Frequently Asked Questions

Benefits

International Benefits

1. What benefits are available to me for services outside the United States?
    
2. Can you give me a few examples of how benefits are paid outside the U.S., its territories and possessions?
    
3. What areas are considered to be inside the United States (and thus NOT subject to the "international" rules)?
    
4. So how would benefits be paid, for example, in Puerto Rico?
    

1. What benefits are available to me for services outside the United States?

The Program provides benefits for covered services you receive outside the United States, its territories and possessions. When you receive covered services internationally, we will pay benefits for such services up to 80% of the maximum amounts that would otherwise be payable.

If you have a 3 or 5 year benefit period, you can use 80% of your maximum lifetime benefit outside the United States; the remaining 20% would be available if you return to the United States.

If you have an unlimited benefit period, your Benefit Period will be limited to 10 years outside the United States. Your maximum lifetime benefit will be equal to 3,650 days (10 years) x 80% of your daily benefit amount. If you return to the United States, your maximum lifetime benefit would remain unlimited.

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2. Can you give me a few examples of how benefits are paid outside the U.S., its territories and possessions?

Example 1: Assuming you selected the comprehensive option with a daily benefit amount of $150 and that you have a 5 year benefit period. For purposes of determining international benefits, your daily benefit amount would be $120 ($150 x 80%) instead of $150. The Federal Long Term Care Insurance Program (FLTCIP) would pay up to $120 per day for services provided to you in a nursing home. The FLTCIP would pay up to $90 ($120 x 75%) per day for services provided to you by a formal or informal caregiver at home. Out of your maximum lifetime benefit of $273,750, you could use up to 80% ($219,000) outside the United States. If you return to the United States, the remaining 20% ($54,750) of your maximum lifetime benefit would be available.

Example 2: Assuming you selected the comprehensive option with a daily benefit amount of $150 and that you have an unlimited benefit period. Let’s also assume that you chose to have that amount reimbursed as a weekly benefit amount equal to $1,050 ($150 x 7). For purposes of determining international benefits, your daily benefit amount would be $120 ($150 x 80%) and your weekly benefit amount would be $840 ($120 x 7). The FLTCIP would pay up to $840 per week for services provided to you in a nursing home. The FLTCIP would pay up to $630 per week ($840 x 75%) for services provided to you by a formal or informal caregiver at home. Your maximum lifetime benefit outside the United States would be limited to $438,000 (3,650 x $120). If you return to the United States, your maximum lifetime benefit would remain unlimited.

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3. What areas are considered to be inside the United States (and thus NOT subject to the "international" rules)?

The Federal Program definition of the United States is "the United States, its territories and possessions". So that means the 50 states and the District of Columbia, the U.S. Virgin Islands, Puerto Rico, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.

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4. How would benefits be paid, for example, in Puerto Rico?

 The same way they'd be paid in the 50 states and the District of Columbia (i.e., NOT using the international rules). Puerto Rico is considered part of the United States under the Federal Program.

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