Federal Long Term Care Insurance Program (FLTCIP) applications were suspended effective December 19, 2022. Read Important Notice >

Resources

Download important information and forms from our library of resources. You can filter by topic to quickly find what you're looking for.



Book One:
Program Details and Rates
Program Information

This book provides a detailed overview of what's covered under the FLTCIP and includes the FLTCIP 3.0 Outline of Coverage and FLTCIP Privacy Notice.

Book Two:
Additional Information
Program Information

This book answers common questions about the FLTCIP. It includes a worksheet to compare the FLTCIP with other plans and a glossary of terms.

Premium Rate Increase
and Lapse History
Program Information Coverage & Billing

This is an important notice that details the FLTCIP's and John Hancock's premium rate increase and lapse history.

NAIC: A Shopper's Guide to
Long-Term Care Insurance
Program Information

The National Association of Insurance Commissioners (NAIC) created this guide to help educate and protect consumers thinking of purchasing long term care insurance.

FLTCIP 3.0
Benefit Booklet
Coverage & Billing

The FLTCIP 3.0 Benefit Booklet is the governing contractual document for enrollees who have coverage under the FLTCIP 3.0 plan.

FLTCIP
Program Overview
Program Information

This brochure explains what long term care is and the value of long term care insurance. It also provides an overview of coverage under the FLTCIP and who's eligible.

Choosing a
Medigap Policy
All

This guide was developed jointly by the Centers for Medicare and Medicaid Services (CMS) and the NAIC. It describes ways to help you cover health care costs and explains what a Medigap policy is.

Authorization for
Disclosure of Information
Claims Coverage & Billing

Use this form to authorize us to speak with a designated person about your coverage.

If a legal representative is authorized to make decisions on your behalf, we require a legal copy of your durable power of attorney or guardianship papers.

Billing
Change Form
Coverage & Billing

Use this form to change your billing method. The FLTCIP offers payroll or retirement pay deductions, automatic bank withdrawals, and direct billing as options to pay for your coverage.

Beginning the
Claims Process
Claims

This brochure explains the key steps in the claims process, such as determining if you're eligible for benefits and educating you on what to expect if you are approved.

Claims
Initiation Kit
Claims

This kit contains the required forms you, or your legal representative, must complete and return to us before we can process your claim.

Claims
Initiation Form
Claims

Use this form to initiate the claims process. Completing the form does not guarantee a claim approval and/or benefit reimbursement.

Medical
Release
Claims

This authorization permits a licensed health care practitioner, medical facility, or other entity that has health documentation, to disclose information about you that we need to determine if you're eligible for benefits.

IRS Form
W-9
Claims

By completing this form, you are certifying that the Tax Identification Number (TIN) provided is correct. This TIN is used in our required reporting to you and the IRS for benefits paid during the year.

Using Your
FLTCIP 1.0 Benefits
Claims

This brochure is for claimants who have FLTCIP 1.0 coverage. It includes important forms and instructions to assist you in the reimbursement of approved care expenses.

Using Your
FLTCIP 2.0 Benefits
Claims

This brochure is for claimants who have FLTCIP 2.0 coverage. It includes important forms and instructions to assist you in the reimbursement of approved care expenses.

Using Your
FLTCIP 3.0 Benefits
Claims

This brochure is for claimants who have FLTCIP 3.0 coverage. It includes important forms and instructions to assist you in the reimbursement of approved care expenses.

Informal Caregiver
Invoice
Claims

If you use an informal caregiver, you must submit this form along with proof of payment. The payment must be made after the services are rendered. Payments made by cash or checks made out to cash are not reimbursable.

Assignment of
Benefits Form
Claims

You have the option to request direct payment to certain home care agencies or facilities. This form is used to assign benefits directly to your provider. It also includes an IRS Form W-9 that your provider must complete.

Claimant Authorization of
Claims Payments via EFT
Claims

This form is for claimants to authorize direct deposit of claims payments via electronic funds transfer (EFT) to a bank account or to change bank account information for an existing authorization.

Provider Authorization of
Claims Payments via EFT
Claims

This form is for providers to authorize direct deposit of claims payments via electronic funds transfer (EFT) to a bank account or to change bank account information for an existing authorization. You must assign benefits to the provider first.

FLTCIP 3.0 Covered/
Not Covered Services
Claims

This brochure summarizes what services are covered and not covered for reimbursement under the FLTCIP 3.0 plan for each provider type.

Explanation of
Claims Topics
Claims

This brochure explains common claims topics and terms that we use in our materials and communications with claimants.

Cover Sheet for
Faxed Documentation
Claims

Use this cover sheet when you fax claims documentation to us. Examples include invoices, proofs of payment, claims initiation and legal documents, and aide notes. Make sure to include your claim number on each page that you are faxing.