Frequently Asked Questions

Consumer Protections

1. What consumer protections do enrollees have?
    
2. What is a contingent nonforfeiture provision?
    
3. What does complete portability mean?
    
4. Can the insurance company cancel coverage?
    
5. Can I decrease my coverage?
    
6. Can I increase coverage?
    
7. 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 do enrollees have?

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

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2. What is a contingent nonforfeiture provision?

"Contingent nonforfeiture" means that if the insurer increases premiums beyond a specific percentage, a participant can choose to either reduce their benefits or elect to stop paying premiums and retain a reduced level of coverage.

We never expect this scenario to happen, but contingent nonforfeiture is built into the coverage offered.

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3. What does complete portability mean?

It means that once you enroll in the program, 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 your affiliation to the Federal Family.

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4. Can the insurance company cancel coverage?

The only times the insurance company may cancel coverage is if you don't pay the premiums. They may also rescind your coverage if you misrepresent facts in completing your application.

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5. 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 Program, and your premiums (which are based on your original age) will also decrease. You do not have to undergo new underwriting in order to decrease your coverage.

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6. Can I increase coverage?

At any time, you may request an increase (upgrade) in your coverage by contacting Long Term Care Partners. In order to receive approval of a request for an increase (outside of an open season), you must provide, at your expense, evidence of your good health that is satisfactory Long Term Care Partners. The amount of an increase is subject to what's then available under the Program.

If you request and Long Term Care Partners approves an increase in your daily benefit amount (not counting an increase due to your inflation protection option), your additional premium is based on your age and the premium rates in effect at the time the increase takes effect.

Other coverage increases you request that Long Term Care Partners approves will cause your entire premium to be based on your age and the premium rates in effect at the time the increase takes effect.

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7. 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 before they are ever issued. If you receive a denial, the denial letter will let you know how to request a review of the denial. If that denial is upheld, you may request an appeal. The letter upholding the denial will explain this process to you.

All appeals are reviewed by an appeals committee composed of: one or more representatives of John Hancock Life Insurance Company, one or more representatives of Metropolitan Life 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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