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• Additional Services & Benefits

Additional Services and Benefits

In addition to our choice of inflation options and the coverage offered under our Facilities-Only and Comprehensive plans, the Federal Program offers a number of additional services and benefits to meet your needs, including:

• Alternate Plan of Care
• Informal Caregiver Provisions
• Caregiver Training
• International Benefits
• Bed Reservations
• Respite Care
• No War Exclusion
• Third-party Claims Review
• Weekly Benefit Amount Option

For a complete list of features and services, see our Benefit Booklet.
 

Alternate Plan of Care

In certain circumstances, our Care Coordinators can authorize customized benefits for services that are not specifically covered under this Program. For example, if you select the Comprehensive Option, the Program may cover making your home wheelchair-accessible.

Under an alternate plan of care, we will also consider a facility that is not normally covered under this Program. A facility that is not licensed by the state may still be considered if it meets your needs. The flexibility of an alternate plan of care allows the Program to provide you with benefits for cost-effective care and services you want and need.

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Informal Caregiver Provisions

The Program covers care provided by informal caregivers — those not licensed or employed by a home care agency. Unlike some other plans, the Comprehensive Option available under this Program also covers approved care provided at home by friends, family members, and other non-licensed caregivers. When informal care is provided by non-family members, it is covered for the Benefit Period you’ve selected (3 Years, 5 Years or Unlimited). When informal care is provided by family members, it is covered for up to 365 days of care in your lifetime.

Informal caregivers cannot have lived with you at the time you became eligible for benefits, but they can live in your home after you become eligible for benefits.

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Caregiver Training

With the caregiver training benefit, the Program will pay up to seven times your Daily Benefit Amount (DBA) (with no Waiting Period) to train a family member or other informal caregiver to care for you.

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International Benefits

Because this Program was designed exclusively for the Federal Family, it features international benefits that provide coverage for those enrollees who may require care outside the U.S. The Program will calculate benefits in the usual way except that it will pay benefits up to 80% of your DBA / Maximum Lifetime Benefit Amount.

You can use up to 80% of your Maximum Lifetime Benefit for services received outside of the U.S.; the other 20% is reserved for covered services you receive in the U.S. (For those who have selected an Unlimited Benefit Period, benefits for services received outside of the U.S. will be limited to 10 years, [3,650 days] x DBA.).

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Bed Reservations

If you are in an assisted living facility, nursing home or hospice facility and need to leave that facility for any reason (e.g., you need to be hospitalized), the bed reservations feature in your coverage will pay to hold your space for up to 30 days per calendar year.

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Respite Care

This benefit helps pay for temporary care if your caregiver (such as a family member) needs to take some time off. This benefit will pay up to 100% of your DBA per day; limited to 30 times your DBA per calendar year (with no Waiting Period).

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No War Exclusion

Unlike coverage under most long term care insurance plans, your coverage under the FLTCIP does not have a war exclusion. As a result, benefits may be payable for conditions due to war or acts of war, declared or undeclared, or service in the armed forces or auxiliary units.

Your coverage, however, may be reduced if a war (declared or undeclared), act of war, or act of terrorism is determined to be a “Catastrophic Event”.

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Third-Party Claims Review

If we deny your appeal of benefits eligibility or claims decision due to evaluation of your medical condition/functional capacity, you may request an independent third-party review. A third party, mutually agreed to by OPM and Long Term Care Partners, will review our evaluation of the medical condition or functional capacity and will provide a final and binding determination within 60 days of receiving all relevant information.

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Weekly Benefit Amount Option

If you select the Comprehensive Option and select (at an additional cost) the Weekly Benefit Amount option, you will have benefits for covered services calculated on a weekly basis. With this option, if your costs exceed your DBA on any particular day but the total of that week’s reimbursable long term care expenses does not exceed your Weekly Benefit Amount, then your expenses will be fully reimbursed. The Weekly Benefit Amount is equal to seven times your DBA.

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