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When Insurance Coverage May Be Continued or Ended

When Your Insurance Coverage Will End

Your insurance coverage will end on the earliest of the following:

• the date you specify to us that you wish your coverage to end;
• the date of your death;
• the end of the period covered by your last premiums payment if you do not pay the required premiums when due;
• the date the group policy ends, subject to continuation of coverage as described below; or
• the date that you have exhausted your Maximum Lifetime Benefit (in this event, Care Coordinationservices will continue). 

Reinstatement of Coverage

If your coverage ends because you did not pay your premiums when due, your coverage will be reinstated as of the date it ended if, within six months of the date your coverage ended, you or your representative:

• submit evidence satisfactory to us that you suffered a cognitive impairment or loss of functional capacity before the expiration of the 30-day grace period for payment of your premiums (the standard of proof we will require will be no more restrictive than the requirements to establish eligibility for benefits); and
• submit all past due premiums to us.

If your coverage ends because you canceled it or did not pay your premium when due, your coverage will be reinstated as of the date it ended, if within 12 months of the date coverage ended, you:

• request reinstatement; and
• submit, at your expense, evidence of your good health that is satisfactory to us; and
• submit all past due premiums to us.

If your coverage is reinstated, your premiums will be based on your age as if your coverage had continued without interruption.  

Late Payment Grace Period

There is a 30-day grace period for payment of your premium. This means that we must receive your premium payment by the 30th day after the date it is due. If we do not receive your premium by the end of this grace period, we will send you written notice of termination of your coverage by first class United States mail. You will have 35 days from the date of the termination letter to pay your premium, otherwise your coverage will end.  

Portability

Your long term care insurance coverage under the Federal Program is fully portable. This means that once you have coverage under the Federal Program and later are no longer a member of an eligible group, you can keep your coverage if you continue to pay the required premiums and have not exhausted your Maximum Lifetime Benefit. Your premiums and coverage will not change because you left the group.  

Continuation of Coverage

If the group policy ends, OPM has stated that it intends to continue your insurance coverage by replacing the group policy with another that will:

• be effective on the day after the group policy ends;
• provide coverage that is substantially the same as that provided by the group policy; and
• calculate your premium based on the same issue age(s) as under the group policy.

In the unlikely event that the group policy ends and there is no replacement policy as described above, we will continue your coverage.

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Call: 1-800-LTC-FEDS (1-800-582-3337) (TTY: 1-800-843-3557)

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