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Exclusions and Limitations
Exclusions
The Federal Long Term Care Insurance Program (FLTCIP) does not pay benefits for any of the following:
- illness, treatment or medical condition arising out of:
- your participation in a felony, riot or insurrection;
- your attempted suicide, while sane or insane; or
- injuries you intentionally inflict on yourself;
- care or treatment for alcoholism or drug addiction;
- care or treatment provided in a government facility, including a Department of Defense or Department of Veterans Affairs facility, unless otherwise required by law;
- care you receive while in a hospital, except in a unit specifically designated as a nursing home or hospice facility;
- any service or supply to the extent the expense for it is reimbursable under Medicare, or would be so reimbursable except for the application of a deductible, coinsurance or copayment amount. (This exclusion will not apply in those instances where Medicare is determined to be the secondary payor under applicable law);
- services or supplies for which you are not obligated to pay in the absence of insurance; or
- services provided by any person who normally lived in your home at the time you became eligible for benefits.