News and Announcements

05/01/2017

Arthritis: Long Term Pain May Require Long Term Care
Read article...

05/01/2017

Americans with Osteoporosis Face an Increased Risk of Needing Long Term Care
Read article...

04/01/2017

Retirement: What's Your Plan?
Read article...


listen to podcasts
Listen Now

 

Benefit Eligibility Determination

Benefit Eligibility Determination

Claims Initiation

The Federal Long Term Care Insurance Program (FLTCIP) allows you or your legal representative to initiate a claim within 12 months after the date you incurred charges for covered services, or by April 1 of the year following the year you incurred charges for covered services, whichever is later. We will send you written notice of our determination of your benefit eligibility after we receive all the information we need. In general, that means within 10 business days.

If Your Benefit Eligibility Is Approved

A care coordinator will call you, and you will receive a letter stating the date you are eligible for benefits. The notification will also include necessary claims instructions, forms that you can use for the submission of invoices, and/or proof of payment to request care reimbursement or to count care toward your waiting period. You will also be assigned a personal care coordinator to assist you.

If Your Benefit Eligibility Is Denied

A care coordinator will call you, and you will receive a letter stating the reason for the denial. If you still feel strongly that you are eligible for plan benefits, you may request a review of the denial by sending a written request to us no later than 60 days after the date of the denial. After our review is completed, we will send you written notice of our decision. If we uphold the initial denial, at that time you may request an appeal.

For more information on the review and appeals process, please refer to the most recent FLTCIP Benefit Booklet we sent you or review the downloadable PDF version via your online account.


Apply today

Apply Today!

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.

apply now