Frequently Asked Questions

Benefits

General Questions

1. What types of benefits does this Program cover?
    
2. What benefits can I choose?
    
3. What types of Inflation Protection can I choose from?
    
4. What is a facilities-only plan vs. a comprehensive plan?
    
5. What is the Daily Benefit Amount (DBA)?
    
6. What are weekly benefits?
    
7. What is the Benefit Period?
    
8. What is the Maximum Lifetime Benefit?
    
9. What is the Waiting Period?
    
10. What is Care Coordination?
     
11. What are the limits on reimbursement for covered services?
     
12. I understand that the Program has a Catastrophic Coverage Limitation, instead of a war/terrorism exclusion. So what's that and how does it affect enrollees?
    

1. What types of benefits does this Program cover?

This Program offers a choice of benefits that can provide a variety of services, including but not limited to:

• nursing home care
• assisted living facility care
• home care (both formal and informal)
• adult day care
• hospice care
• respite services
• bed reservations
• caregiver training

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2. What benefits can I choose?

You can customize your insurance in several areas:

• Facilities-Only or Comprehensive Coverage
• Daily Benefit Amount (from $50 to $300 in $25 increments)
• Weekly Benefits (available with a comprehensive plan only)
• Benefit Period (3 year, 5 year or unlimited)
• Waiting Period (30 days or 90 days)
• Inflation Protection (automatic compound or future purchase)

OR alternatively you can choose from four pre-packaged plans. If you do, you will only have to choose your inflation protection method.

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3. What types of Inflation Protection can I choose from?

To help your coverage keep pace with inflation, the Federal Long Term Care Insurance Program lets you choose between the following two inflation protection options:

Automatic Compound Inflation Option

With this option, your Daily Benefit Amount (DBA) and the remaining portion of your maximum lifetime benefit will automatically increase at a rate of 5% compounded annually with NO corresponding increase in your premium. The benefit increases continue even if you are eligible for benefits.

While the initial premium is higher with this option, you won't have to think about the cost of having to buy additional coverage or worry about whether your coverage (especially after you retire) will keep pace with inflation. Your benefits increase year after year, while your premium remains level.

Future Purchase Option

This allows you to buy additional coverage every two years at an extra cost. The increase offered in your Daily Benefit Amount and the remaining portion of your maximum lifetime benefit is based on increases in the Consumer Price Index for Medical Care.

With the Future Purchase Option, you can assess the costs of care in the future and make a decision to upgrade when you can afford to. Each time you buy additional coverage, your premium will increase. The premium for the additional coverage will be based on your age and premium rate at the time the increase takes effect.

Every two years you will receive your Future Purchase Option notification provided you are not eligible for benefits and have not declined three Future Purchase notifications in the past.

A unique feature of our Program is your ability to switch to the Automatic Compound Inflation Option, for an additional premium, without proof of good health when you receive your Future Purchase notification as long as you are not eligible for benefits and have not declined three Future Purchase notifications in the past.

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4. What is a facilities-only plan vs. a comprehensive plan?

A Facilities-only Plan covers care in assisted living facilities, nursing homes and inpatient hospice care. It also provides benefits for respite services in a facility. It does not cover home care.

A Comprehensive Plan covers everything a facilities-only plan covers plus care at home (formal or informal care), in adult day care centers, hospice care at home and respite services at home.

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5. What is the Daily Benefit Amount (DBA)?

This is the maximum amount the plan will pay in any single day. If the cost of the care you receive in a single day costs less than your DBA, the difference is carried over for you to use later.

You choose your daily benefit amount. You can choose a DBA from $50 to $300 in $25 increments. The cost of care in an assisted living facility or a nursing home or hospice care (whether in a facility or at home) will be reimbursed up to 100% of your DBA. Home care and adult day care will be reimbursed up to 75% of your DBA.

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6. What are weekly benefits?

You can choose whether you want your benefits reimbursed on a daily basis or on a weekly basis (equal to 7 times your DBA) for greater flexibility. Weekly benefits are available with a comprehensive plan only.

For example, if you elect a $100 daily benefit amount and choose to have your benefits reimbursed on a weekly basis, that would mean you had a weekly benefit amount of $700. Your reimbursement would not be limited to only $100 per day. Weekly benefits cost more than daily benefits.

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7. What is the Benefit Period?

This is the length of time your Maximum Lifetime Benefit will last if you receive care every single day at a cost equal to or more than your Daily Benefit Amount (DBA). If you receive services that cost less than your DBA, or don't receive services every day, your benefits will last longer than your benefit period.

You choose your benefit period — either 3 years, 5 years, or unlimited.The Benefit Period is used as a multiplier, along with your DBA, to calculate your Maximum Lifetime Benefit.

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8. What is the Maximum Lifetime Benefit?

This is the maximum your plan will pay. Here is how we arrive at the figure:

Daily Benefit Amount (DBA) x Benefit Period (in days) = Maximum Lifetime Benefit

For example, if you choose a $100 DBA and a 3 year Benefit Period, your Maximum Lifetime Benefit would be $109,500 ($100 x 1095 days (which is 3 years at 365 days/year)) =$109,500.

If you receive services that cost less than your DBA, or don't receive services every day, your benefits will last longer than your benefit period. This amount of money is available for reimbursement of approved long term care costs for as long as you're eligible for benefits, after you meet the waiting period you selected.

You may have heard the maximum lifetime benefit referred to as a "pool of money." An unlimited benefit period has no maximum lifetime benefit — it is unlimited.

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9. What is the Waiting Period?

The waiting period is the number of days during which you must be eligible for benefits and receiving covered services before your benefits start. It works like a deductible in health insurance.

You only have to satisfy the waiting period once in your lifetime. Days applied toward satisfying the waiting period need not be consecutive, nor associated with the same episode of care. The days will be added together until the waiting period is satisfied.

When you apply for coverage, you select the length of your waiting period — the standard is 90 days, but you may choose 30 days instead, at an additional cost.

The Program does not pay benefits during your waiting period. However, the waiting period does not apply to hospice care, respite care, and caregiver training. Because there is no waiting period for hospice care, respite care, and caregiver training, these covered services do not count toward meeting your waiting period.

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10. What is Care Coordination?

Long Term Care Partners' care coordinators (all registered nurses) are available under the Program to provide general information about long term care services, assess and approve your need for long term care services, develop a plan for your receipt of long term care services, and then monitor and reassess those services.

The care coordinators can tell you about any providers in your area who offer discounts for the services you need and provide other assistance such as locating community resources.

Care coordination services are also available to your qualified relatives even if they aren't enrolled in the program, as long as you are enrolled in the Program. (Certain services for qualified relatives may be provided at an additional charge.)

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11. What are the limits on reimbursement for covered services?

The Federal Program provides reimbursement for actual charges you incur for covered services up to the following percentages:

If you select the Comprehensive Option, you may choose to have benefits for covered services determined on a weekly instead of a daily basis. The weekly benefit amount is equal to 7 x your daily benefit amount. If you choose the weekly benefit amount, the Federal Program provides reimbursement for actual charges you incur for covered services up to the following percentages:

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12. I understand that the Program has a Catastrophic Coverage Limitation, instead of a war/terrorism exclusion. So what's that and how does it affect enrollees?

Only a real catastrophic event that affects such a significant number of enrollees that it threatens to undermine the financial stability of the Program can trigger the Limitation. Both Long Term Care Partners and OPM must agree the event meets this definition.

If a catastrophic event triggers the Limitation and the Limitation affects your claim, your Daily Benefit Amount would remain the same, but your Benefit Period would be shortened.

Only enrollees who become eligible for benefits as a result of a catastrophic event are affected. Enrollees who file a claim not related to the event are not affected, nor are enrollees who are already on claim at the time. Also, anyone whose claim is denied has the right to an independent third party review of their claim. Long Term Care Partners will restore any benefits reduced under the catastrophic provision if the Program later develops sufficient reserves to cover those reductions.

We believe that our Catastrophic Coverage Limitation is much better than a war/terrorism exclusion. A war/terrorism exclusion, common to other long term care insurance policies, excludes payment of benefits for anyone whose claim arises due to a war or terrorism. There is no threshold or requirement that the claim threaten the financial stability of the Program -- if a claim is due to war, it is not paid. Of course, events other than war or terrorism could trigger the Catastrophic Coverage Limitation.

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