Federal Long-Term Care Insurance Program (FLTCIP)
The Federal Long-Term Care Insurance Program (FLTCIP) provides insurance to help pay for the costs of care when enrollees need help with activities they perform every day, or when they have a severe mental impairment, such as Alzheimer’s disease. Such activities include, among other things, bathing, dressing, using the toilet, moving to or from a bed or a chair, and eating.
As you get older, of course, the likelihood of your need for long-term care increases. It has been estimated that about 70% of individuals over age 65 will require at least some type of long-term care services during the remainder of their lifetime. And over 40% will need care in a nursing home for some period of time.
It is difficult to predict how much or what type of care any individual person might need. On average, someone age 65 today will need long-term care services for about three years. Service and support needs vary from one person to another and often change over time. Women need care for somewhat longer (on average 3.7 years) than do men (on average 2.2 years). While nearly one-third of today’s 65-year-olds may never need long-term care services, about 20% of people over 65 will need care for more than five years.
The Need for Long-Term Care Insurance
Long-term care is expensive, and the need for such care can potentially exhaust a family’s resources unless they are very wealthy. Long-term care insurance helps protect your income and assets, and can help you remain financially independent should you or a family member need such services at home, in a nursing home, or at another long-term care facility.
Most health insurance programs, including the Federal Employees Health Benefits (FEHB) Program, TRICARE (the healthcare program for Uniformed Service members, retirees and their families), and TRICARE For Life (healthcare coverage for TRICARE beneficiaries over 65), provide little or no coverage for long-term care. That is why the U.S. Office of Personnel Management (OPM) sponsors a long-term care insurance program for federal government employees (FLTCIP).
|Insurance coverage under FLTCIP is provided by the John Hancock Life & Health Insurance Company, and is administered by Long-Term Care Partners LLC on behalf of John Hancock|
Most federal employees and annuitants, active and retired members of the uniformed services, and their qualified relatives are eligible to apply for insurance coverage under FLTCIP.
Benefits under FLTCIP
Many people think that all long-term care is provided in nursing homes. However, long-term care is most often provided at home, in adult day-care facilities, or in assisted living facilities.
Here are some of the major features of the program:
- Home, Assisted Living and Nursing Home Care
You can choose the setting where you want your care, — your home, assisted living or nursing home, or a variety of other settings. In addition, FLTCIP covers care provided in the home by friends, family members, and other unlicensed caregivers.
- Stay-at-Home Benefit
FLTCIP offers a stay-at-home benefit which can pay benefits for numerous options that support care in a home environment, such as care planning visits, home modifications, an emergency medical response system, durable medical equipment, caregiver training, and home safety checks.
- Portable Coverage
Coverage is portable. You can keep it as long as you continue to pay the required premiums and have not exhausted your maximum lifetime benefit, even if you are no longer a member of an eligible group (for example, if you leave government employment).
- Guaranteed Renewable
Your insurance coverage is guaranteed renewable. It cannot be canceled by the insurance carrier as long as you pay your premiums. It cannot be canceled due to your age or a change in your health.
Waiver of Premium
Other Features of FLTCIP
In addition to the main features of FLTCIP listed above, the program includes a number of other features:
- Alternate Plan of Care
In certain circumstances, the plan’s care coordinators can authorize customized benefits for services that are not specifically covered under FLTCIP. For example, under an alternate plan of care, a facility not normally covered under the program may be considered to provide services.
- Informal Caregiver Provisions
FLTCIP covers approved care provided at home by informal caregivers such as friends, family members, and other non-licensed caregivers. When informal care is provided by non-family members, it is covered for the benefit period you’ve selected. When informal care is provided by family members, it is covered for up to 500 days of care in your lifetime. Informal caregivers cannot have lived with you at the time you became eligible for benefits, but they can live in your home after you become eligible for benefits.
- Caregiver Training
FLTCIP pays up to seven times the daily benefit amount (DBA) to train family member or other informal caregivers to care for you.
- International Benefits
Because FLTCIP was designed exclusively for federal employees and related individuals, many of whom work outside the U.S., it features international benefits that provide coverage for those who may require care outside the United States. When you receive such services, FLTCIP pays benefits up to 80% of the benefit amounts shown on your Schedule of Benefits. If your Schedule of Benefits shows that you have an unlimited maximum lifetime benefit, benefits payable for any covered services you receive outside the United States will be limited to 10 years.
- Bed Reservations
If you are in an assisted living facility, nursing home or hospice facility and need to leave that facility for any reason (for example, if you need to be hospitalized), the bed-reservations feature in your coverage will pay up to 100% of the daily benefit amount for up to 60 days per calendar year to hold your space.
- Respite Care
This benefit provides temporary care if the caregiver (such as a family member) needs to take some time off. Respite care is covered up to 30 times the daily benefit amount per calendar year, and there is no waiting period requirement.
- There is No “War Exclusion”
Unlike coverage under most long-term care insurance plans, coverage under FLTCIP does not have a war exclusion. As a result, benefits may be payable for conditions due to war or acts of war, declared or undeclared, or service in the armed forces or auxiliary units.
- Third-Party Review of Claims
If your appeal of benefits eligibility or of a claims decision is denied, you may request an independent third-party review – provided by a third party that is mutually agreed to by OPM and Long Term Care Partners. The review, to be completed within 60 days of the time of request, will be final and binding.
- Alternate Plan of Care