Frequently Asked Questions

Consumer Protections

1. What consumer protections are in place?
    
2. What is a contingent nonforfeiture benefit?
    
3. What does portability mean?
    
4. What is protection against unintended lapse (PAUL)?
    
5. Can the insurance company cancel coverage?
    
6. Can I decrease my coverage?
    
7. Can I increase coverage?
    
8. What if I disagree with the insurance company's decision on being eligible for benefits and/or its decision on my claim?

1. What consumer protections are in place?

The Federal Long Term Care Insurance Program (FLTCIP) includes numerous consumer protections, including a contingent nonforfeiture provision, inflation protection options, portability, and guaranteed renewability (the insurance company can't cancel coverage except for non-payment of premiums).

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2. What is a contingent nonforfeiture benefit?

A contingent nonforfeiture benefit is built into the FLTCIP. If the insurer increases your premium over your initial premium rate by a specific percentage that varies by issue age, you will be provided with the following options:

• you may maintain your current benefits and pay the new increased premium;
• you may reduce your benefits to maintain your current premium; or
• you may convert your coverage to paid-up coverage, and your new maximum lifetime benefit would be equal to the amount of premiums you have paid for your coverage.

Note: The percentage increase is cumulative from the date you first purchased your coverage (in the event that your premium rate is increased more than once).

Table. Contingent nonforfeiture thresholds

From the National Association of Insurance Commissioners, “Long Term Care Insurance Model Regulation,” http://webcache.googleusercontent.com/search?q=cache:iEXX5gcbs6wJ:www.id.state.az.us/publications/ltc_mod_reg_641.pdf+arizona+long+term+care+model+act&cd=1&hl=en&ct=clnk&gl=us&client=firefox-a (accessed October 21, 2010).

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3. What does portability mean?

It means that once you enroll, you will remain enrolled as long as you pay the premiums. It doesn't matter if you leave Federal service, divorce your Federal spouse, or otherwise lose the affiliation that made you eligible to apply for coverage under the FLTCIP.

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4. What is protection against unintended lapse (PAUL)?

When you enroll, you are given an opportunity to designate a person who will be sent a notice if your coverage is about to lapse for nonpayment of premiums. This person is not responsible for making your payments. It may be a good idea to choose someone living outside of your household as your designee.

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5. Can the insurance company cancel coverage?

FLTCIP coverage is guaranteed renewable, which means that the only time the insurance company may cancel coverage is if you don't pay your premiums. There is also a 30-day grace period for late payments. And, as explained in the preceding question, if you assign a protection against unintended lapse (PAUL) designee, we will notify him/her if you are about to lapse due to nonpayment of premiums.

The insurance carrier may transfer your coverage to another carrier if OPM selects a different carrier to insure the FLTCIP. They may also void your coverage if you misrepresent facts in completing your application.

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6. Can I decrease my coverage?

Yes. You can request a decrease in your coverage at any time. You can decrease to anything that is available under the FLTCIP, and your premiums (which are based on your age at purchase) will also decrease. You do not have to undergo new underwriting in order to decrease your coverage.

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7. Can I increase coverage?

At any time, you may request an increase (upgrade) in your coverage by contacting Long Term Care Partners. When you request an increase, you must provide, at your expense, evidence of your good health that is satisfactory to Long Term Care Partners. The amount of an increase is subject to what's then available under the FLTCIP.

If you request and we approve any coverage increase, your premium for the additional coverage will be based on your age and the premium rates in effect at the time the increase takes effect.

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8. What if I disagree with the insurance company's decision on being eligible for benefits and/or its decision on my claim?

All denials are reviewed internally at Long Term Care Partners before they are ever issued. If you receive a denial, the denial letter will let you know how to request a review of the decision. If the denial is reviewed and upheld, you may request an appeal. The letter upholding the denial will explain the appeal process to you.

All appeals are reviewed by an appeals committee composed of one or more representatives of John Hancock Life & Health Insurance Company and other person(s) mutually agreed upon by OPM and Long Term Care Partners.

If the appeals committee upholds the denial, you may have the right to request a review by an independent third party. The letter upholding the denial will give you the details on requesting a review by an independent third party. The decision by the independent third party is final and binding on Long Term Care Partners.

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