Definitions

National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia, and five U.S. territories.

Medicare
For more information on Medicare, go to medicare.gov.

Need more help? Get answers to frequently asked questions about claims.

 

Coordination of Benefits

Coordination of Benefits

Some enrollees may be eligible for benefits for long term care services under another insurance plan or through other programs. For this reason, the FLTCIP includes a coordination of benefits provision, which follows the guidelines set by the National Association of Insurance Commissioners.

In determining the amount of benefits we'll pay, this provision allows us to look at other plans—such as government programs, group medical benefits, and other employer-sponsored long term care insurance—that may pay benefits for the long term care services you receive. We'll advise you on whether or not the FLTCIP is the primary plan. If the FLTCIP is primary (meaning it pays first), we'll pay benefits without coordinating with other plans. This means we will pay benefits to the maximum extent permitted by your coverage.

Medicare

When Medicare is the primary plan, the services they cover are not eligible for reimbursement under the FLTCIP. However, services covered by Medicare can be applied to the waiting period.

Other plans

If another plan or program is primary, such as an FEHB plan, then it will pay first for the services they cover. In this case, we'll require you to submit the explanation of benefits you received from that other plan or program showing that you submitted a claim to it and how that claim was decided. We may also request a copy of the other plan, program booklet, or terms of coverage. We'll pay no more than the difference between the amount payable by your other coverage(s) and your actual covered expenses.


Image of son and father looking at brochure.

Using Your FLTCIP Benefits Brochure

If you've met the conditions for benefit eligibility, this brochure is intended to assist you at the time of claim by providing an overview of the process. It also contains important forms and instructions to assist you in the reimbursement of approved care expenses. There are two versions of this brochure: one for enrollees in a FLTCIP 1.0 plan and one for enrollees in a FLTCIP 2.0 plan.

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