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General Provisions
Statements Made by You Relating to Insurability
No statement made by you which relates to insurability will be used by us to Void your coverage or to deny an otherwise valid claim, unless the statement was contained in a Written form that you signed and a copy of such form was provided to you.
If your coverage has been in force for less than 6 months, we may Void your coverage upon a showing of Misrepresentation by you.
If your coverage has been in force for at least 6 months but less than 2 years, we may Void your coverage upon a showing of Misrepresentation that pertains to the condition for which benefits are sought.
If your coverage has been in force for 2 years or more, we may Void your coverage only upon a showing that you knowingly and intentionally, by statement or omission, provided false or misleading information Material To Your Insurability.
If your coverage is Voided, no claims for benefits will be paid, and the Notice and Review of Claim Determination and Appeals sections will not apply. If we Void your coverage, our letter notifying you will explain the process for requesting review of our decision. If you believe that your coverage was Voided in error, you may request that we review our decision. You must submit your request in writing to us within 30 days of the date of the letter Voiding your coverage.
If you request a change in coverage, a reinstatement of coverage, or an increase in benefits and the information provided in support of your request contains a Misrepresentation, we may Void the change, reinstatement or increase or deny any changed, reinstated, or increased benefits on an otherwise valid claim in accordance with the above provisions, provided that the time limits shall refer to the time period that the change, reinstatement, or increase in benefits has been in effect.
For purposes of determining how long your coverage has been in force, your coverage under any prior Benefit Booklet issued to you under the Federal Long Term Care Insurance Program (FLTCIP) will be considered.
If your date of birth is not correct as shown on your Application, we may make a retroactive adjustment in premium and/or benefits that we deem appropriate, based on the correct information.
Your coverage has no cash surrender value or other monetary value that can be paid, assigned, borrowed, or pledged as collateral for a loan.
Your coverage is underwritten by John Hancock Life & Health Insurance Company.
Right to Change Contract Provisions
We reserve the right to make changes in this Benefit Booklet, the Group Policy, or the administration of the FLTCIP consistent with applicable laws or regulations. Any such change will be made in consultation with OPM and will apply to all enrollees who have received affected Benefit Booklets. We will give you Written notice of any change to this Benefit Booklet as soon as is reasonably possible.
Interpretation of Terms, Conditions and Provisions
The Group Policy, this Benefit Booklet and your Schedule of Benefits determine the governing contractual provisions. We will apply them consistent with the Act and FLTCIP regulations. We have discretion to interpret the terms, conditions and provisions of the Group Policy, this Benefit Booklet and the Schedule of Benefits. OPM may consult with us about our interpretation.
No legal action or suit under the FLTCIP may be started against us or the FLTCIP administrator:
No legal action or suit to recover benefits under the FLTCIP may be started against OPM or the independent third party that reviews a denial on appeal.
In any action at law or in equity that relates to the FLTCIP, the amount of recovery shall be limited to the benefit that would be payable under the FLTCIP. No extra-contract, punitive, compensatory, or consequential damages shall be recoverable under the FLTCIP.
The FLTCIP shall supersede and preempt any state or local law, regulation, or requirement as permitted by the Act or any FLTCIP regulations.
We will refund any premium that you paid and that has not already been refunded to cover any period:
If, at the time of your death, any portion of benefits is payable or any premium is to be refunded as described under the Refund of Premiums subsection, we will pay such amount to your estate or to an alternative payee. The alternative payee must be a person who is deemed, in our sole discretion, to be justly entitled to the payment. Neither the FLTCIP administrator nor we will be liable as a result of any payment made in good faith under this provision.
| Call: 1-800-LTC-FEDS (1-800-582-3337) (TTY: 1-800-843-3557) |
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