCIP relies on self-certification of an applicant's eligibility. The application asks the applicant to designate his/her eligibility category. The applicant's signature in the Agreement and Authorization section of the application signifies that the answers the applicant has given on the form (including his/her status as an eligible individual) are true and complete. This signature also attests that the applicant understands that if he/she is approved for coverage, but shouldn't have been because one or more answers are not true, LTC Partners has the right to deny benefits or cancel the insurance.

An enrollee who misrepresents his/her inclusion in an eligible group on the application risks losing coverage, and there is no time limit on this.

Can an employee in nonpay status apply?

An employee should not apply for FLTCIP coverage while in nonpay status. The coverage will not become effective as long as the employee is in a nonpay status. And the application may no longer be valid by the time the employee returns to pay status, because health and eligibility may have changed. It is simpler to wait to apply until after returning to a pay status.

Are new employees eligible to apply?

A new employee or new member of the uniformed services and his/her spouse will have 60 days from becoming eligible to apply for coverage with abbreviated underwriting. This 60-day opportunity also applies when an employee is for the first time entering a position that conveys eligibility for FLTCIP, and when an employee returns to service after a break in service of 180 days or more.

The employing office is responsible for letting a new employee know about eligibility to apply for the FLTCIP when it counsels the employee on other benefits, such as FEHB and FEGLI.

What if a new employee misses this 60-day period?

The employing office may authorize a belated new employee application when an employee can show that he/she was unable, for causes beyond his/her control, to submit an application within the initial 60-day eligibility period. The employing office must make this determination within 6 months from the first day the employee became eligible. The employing office must make this authorization in writing so that the employee can submit that documentation with his/her application.

Do employees' new spouses get a 60-day period to apply?

Yes. When an employee or member of the uniformed services marries, the new spouse has 60 days from the date of the marriage to apply for coverage using an abbreviated underwriting application. However, if the employee or member of the uniformed services wants to apply as well, he/she must apply with the full underwriting application. That's because the employee/member already had an opportunity to apply using an abbreviated underwriting application.

What about other new qualified relatives?

Other new qualified relatives of an employee or annuitant, or member or retired member of the uniformed services, may apply for coverage at any time using a full underwriting application.

When does the coverage become effective?

Once LTC Partners approves an application for coverage, it will send notice of the approval to the applicant and provide an "original effective date" of coverage. An employee or member of the uniformed services must be actively at work for at least half of his/her regularly scheduled work hours on that date for coverage to take effect (or on the last workday before that date, if it falls on a weekend or holiday).

If employees work other than a full-time schedule, and the original effective date falls on a date that they are not scheduled to be at work, then they must meet the actively at work requirement on their closest workday before that original effective date.

Applicants are solely responsible for letting LTC Partners know if they do not meet the actively at work definition on the original effective date. Employing offices should not attempt to police or verify that an employee is actively at work on his/her original effective date.

Applicants are also solely responsible for letting LTC Partners know if their health changes from the time they completed their application until the effective date of their coverage. If it does, and if that change in health is such that they would now answer one or more questions differently on the application, they have a duty to inform LTC Partners. LTC Partners will then determine if they are still approved for coverage. If they do not inform LTC Partners of this change in health, then LTC Partners may have the right to deny a claim for benefits or rescind coverage.

The rules on coverage effective dates are explained in the Benefit Booklet that LTC Partners sends to applicants upon approval for coverage.

What does "actively at work" mean?

"Actively at work" means that a Federal civilian or Postal employee meets all of the following conditions:

1. the employee is reporting for work at the usual place of employment or other location to which Government business requires him/her to travel; and



2. the employee is able to perform all the usual and customary duties of employment on his/her regular work-schedule; and



3. the employee is not absent from work due to sickness, injury, annual leave, sick leave or any other leave. (An employee is not considered to be on leave on his/her alternate work schedule's scheduled day off.)

A member of the uniformed services is actively at work when he/she is on active duty and physically able to perform the duties of his/her position.

What happens if the employee is not actively at work on the original effective date?

If the employee does not meet the actively at work definition on the original effective date, he/she is obligated to 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 the employee returns to being actively at work. However, for coverage to become effective on the revised effective date, the employee must meet the actively at work requirement on that date as well. An employee's coverage will not become effective until he/she meets the actively at work requirement on the coverage effective date issued by LTC Partners. If LTC Partners discovers that an employee was not actively at work on the "effective" date of his/her coverage, benefits will never be paid because coverage never went into effect.

Are effective dates always on the first day of a month?

Yes. Effective dates will always be on the first day of a month. If a coverage effective date falls on a weekend or a holiday, the employee must be actively at work on the last workday before that date.

What happens if an employee's eligibility status changes before the coverage effective date?

If an employee retires after applying for coverage but before the coverage becomes effective, the coverage will not go into effect. If the employee still wishes to have the coverage, he/she must reapply for coverage using the full underwriting application required of annuitants. An employee applying for FLTCIP coverage who is considering retirement may wish to consider delaying retirement until after his/her FLTCIP coverage has gone into effect.

Who makes insurability decisions?

LTC Partners makes all insurability decisions, and those decisions cannot be appealed to OPM. However, an applicant may ask LTC Partners to reconsider its decision. This is similar to FEGLI Program requirements, where decisions to deny life insurance coverage cannot be appealed to OPM.

Is coverage portable?

Yes, once it is effective, FLTCIP coverage is fully portable. An enrollee can continue coverage as long as he/she pays premiums. This includes when an employee separates or retires from Federal service, or when a qualified relative loses eligibility status (such as through divorce). There are no requirements to carry it for any length of time before retirement or separation. For example, an employee whose coverage became effective on October 1 can retire on October 2 and carry coverage into retirement with no additional underwriting. The employing office does not need to take any action to ensure portability. Premiums do not change just because an employee retires or leaves an eligible group.

What long term care isn't:

Long term care is not the same as acute medical care. Acute medical care is short-term, and there's usually an expectation that your medical problem will be cured. Acute medical care is mainly provided by doctors.

Long term care is not always administered in a nursing home. In fact, more than 75% of all people receiving long term care assistance are not in nursing homes.

Most long term care is not covered by Medicare or health insurance programs such as TRICARE and FEHB. Medicare pays a limited amount of "skilled nursing care." Neither Medicare, TRICARE, the FEHB Program, nor most other health care plans pay for help with daily activities - which is the kind of long term care most people need.

What long term care is:

Long term care is ongoing assistance. Typically it is provided by home health aides and other health care providers to people who need ongoing or even lifelong care. The goal of long term care is to help with day-to-day living.

Long term care is provided in a number of settings. They include your own home, assisted living facilities, adult day care centers, and hospices. Long term care is covered completely or in part by long term care insurance. Most plans let you choose the amount of the coverage you want, as well as how and where you want to use your benefits. A comprehensive plan includes benefits for all levels of care, custodial to skilled. To find out more about the new Federal Long Term Care Insurance Program and subscribe for FREE to "Get Smart About Your Future" visit the LTC Partners web site at www.LTCFEDS.com !

Who is Sponsoring This Program?

The program, established by Public Law 106-265, the Long-Term Care Security Act, is sponsored by the U.S. Office of Personnel Management.

What Companies Are Providing the Insurance?

Coverage under this Program is being offered by Metropolitan Life Insurance Company and John Hancock Life Insurance Company, forming a partnership named Long Term Care Partners, LLC. Call 1-800-LTC-FEDS (1-800-582-3337), TDD 1-800-843-3557, or visit the LTC Partners web site at www.LTCFEDS.com for free information today!

Will I Be Guaranteed Coverage?

All employees who apply for the insurance will not be eligible for the standard insurance. However, all employees who apply will be offered something, perhaps non-standard insurance (different benefits and/or higher premiums) or a non-insurance product. It is not like the FEHB program where everyone eligible who applies for a given policy gets the same coverage and pays the same premium.