Frequently Asked Questions

Applying for Coverage

Coverage Exclusions

1. The Federal Long Term Care Insurance Program (FLTCIP) denies coverage to people who use a wheelchair. How can this be allowed?



2. Can someone with disabilities enroll?



3. Why can't all employees enroll in the standard insurance coverage?



4. Is there an exclusion for preexisting conditions?

1. The Federal Long Term Care Insurance Program (FLTCIP) denies coverage to people who use a wheelchair. How can this be allowed?

The Americans with Disabilities Act (ADA) does not prohibit the underwriting of risks by insurance companies. Insurance companies may legally decline to insure people who are not acceptable insurance risks, as long as it is actuarially justified and all classes of people with the same or similar conditions are treated in the same manner.

For example, it is standard industry practice to decline to issue long term care insurance coverage to people in wheelchairs, people who use some other medical devices, and/or people who have certain medical conditions or combinations of conditions because people in these categories have a significantly higher chance of needing long term care services.

Accepting such risks would increase the price of the insurance considerably, resulting in adverse selection and potentially the eventual demise of the FLTCIP.

The Long-Term Care Security Act, which established the FLTCIP, recognized that underwriting would be necessary. The law states, "Nothing in this chapter shall be considered to require that long-term care insurance coverage be guaranteed to an eligible individual."

The FLTCIP does offer an alternative to those whose applications for standard coverage are denied. Visit the Alternative Insurance Plan and the Service Package FAQs to learn more.

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2. Can someone with disabilities enroll?

Anyone in an eligible group can apply for coverage. Of course, there are a range of disabilities and differing levels of severity of medical conditions. So as with all applicants, some people with disabilities or particular medical conditions will have their applications approved and others will not be approved.

As with all other applicants, acceptance or denial of a disabled person's application will depend on whether the person can meet the underwriting requirements. Depending on answers to the underwriting questions, those denied may be offered other options.

The FLTCIP does offer an alternative to those whose applications for standard coverage are denied. Visit the Alternative Insurance Plan and the Service Package FAQs to learn more.

The Federal government has distinguished itself as a leader in recruiting individuals with disabilities. As a result, they have significantly more employees with disabilities than many private sector employers. Without some form of underwriting (questions about health status), we could not offer attractive and affordable long term care insurance.

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3. Why can't all employees enroll in the standard insurance coverage?

All employees who apply will be offered some form of benefit. However, due to health reasons, a small minority will be offered the Alternative Insurance Plan or the Service Package. These individuals would probably not be able to receive any long term care insurance benefits from the private sector.

Because over 90% of eligible employees have health insurance, the added costs of those in poor health can be spread over many, many others. The percentage of employees who typically purchase long term care insurance is less than five percent. So it wouldn't take many in poor health to drive up the costs (premiums) for the others.

If the FLTCIP guaranteed standard insurance to all employees who applied, the insurance carrier would have added the expected costs of those in poor health to the premium. With no government contribution, many healthier employees who could pass underwriting would find less expensive premiums and purchase coverage elsewhere. The program would then be left with insuring fewer healthy individuals and more individuals who couldn't purchase private insurance, requiring even higher premiums to cover their risks.

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4. Is there an exclusion for preexisting conditions?

No. Preexisting conditions may prevent you from obtaining FLTCIP coverage in the first place, but if you qualify for coverage, they won't cause a denial of a claim for benefits, so long as they were appropriately disclosed on your application.

You have to pass underwriting to enroll in this program (answering health questions, possibly authorizing access to medical records, possibly being interviewed by a registered nurse). If your application is approved and you become eligible for benefits, you cannot be denied benefits because of a preexisting condition that you disclosed during the application process.

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