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Outline of Insurance Coverage

Group Policyholder: United States Office of Personnel Management (OPM)
Insurer: John Hancock Life Insurance Company or Metropolitan Life Insurance Company
Federal Program Administrator: Long Term Care Partners, LLC
Group Policy Numbers: 900-001, 900-002

1. NOTICES
2. PURPOSE OF THE OUTLINE OF COVERAGE
3. LONG TERM CARE COVERAGE
4. ACTIVELY AT WORK REQUIREMENT
5. BENEFITS PROVIDED BY THE FEDERAL PROGRAM
   • Covered services
   • Benefit amounts
   • Maximum lifetime benefit
   • Schedule of benefits
   • International benefits
   • Alternate plan of care
   • Payment of benefits
   • Eligibility for benefits
   • Activities of Daily Living
   • Waiting period
   • Waiver of premium
   • Care coordination services
      
6. EXCLUSIONS AND LIMITATIONS
   • Exclusions
   • Limitations
   • Coordination of benefits
   • Catastrophic coverage limitation
      
7. RELATIONSHIP OF COST OF CARE AND BENEFITS
   • Automatic Compound Inflation (ACI) option
   • Future Purchase option (FPO)
   • Comparisons of ACI and FPO
     • Graphs for Comparing Inflation Options for ISSUE AGE 45
     • Graphs for Comparing Inflation Options for ISSUE AGE 55
     • Graphs for Comparing Inflation Options for ISSUE AGE 65
   • Other benefits changes (upgrades and downgrades)
      
8. WHEN YOUR PREMIUM MAY CHANGE
    
9. WHEN YOU MAY RECEIVE A PREMIUM REFUND
   • 30 day free look / cancellation of coverage
   • Other refunds of premium
      
10. WHEN INSURANCE COVERAGE MAY BE CONTINUED OR ENDED
    • When your insurance coverage will end
    • Reinstatement of coverage
    • Late payment grace period
    • Portability
    • Continuation of coverage
       
11. PREMIUMS
     
12. APPLYING FOR COVERAGE UNDER THE FEDERAL PROGRAM

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

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