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Benefits Provided by the Federal Program
International Benefits
The Federal Program provides benefits for covered services you receive outside the United States, its territories and possessions (collectively referred to as the “United States”). When you receive such services, we will pay benefits up to 80% of the amounts listed in the Benefit Amounts subsection.
If you have a 3 Year or 5 Year Benefit Period, 80% of your Maximum Lifetime Benefit can be used for covered services you receive outside the United States; the remaining 20% is reserved for covered services you receive in the United States.
If you have an Unlimited Benefit Period, your Benefit Period will be limited to 10 years for covered services you receive outside the United States. For such services, your Maximum Lifetime Benefit will be equal to 3,650 days (10 years) x 80% of your Daily Benefit Amount. Your Maximum Lifetime Benefit for covered services you receive in the United States will remain unlimited.
The coordination of benefits provision described in the section titled Exclusions and Limitations (Coordination of Benefits subsection) does not apply to international benefits.
Example 1: Let’s assume that you select the Comprehensive Option with a Daily Benefit Amount of $150 and you have a 5 Year Benefit Period. For purposes of determining international benefits, your Daily Benefit Amount is $120 ($150 x 80%) instead of $150.We would pay up to $120 per day for services provided to you in a nursing home.We would pay up to $90 ($120 x 75%) per day for services provided to you by a formal or informal caregiver at home. Out of your Maximum Lifetime Benefit of $273,750, you could use up to 80% ($219,000) for all covered services you receive outside the United States. If you return to the United States and receive covered services, the remaining 20% ($54,750) of your Maximum Lifetime Benefit will be available for those services.
Example 2: Let’s assume that you select the Comprehensive Option with a Daily Benefit Amount of $150 and you have an Unlimited Benefit Period. Let’s also assume that you chose to have that amount reimbursed as a Weekly Benefit Amount equal to $1,050 ($150 x 7). For purposes of determining international benefits, your Daily Benefit Amount is $120 ($150 x 80%) and your Weekly Benefit Amount is $840 ($120 x 7).We would pay up to $840 per week for services provided to you in a nursing home. We would pay up to $630 per week ($840 x 75%) for services provided to you by a formal or informal caregiver at home. Your Maximum Lifetime Benefit for covered services you receive outside the United States would be limited to $438,000 (3,650 x $120). If you return to the United States and receive covered services, your Maximum Lifetime Benefit would remain unlimited for those services.
| Call: 1-800-LTC-FEDS (1-800-582-3337) (TTY: 1-800-843-3557) |
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