Important Legal Information
Please read the information in each link below carefully. Your application for insurance coverage under the Federal Long Term Care Insurance Program (FLTCIP) - received either online or via downloading, completing, and mailing a paper application - confirms that you have read and understand the information below.
- Applying and underwriting
- Authorization to use and disclose health information
- For claim-related purposes of the FLTCIP, including determining eligibility for benefits, care coordination, claim decision-making, coordinating benefits with other insurance companies or payers, claim payment, claim appeals, and claims management activities, you authorize any licensed health care practitioner, medical facility, employer, insurance company, or any other entity or person who has any health information about you to give that health information to Long Term Care Partners, LLC, John Hancock Life & Health Insurance Company, their reinsurers, and their subcontractors who need to know health information to provide contracted services.
The health information you are permitting to be disclosed and used for the FLTCIP includes any information on your medical history, and the diagnosis, prognosis, and treatment of any physical or mental condition. It includes the disclosure of any medical care or surgery, psychiatric or psychological care or examinations, and information about alcohol or drug use (including any information otherwise protected by Federal Regulations 42 CFR Part 2 or other applicable laws). You understand that this authorization includes your consent to use and disclose medical information that relates to mental illness, HIV, AIDS, HIV-related illness, sexually transmitted diseases, or other serious communicable diseases, but only in accordance with any law or regulation that applies to any such disclosure of this information about you.
You understand that:
- If you do not sign this authorization, any claim for long term care insurance benefits may be denied.
- You may revoke this authorization at any time, except to the extent that:
- action has already been taken in reliance on it before your revocation, or
- Long Term Care Partners or your insurer has a right to contest your long term care insurance claim or coverage.
- If you do revoke this authorization, you understand that any claim for long term care insurance benefits may be denied.
- To revoke this authorization, you must notify Long Term Care Partners, LLC, P.O. Box 797, Greenland, NH 03840-0797, in writing.
- If you do not revoke this authorization, it will be valid from the date you sign it to the date the claim is closed.
- Your health information may be redisclosed and no longer protected by applicable law, including federal health information privacy regulations.
This can occur only if such redisclosure is required or allowed by law (e.g., in response to a subpoena).
- A copy of this authorization is as valid as the original.
- Authorization for automatic bank withdrawal or payroll/annuity deduction
- Agreement and acknowledgment
- Online application consent (online applications only)
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Federal family members can apply for coverage anytime—you do not have to wait for the next open season. Premiums are based on your age and the premium rates in effect at the time we receive your application—the younger you are when you apply, the lower your premium will be.