Frequently Asked Questions

Benefits

General Questions

1. What types of benefits does FLTCIP 2.0 cover?
    
2. What benefits can I choose with FLTCIP 2.0?
    
3. What types of Inflation Protection can I choose from?
    
4. What is the Daily Benefit Amount (DBA)?
    
5. What is the Benefit Period?
    
6. What is the Maximum Lifetime Benefit?
    
7. What is the Waiting Period?
    
8. What is Care Coordination?
    
9. What is the Stay-At-Home benefit?
    
10. What are the limits on reimbursement for covered services?
     
11. What makes me eligible for benefits?
    

1. What types of benefits does FLTCIP 2.0 cover?

The FLTCIP 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, the FLTCIP 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 is available for:

• Home care provided by a nurse, a home health aide, a 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 and assisted living facilities.
• 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 insurance 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, 5% 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 DBA and remaining portion of your maximum lifetime benefit will automatically increase by either 4% or 5% (depending on the percentage you choose when you apply) 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.*

With long term care costs continuing to rise almost every year, you may want to consider the Automatic Compound Inflation Option. The initial premiums are higher than the Future Purchase Option because you are prefunding automatic future benefit increases that are designed to help keep pace with inflation.

Future Purchase Option

With this option, you are given the opportunity to increase your DBA and maximum lifetime benefit every two years with a corresponding increase in your premium. Premiums are not guaranteed.* 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).

The amount of the increase to your DBA and the corresponding increase in your premium will be sent in a notice to you every two years in the fall. The increase will automatically take effect unless you tell us at that time you do not want the increase. Your coverage must be in effect for at least 12 months in order for you to receive your first increase under this option.

As your benefits increase, your Future Purchase Option premium increases and may eventually become greater than the Automatic Compound Inflation Option premium. You may want to consider if you can afford increased premiums for future increases to your benefits. If you do not plan to accept future increases, you may want to consider how you will pay for any long term care that exceeds the amount your insurance will cover.

You can change to the Automatic Compound Inflation Option at any time if you provide evidence of insurability (meaning you will be required to provide, at your expense, evidence of good health that is satisfactory to us).

* Premiums are set with the expectation that they will be sufficient, but they are not guaranteed. Premiums can increase only if you are among a group of enrollees whose premium is determined to be inadequate and both OPM and the insurer agree to the rate change.

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4. 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 $100 to $450 in $50 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 are also reimbursed up to 100% of your DBA.

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5. 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 can 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.

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6. What is the Maximum Lifetime Benefit?

The maximum lifetime benefit (MLB) is the maximum amount your coverage can pay. To calculate your MLB, multiply your DBA by your benefit period (in days).

FLTCIP benefit periods: 2 years (730 days), 3 years (1,095 days), 5 years (1,825 days), or the unlimited benefit period (no maximum lifetime benefit).

Example: The following is the MLB calculation for an enrollee with a DBA of $150 and a 3 year benefit period:

$150 x 1,095 days = $164,250 maximum lifetime benefit

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7. What is the Waiting Period?

The waiting period is 90 days. The waiting period is the number of calendar days during which you must be eligible for benefits before the Program will pay benefits. The Program 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. How does a calendar day waiting period work, and how does it differ from a service day waiting period?

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8. What is Care Coordination?

If you are approved for coverage and enroll, you will have unlimited access to the Program’s care coordinators. They are registered nurses (RNs) or licensed social workers 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. They can also help you find high-quality care providers in your area and share the results of state survey reports about service availability, quality, costs, and licensing. Gaining access to this level of detailed information allows you to make a 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. Unlike most long term care insurance plans, the FLTCIP also 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 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 daily benefit amount. The waiting period does not apply to the stay-at-home benefit. Benefits paid under the stay-at-home benefit will not reduce your maximum lifetime benefit.

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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10. 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:

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11.What makes me eligible for benefits?

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

a licensed health care practitioner has certified within the last 12 months that you are unable to perform at least 2 activities of daily living (without substantial assistance from another person), 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 (such as Alzheimer’s disease); and
• we agree with that certification; and
• we approve a written plan of care established for you by a licensed health care practitioner or our care coordinator.

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