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• Additional Services & Benefits

FLTCIP 2.0 Additional Services and Benefits

In addition to our choice of inflation options and our comprehensive covered services, the Federal Program offers a number of additional services and benefits to meet your needs, including:

• Stay-at-home benefit
• Alternate plan of care
• Informal caregiver provisions
• Caregiver training
• International benefits
• Bed reservations
• Respite care
• No war exclusion
• Third-party review of claims

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

Stay-at-home benefit

The FLTCIP offers a stay-at-home benefit which can pay benefits for numerous options that support care in a home environment such as care planning visits, home modifications, an emergency medical response system, durable medical equipment, caregiver training, and home safety checks.

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Alternate plan of care

In certain circumstances, our care coordinators can authorize customized benefits for services that are not specifically covered under the FLTCIP. For example, under an alternate plan of care, we will consider a facility that is not normally covered under the FLTCIP if it meets your needs. The flexibility of an alternate plan of care allows the FLTCIP to provide you with benefits for cost-effective care and the services you want and need.

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Informal caregiver provisions

The FLTCIP covers approved care provided at home by informal caregivers such as 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 (2 years, 3 years, 5 years or unlimited). When informal care is provided by family members, it is covered for up to 500 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 FLTCIP pays up to seven times the 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 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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Bed reservations

If you are in an assisted living facility, nursing home or hospice facility and need to leave that facility for any reason (for example, you need to be hospitalized), the bed reservations feature in your coverage will pay up to 100% of the daily benefit amount for up to 60 days per calendar year to hold your space.

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Respite care

This benefit provides you with temporary care if your caregiver (such as a family member) needs to take some time off. Respite care is covered up to 30 times the daily benefit amount per calendar year and there is no waiting period requirement.

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No war exclusion

Unlike coverage under most long term care insurance plans, 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.

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Third-party review of claims

If we deny your appeal of benefits eligibility or of a claims decision, 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 your medical condition or functional capacity and will provide a final and binding determination within 60 days after we receive your request for appeal.

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