Frequently Asked Questions

Benefits

The benefits discussed here are included in FLTCIP 2.0 (the latest plan design). If you are a FLTCIP 1.0 enrollee researching the differences between your plan and the latest plan design, please read the FLTCIP Plan Comparison to see what FLTCIP 2.0 offers and how it compares to the original plan, FLTCIP 1.0.

1. What types of benefits does FLTCIP 2.0 offer?
    
2. What benefits can I choose with FLTCIP 2.0?
    
3. What is the daily benefit amount (DBA)?
    
4. What is the benefit period?
    
5. What is the maximum lifetime benefit (MLB)?
    
6. What types of inflation protection can I choose from?
    
7. What is the waiting period?
    
8. What is care coordination?
    
9. What are bed reservations and when would I need them?
    
10. What is the stay-at-home benefit?
     
11. What are the limits on reimbursement for covered services?
     
12. What makes me eligible for benefits?
    

1. What types of benefits does FLTCIP 2.0 offer?

The Federal Long Term Care Insurance Program’s (FLTCIP’s) FLTCIP 2.0 plan provides comprehensive coverage, regardless of whether you receive care at home, in an assisted living facility, in a nursing home, or in an inpatient hospice care environment. Additionally, FLTCIP 2.0 covers care provided in the home by friends, family members, and other unlicensed caregivers who did not normally live in your home at the time you became eligible for benefits. When informal care is provided by your family members, it is covered for up to 500 days.

Up to 100% of your daily benefit amount (DBA) is available for:

• Home care provided by a nurse, home health aide, therapist, or other authorized provider (including a friend or family member authorized to act as an informal caregiver)
• Care provided in the community, including adult day care
• Care provided in an assisted living facility
• Nursing home care, including room and board, skilled and custodial care, and a wide range of other services

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2. What benefits can I choose with FLTCIP 2.0?

You can customize your coverage in several areas:

• Daily benefit amount (from $100 to $450 in $50 increments)
• Benefit period (2 year, 3 year, 5 year, or unlimited)
• Inflation protection (4% Automatic Compound Inflation Option, 5% Automatic Compound Inflation Option, or Future Purchase Option)

Alternatively, you can choose from four prepackaged plans. If you do, you will select only your inflation protection option.

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3. 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 is less than your DBA, the difference is carried over for you to use later.

You choose your daily benefit amount. You may choose a DBA from $100 to $450 in $50 increments. The cost of home care and adult care as well as 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.

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4. What is the benefit period?

This is the length of time benefits will be paid if you receive benefits each and every day equal to your DBA. You may choose from a 2 year, 3 year, 5 year, or unlimited benefit period.

If you receive services that cost less than your DBA or you don’t receive services every day, your benefits will last longer than your benefit period.

The benefit period is used together with the DBA to calculate the maximum lifetime benefit (MLB).

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5. What is the maximum lifetime benefit (MLB)?

The maximum lifetime benefit (MLB) is the total amount of money that can be paid over the lifetime of your coverage.

It is equal to your benefit period (in days) multiplied by your daily benefit amount. It may increase or decrease (i.e., with plan changes, inflation option increases, etc.) and is reduced as benefits are paid.

If you are currently enrolled, refer to your most recent Schedule of Benefits and Benefit Booklet for more detail.

If you have questions, please contact our Customer Service Center at 1-800-LTC-FEDS (1-800-582-3337) (TTY 1-800-843-3557).

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6. What types of inflation protection can I choose from?

To help your coverage keep pace with inflation, the FLTCIP lets you choose between the following two inflation protection options:

The Automatic Compound Inflation Option

With this option, your DBA and remaining portion of your MLB will automatically increase by either 4% or 5% (depending on the percentage you choose) compounded every year. The increases under this option are made even if you are eligible for benefits, without regard to your age, claim status, claim history, or the length of time your coverage has been in effect. Your premium does not increase annually as a result of this annual increase in benefits. However, premiums are not guaranteed.*

The Future Purchase Option

With this option, you are given the opportunity to increase your DBA and the remaining portion of your MLB every two years with a corresponding increase in your premium.* You may decline the increase an unlimited number of times. The increase in your benefits is based on the U.S. Department of Labor’s Consumer Price Index for All Urban Consumers (CPI-U). Your coverage must be in effect for at least 12 months in order for you to receive your first increase under this option.

To learn more about these options, visit the Inflation Protection Option section of our website or the Inflation Protection Options FAQs, or read the Relationship of Cost of Care and Benefit Selection section in the FLTCIP 2.0 Outline of Coverage in Book 1.

* Premiums are not guaranteed. Your premium will not change because you get older or your health changes or for any other reason related solely to you. Premiums may only increase if you are among a group of enrollees whose premium is determined to be inadequate. While the group policy is in effect, OPM must approve the change.

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7. What is the waiting period?

The waiting period is the time between becoming eligible for benefits and when long term care insurance actually begins paying benefits. Sometimes known as an elimination period or deductible, it helps keep premiums affordable. FLTCIP 2.0 offers a 90 calendar day waiting period.

Under the calendar day waiting period, once an enrollee is determined to be eligible for benefits, the day the enrollee is determined to be eligible for benefits and every day thereafter count toward the waiting period. The enrollee does not have to receive long term care services during the waiting period.

The FLTCIP does not pay benefits for services you receive during your waiting period except for hospice care, respite services, and the stay-at-home benefit. 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.

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8. What is care coordination?

If you are approved for coverage and enroll, you will have unlimited access to the FLTCIP’s care coordinators. They are registered nurses (RNs) who have worked extensively in the field of long term care. You can contact them to ask any questions you may have about long term care (even if you are not receiving benefits). If you initiate a claim and are approved for benefits, care coordinators will work with you and/or your family members to develop a plan of care to meet your individual care needs. With the use of provider locator tools, care coordinators can also help you find appropriate formal providers in your area, along with the cost of care and licensing status. They can share the results of state survey reports about service quality to help you make the most knowledgeable decision about which provider is best for you.

Care coordinators can also arrange for discounted services, monitor the care you’re receiving, and assist with changing your plan of care as your needs change. This service is personal because you can talk to the same care coordinator who knows your particular situation each time you call. In addition, the FLTCIP provides certain care coordination services to qualified relatives of enrollees at no cost. This can be invaluable in helping reduce the stress that may develop when a relative needs long term care.

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9. What are bed reservations and when would I need them?

If you are in a nursing home, an assisted living facility, or a hospice facility and you leave the facility temporarily (for example, you need acute care in a hospital for a few days), that facility may charge you to hold your bed until you return. The FLTCIP bed reservation feature covers the cost of holding a space in the facility.

Benefits for bed reservations are limited to 60 days per calendar year.

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10. What is the stay-at-home benefit?

The stay-at-home benefit is designed to enable enrollees who are in need of long term care services to stay at home for as long as possible. The stay-at-home benefit is equal to 30 times your DBA. The waiting period does not apply to the stay-at-home benefit. Benefits paid under the stay-at-home benefit will not reduce your MLB.

The stay-at-home benefit will reimburse expenses for the following:

• care planning visits
• home modifications
• emergency medical response systems
• durable medical equipment
• caregiver training
• home safety checks

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

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

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12. What makes me eligible for benefits?

You are eligible for benefits if, after your coverage becomes effective:

1. A licensed health care practitioner has certified within the last 12-months that:
   
   
• you are unable to perform, without substantial assistance from another person, at least 2 activities of daily living for an expected period of at least 90 days due to a loss of functional capacity; or
  
  
• you require substantial supervision due to your severe cognitive impairment; and
  
  
2. We agree with that certification; and
   
   
3. We approve a written plan of care established for you by a licensed health care practitioner or our care coordinator.

• places a person in jeopardy of harming him/herself or others and, therefore, the person requires substantial supervision by another person; and
  
  
• is measured by clinical evidence and standardized tests that reliably measure impairment in short or long term memory; orientation to people, places or time; and deductive or abstract reasoning.

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