Frequently Asked Questions

Benefits

Miscellaneous Benefits Questions

1. If I never use this insurance, can I get my premiums back?
    
2. Does the Program offer a spousal discount or any spousal benefits?
    
3. If I'm a Federal employee and enroll and then become disabled later, can I retire on disability and also qualify for benefits under the Federal Program?
    
4. Does the Federal Program coordinate benefits with other programs?
    
5. Why won't the FLTCIP pay for care given by people who normally live with me, such as my spouse?

1. If I never use this insurance, can I get my premiums back?

No. This is an insurance product. Think about how homeowners insurance works. If your house never burns up, you don't get your premiums back. Your premiums paid for protection you had while you owned the house.

Some long term care insurance products have a feature called "return of premium on death", or similar title. That provision would refund premiums to the enrollee's estate if the enrollee didn't file any claims and died before a certain age (e.g., 65). That is an expensive feature because the people who set the premiums always assume that there will be some policies that never pay out benefits -- those dollars are used to reduce everyone's premiums. Insurance by nature has many cross subsidies among enrollees.

Our program does not offer a return of premium feature.

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2. Does the Program offer a spousal discount or any spousal benefits?

No, the Program does not offer a separate spousal discount or benefit. FLTCIP rates are designed to be as low as possible for the entire eligible population. If we offered a spousal discount, rates for the rest of the group would have to be made higher to compensate for the discounts.

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3. If I'm a Federal employee and enroll and then become disabled later, can I retire on disability and also qualify for benefits under the Federal Long Term Care Insurance Program?

See the FAQ on being eligible for benefits. The Federal Long Term Care Insurance Program and the Federal disability retirement program are separate entities.

Once you have FLTCIP coverage, it's yours for life as long as you pay premiums. Any future eligibility for disability retirement or compensation benefits will not affect the terms of your FLTCIP coverage, including qualifying you for benefits. You must establish your eligibility for LTC benefits separately.

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4. Does the Federal Program coordinate benefits with other programs?

Yes. The Federal Program includes a coordination of benefits (COB) provision. This COB provision follows the guidelines set by the National Association of Insurance Commissioners (NAIC).

The COB provision allows Long Term Care Partners to look at other plans that might pay benefits for long term care services that you receive. The other plans they look at include government programs (other than Medicaid), group medical benefits, and other employer-sponsored long term care insurance.

They do not look at Medicaid, individual insurance policies or association group insurance policies. This COB provision does not apply to international benefits.

If the Federal Long Term Care Insurance Program (FLTCIP) is primary (this means it pays first), the FLTCIP will pay benefits without coordinating with other plans. That means that they will pay benefits to the maximum extent permitted by your coverage.

If another plan or program is primary, then it will pay first. In that case, Long Term Care Partners requires you to submit the explanation of benefits you received from that other plan or program showing that you submitted a claim to it and how that claim was decided.

Long Term Care Partners may also request a copy of the other plan or program booklet or terms of coverage. The FLTCIP will pay no more than the difference between the amount payable by your other coverage(s) and your actual expenses.

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5. Why won't the FLTCIP pay for care given by people who normally live with me, such as my spouse?

There are a few reasons for this restriction:

First, persons who normally live with you are natural sources of long term care services. Insurance, by definition, is not intended to cover services that would be provided without cost to the person receiving care in the absence of insurance. This helps to keep the cost of the insurance down.

The Program does indeed recognize the valuable role that spouses and other household members play in the long term care arena. The Federal Long Term Care Insurance Program provides a generous respite care benefit that is not subject to the waiting period. This benefit allows your regular caregiver (such as your spouse) to have a break from caring for you. The respite benefit will pay for services provided to you in a facility or by a formal or informal caregiver at home, for up to 30 times your daily benefit amount per calendar year.

The Program also provides a caregiver training benefit, also not subject to the waiting period. This benefit will pay up to 7 times your daily benefit amount in your lifetime for services to train someone to care for you -- including spouses and other persons who normally live with you.

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