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?

Because this program was designed exclusively for the Federal Family, it features international benefits that provide coverage for enrollees who live or may require care outside the United States. When you receive such services, the FLTCIP pays benefits up to 80% of the benefit amounts shown on your Schedule of Benefits.

If your Schedule of Benefits shows that you have a 2, 3, or 5 year benefit period, 80% of your maximum lifetime benefit (MLB) can be used for covered services you receive outside the United States; the remaining 20% will be available for covered services you receive in the United States.

If your Schedule of Benefits shows that you have an unlimited MLB, benefits payable for any covered services you receive outside the United States will be limited to 10 years. For such services, your MLB will be equal to 3,650 days (10 years) x 80% of your daily benefit amount. Your MLB for covered services you receive in the United States will 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 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. 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 a daily benefit amount of $150 and that you have an unlimited benefit period. For purposes of determining international benefits, your daily benefit amount would be $120 ($150 x 80%) instead of $150. The FLTCIP would pay up to $120 per day for services provided to you. 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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