Get answers to frequently asked questions about the Federal Long Term Care Insurance Program (FLTCIP).
If you choose the automatic compound inflation option (ACIO), your daily benefit amount and the remaining portion of your maximum lifetime benefit will automatically increase by your ACIO percent compounded annually with no corresponding increase in your premium. If you choose the future purchase option for inflation protection, your premiums will increase when your benefits increase.
It's important to note that FLTCIP premiums are not guaranteed. Your premium will not change because you get older or your health changes or for any other reason related solely to you. However, premiums may increase if you are among a group of enrollees whose premium is determined to be inadequate. While the group policy is in effect, the U.S. Office of Personnel Management (OPM) must approve the change.
No. Premiums do not increase just because you're retiring or due to any other change in your work status.
It's important to note that FLTCIP premiums are not guaranteed. Your premium will not change because you get older or your health changes or for any other reason related solely to you. However, premiums may increase if you are among a group of enrollees whose premium is determined to be inadequate. While the group policy is in effect, the U.S. Office of Personnel Management (OPM) must approve the change.
We understand that the COVID-19 crisis may cause financial hardship and that it may be difficult for some enrollees to make regularly scheduled premium payments at this time.
To support our FLTCIP enrollees who are unable to make regularly scheduled payments due to the impacts of COVID-19, we extended coverage protection as well as the premium payment grace period time frame. In addition, we have limited the amount of premium due in any given month to reflect no more than two months of premium. If you owe a past due amount greater than two months of premium, and you are financially able, we encourage you to pay the additional premium to bring your account current.
Please note, if you are determined eligible for benefits, or if you are satisfying your waiting period, any outstanding premiums must be paid prior to receiving reimbursement for benefits.
For additional information about COVID-19, visit the Centers for Disease Control and Prevention at http://cdc.gov or your local health department website.
You have three options for paying your FLTCIP premiums:
If you're an eligible employee or retiree, you may also pay the premiums for any of your qualified relatives who apply and are approved for coverage, even if you don't apply or you apply and are denied coverage.
Payroll deduction: Payroll deduction means that your premiums are automatically deducted from your pay. Most employees and active members of the uniformed services choose this method of payment.
Retirement pay/annuity deduction: Retirement pay/annuity deduction means that your premiums are automatically deducted from your retirement pay/annuity. Most retirees choose this method of payment.
Automatic bank withdrawal: Automatic bank withdrawal (ABW) means that your premiums are automatically withdrawn from your checking or savings account between the third and fifth business day of every month.
There are many payroll and annuity providers across the federal government. For this reason, we need your payroll or annuity office identifier to map your premium payment to the appropriate provider so we can successfully take deductions for your coverage.
On your application or Billing Change Form, you must provide your payroll or annuity office identifier if you want your premiums deducted from your pay. To find your office identifier, use our agency search tool. You will need to know the name of your agency or the office that pays your annuity.
If your payroll is serviced by the National Finance Center, you may also find your payroll office identifier on your Earnings and Leave Statement.
If you're unable to locate your agency using our agency search tool, then your agency may not support deductions. Please call the BENEFEDS Customer Service Center for assistance. BENEFEDS administers the premium payment processes on behalf of the FLTCIP.
You may also pay your premiums through automatic bank withdrawal or by direct bill.
At this time, eligible District of Columbia employees can't have premiums deducted from their pay. However, eligible District of Columbia annuitants may have premiums deducted from their annuity. You will be asked to provide an annuity office identifier and your CSA or CSF number on your application or Billing Change Form. The annuity office identifier for eligible District of Columbia annuitants is 24900002.
Your first deduction should be taken from the paycheck that covers the first full pay period that begins on or after your effective date of coverage. For many employees, this means that you may not actually see the premiums deducted from your pay until several weeks after your coverage has gone into effect.
For example, a February 1 effective date may be in the middle of a pay period. Premium deduction will begin during the next full pay period and show up in your check following that pay period.
If you do not see a deduction after two full pay periods, please call the BENEFEDS Customer Service Center for assistance. BENEFEDS administers the premium payment processes on behalf of the FLTCIP.
Your first deduction will be taken from the retirement pay/annuity check that pays you for the month in which your coverage begins. Since your retirement pay is paid in arrears, your premiums will not be deducted until the month after your effective date of coverage.
For example, if you have a February 1 effective date, your first deduction will be taken from the check you receive in March, since that check covers your February payment. Your coverage would still be effective on February 1.
Note: If you recently retired under CSRS or FERS, premiums for the FLTCIP cannot be deducted from your annuity while you are receiving interim payments (sometimes called "special pay"). This means that until the U.S. Office of Personnel Management (OPM) finalizes your annuity, we can't take deductions from your annuity to pay your premiums. While you are receiving interim payments, you may pay your premiums either by automatic bank withdrawal or direct bill. Once your annuity is finalized, we will begin your deductions.
Yes. Employees and retirees may authorize payroll or retirement pay deductions to pay for a qualified relative's FLTCIP coverage. You do not need to be enrolled in the FLTCIP, but you must provide your authorization and signature, either on your qualified relative's application or Billing Change Form.
No you cannot. The system that processes your annuity payments is not equipped to deduct premiums from survivor annuities.
You do not have to pay premiums if you are eligible for benefits and have satisfied your waiting period. Premiums are also waived if you are eligible for benefits and receiving hospice care, since the waiting period does not apply to hospice care.
If you satisfy the requirements for waiver of premium on the first day of a month, the waiver will take effect on that date. Otherwise, the waiver will take effect on the first day of the following month. If, at a later date, you are no longer eligible for benefits (e.g., you recover) and wish to maintain your coverage, you will have to resume paying premiums.
If you stop paying premiums, your coverage under the FLTCIP will be canceled unless you're eligible for a paid-up, limited benefit, referred to as the contingent benefit upon lapse in your FLTCIP Benefit Booklet.
The contingent benefit upon lapse is a consumer protection feature that is built in to your FLTCIP coverage. If your premium increases beyond a certain percentage as specified by the National Association of Insurance Commissioners, it allows you to stop paying premiums and provides paid-up coverage with a reduced level of benefits.
Within 30 days after you receive your FLTCIP Benefit Booklet (which you'll automatically get if your application is approved), you may cancel your coverage and you'll receive a full refund of any premium you've already paid for the coverage. This is called a 30-day free look period.
You may cancel your coverage at any time after the 30-day free look period, but you will not receive a full refund of your premiums. You will only receive a refund of any premium that you paid to cover any period after the effective date of your cancellation.
In some cases your payroll deductions will switch automatically to your new location. If you transfer to a new agency within the same agency payroll office, we will most likely receive a notification of your transfer and be able to make the change for you.
If you transfer to an agency outside of your previous agency payroll office, then you must contact us to continue payroll deduction of your premiums. We will work with your new agency location to set up payroll deductions with them.
Depending on when we learn of your transfer, we may not be able to change your payroll deductions in time for your first paycheck at the new location. If this is the case, you may receive a direct bill for the premiums due that were not collected.
To report your transfer or any other change in your employment, please call the BENEFEDS Customer Service Center. BENEFEDS administers the premium payment processes on behalf of the FLTCIP.
In most cases, you don't need to do anything to begin paying your FLTCIP premiums through your retirement pay. Once we receive notification from your payroll office of your retirement, we will work with your retirement system to set up premium deductions from your retirement pay. However, there are some cases when we are not notified. If you have not seen a deduction after two full pay periods, call the BENEFEDS Customer Service Center.
If you are retiring under CSRS or FERS, premiums for the FLTCIP can't be deducted from your annuity while you're receiving interim payments (sometimes called "special pay"). This means that until the U.S. Office of Personnel Management (OPM) finalizes your annuity, we can't take deductions from your annuity to pay your premiums. While you're receiving interim payments, you may pay your premiums either by automatic bank withdrawal or by direct bill. Once your annuity is finalized, we will begin deductions from your annuity.
Yes. The FLTCIP is designed to be a tax-qualified plan under the Internal Revenue Code. This means the benefits you receive generally aren't considered taxable income and you can deduct the premiums you pay as medical expenses as long as your total qualified medical expenses exceed 10% of your adjusted gross income.
The amount of long term care insurance premiums you can deduct depends on your age. There may be additional tax benefits in your state. Check with your state insurance department for more information.
Here are the current published Internal Revenue Service (IRS) limits by age:
| Your age | 2023 tax year | 2024 tax year |
|---|---|---|
| 40 or younger | $480 | $470 |
| 41–50 | $890 | $880 |
| 51–60 | $1,790 | $1,760 |
| 61–70 | $4,770 | $4,710 |
| 71 or older | $5,960 | $5,880 |
Rates are subject to change each year as determined by the IRS. Please consult irs.gov for the latest tax deduction information.
Note: This is not intended to provide tax advice. Always consult your tax attorney or certified public accountant when dealing with tax deduction considerations.
Yes, generally only if the IRS tax code is amended.
Yes. Many states offer state tax incentives to encourage the purchase of long term care insurance. If you would like to find out whether your state offers such incentives, please contact your state insurance department directly.
No. The law governing the FLTCIP requires the FLTCIP to offer only tax-qualified plans.
No. Section 125 of the Internal Revenue Code specifically excludes from the definition of qualified benefits, "any product which is advertised, marketed, or offered as long term care insurance."
Yes. HSAs can be used to pay long term care insurance premiums, subject to limits based on age, which are published by the IRS and are adjusted annually. An HSA is an account established to pay for qualified medical expenses, including qualified long term care costs and long term care insurance premiums. Contributions and withdrawals are tax-free for qualified expenses.
To open up an HSA you must be covered under a high deductible health plan and meet certain other requirements.
An FSA is an account established to pay for qualified out-of-pocket health care and dependent care expenses. According to section 125 of the Internal Revenue Code, you cannot use it to pay FLTCIP premiums.
It's possible. The payment of the premium stabilization feature (PSF) amount as a refund of premium death benefit may have federal and state tax implications for your estate or other designated beneficiary. You may want to review this benefit with a qualified tax professional or attorney to determine any such tax impact.
When you receive the Beginning the Claims Process brochure, you must review the eligibility requirements and then complete and submit these required forms:
We are only authorized to speak with you, the policy holder. If you'd like to authorize us to speak with a designated person about your coverage, complete and return the Authorization for Disclosure of Information.
The determination process can take several weeks, depending on the amount of information (and its availability) needed to determine your claims benefit eligibility date. This is the date when you started needing long term care assistance, according to the policy.
We'll send you a written notice of our decision on whether or not you are eligible for benefits no later than 10 business days after we speak with you and receive all of the requested information.
Learn more about authorized FLTCIP contacts: who we can speak to, what we need on file, and what you are authorized to do.
Learn more about authorized FLTCIP contacts: who we can speak to, what we need on file, and what you are authorized to do.
If you are enrolled in a FLTCIP 1.0 plan, you have either a 30 or 90 service day waiting period. If you are enrolled in a FLTCIP 2.0 or FLTCIP 3.0 plan, you have a 90 calendar day waiting period. To determine what waiting period you have, please refer to your latest schedule of benefits, or view your waiting period and other benefits by accessing your online account.
If you are enrolled in a FLTCIP 1.0 plan, you have either a 30 or 90 service day waiting period, depending on what you selected for your coverage. A service day waiting period is the number of days you must be eligible for benefits and receiving and paying for care before we will pay the benefits of your plan. FLTCIP 1.0 enrollees must supply us with invoices as proof that services have been provided in order to count toward your service day waiting period.
If you are enrolled in a FLTCIP 2.0 or FLTCIP 3.0 plan, you have a 90 calendar day waiting period. A calendar day waiting period is the number of calendar days you must be eligible for benefits before we will pay the benefits of your plan. For FLTCIP 2.0 and FLTCIP 3.0 enrollees, your waiting period will end 90 days from the date you were determined to be benefit eligible by our care coordinators.
A care coordinator may approve alternative services to your plan of care that we deem to be both appropriate for you and cost-effective for the FLTCIP. The charges you incur for these alternative services must be approved before they are applied to a plan of care and submitted for reimbursement. To learn more about the alternate plan of care, contact Customer Service at 1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-543-3557.
We will pay actual charges you incur for stay-at-home services up to the stay-at-home lifetime benefit amount. The stay-at-home lifetime benefit amount is equal to 30 times your daily benefit amount. The waiting period does not apply to the stay-at-home benefit. Except for care planning visits, you must be living at home in order to be eligible for the stay-at-home benefit. Stay-at-home services consist of expenses for:
The maximum amount payable in your lifetime for caregiver training will be seven times your daily benefit amount.
If you have the automatic compound inflation option (ACIO), your daily benefit amount and the remaining portion of your maximum lifetime benefit will automatically increase by the ACIO percentage reflected in your plan of care, compounded annually. The increases under this option are made even if you are eligible for benefits, without regard to your age, claims status, claims history, or the length of time your coverage has been in effect.
If you have the future purchase inflation option, you will not receive offers if you are benefit eligible on the effective date of the option.
You will not have to pay your premium if you are eligible for benefits and have satisfied the waiting period. We will also waive your premium if you are eligible for benefits and receiving hospice care. If you satisfy the requirements for waiver of premium on the first day of a month, the waiver will take effect on that date. Otherwise, the waiver will take effect on the first day of the following month.
If, at a later date, you are no longer eligible for benefits (e.g., you recover) and wish to maintain your coverage, you may do so provided you have not exhausted your maximum lifetime benefit. To maintain your coverage, you will have to resume paying your premium on the first day of the month following the month in which you are no longer eligible for benefits.
While you are receiving care, we will review your eligibility for benefits and plan of care at least once every 12 months and sometimes more frequently depending on your specific condition(s) and the type of care being provided.
Please notify us of any anticipated or actual change in your condition, care, or caregivers as soon as possible. Any change must be reviewed and approved by our care coordination staff prior to making the change in order to avoid reimbursement denials or delays. The reimbursement process for expenses paid by you depends on where you receive long term care and who provides that care. Your care coordinator will contact you periodically to review your current needs and the existing plan of care.
Please submit your request for reimbursement by one method only. Duplicate submissions of the same invoice will delay claims processing. Invoices may be submitted by:
If you use an informal caregiver, you must submit the Informal Caregiver Invoice, which is available in the Using Your FLTCIP Benefits brochure, as well as proof of payment. Proof of payment includes canceled personal, business, substitute, or cashier's checks; eStatements; money orders; online bill pay; or payroll payments. Payments must be paid after the services are rendered. Payments made by cash or checks made out to cash are not reimbursable.
If you use a formal caregiver (home care agency) or adult day care center, you must submit an itemized invoice that includes the following:
The invoice may be submitted by either you or the agency.
If you use an assisted living facility or nursing home, you must submit an itemized invoice that includes the following:
The invoice may be submitted by either you or the facility.
We pay benefits using the expense-incurred method. This method reimburses you for actual charges you incur for covered services received up to a specific dollar amount. We will only pay for services based on invoices that are submitted directly to us. Each time a payment is made for service provided for your care, an explanation of benefits is mailed to you and is available within your online account for your review. Your invoice will be processed within five business days after all requirements are received.
If you elect to receive your payments by electronic funds transfer, you must complete the Claimant Authorization of Claims Payments via Electronic Funds Transfer. The completed form should be submitted to Long Term Care Partners with a voided check. As payments are made, the funds will be automatically transferred to your account.
If you prefer to receive your payment by mail, you will typically receive reimbursement within 10 days after all requirements are received.
Payments are typically made to you, the claimant, for expenses incurred. However, claimants have the option to request direct payment to certain home care agencies or facilities. With this option, called assignment of benefits, invoices are submitted directly to Long Term Care Partners by the provider, and payments are made directly to the provider. To select this option, you must complete the Assignment of Benefits Form. You may want to verify with your provider if they accept an assignment of benefits.
Your provider may receive their payments by either electronic funds transfer (EFT) or by check. If they would like to be reimbursed by EFT, the provider must complete the Provider Authorization of Claims Payments via Electronic Funds Transfer. This form should be returned with the completed Assignment of Benefits and W-9 forms.
Note: An assignment of benefits is only available for home care agencies and facilities within the United States.
An explanation of benefits (EOB) is a statement sent to you by your long term care insurance carrier to describe what services were paid for on your behalf. The EOB is also available within your online account for your review.
Yes. Claimants will receive a 1099-LTC for all payments that are made to them. We will also issue a 1099-MISC for payments that are made directly to a provider. These forms are mailed by the end of January for payments made in the previous year.
An informal caregiver is a person providing maintenance or personal care whose services are not arranged for or supervised by a home care agency.
You are required to provide a copy of a valid driver's license or passport, and a valid Social Security number for each informal caregiver.
A formal caregiver is a caregiver whose services are arranged and supervised by a home care agency (the caregiver is an employee of the agency). We require a copy of the state-issued license for the appropriate type of home care agency and a Federal Employer Identification number. We will make reasonable attempts to obtain this information directly. However, we may ask for your assistance if we are unsuccessful in getting the information.
A facility may be an adult day care center, an assisted living facility, a nursing home, or a hospice facility. We require a copy of the state-issued license for the appropriate facility and a Federal Employer Identification number. The facility must also complete the appropriate facility form. We will make reasonable attempts to obtain this information directly. However, we may ask for your assistance if we are unsuccessful in getting the information.
If you would like to authorize us to speak to a designated person about your coverage, please complete the Authorization for Disclosure of Information form and mail it to us at Long Term Care Partners, P.O. Box 797, Greenland, NH 03840. Until we have received this authorization form or a legal copy of your financial power of attorney or guardianship papers (as determined by your state of residence), we will not be able to discuss your coverage with anyone other than you (including your spouse).
Any time we speak to you or your authorized legal representative about specific health information or coverage, we are required to verify your identity by asking you to answer some security questions. When you call, you will reach one of our claim services consultants, who will ask you to verify three facts:
This security check is required to protect your personal health information.
When you call our toll-free number, you will reach one of Customer Service claim service consultants (CSC), who are trained to support our care coordination and claims process. The CSC will ask how they may assist you. Many questions can be answered by the CSC. The CSC will be your prime contact to determine the status of any invoice processing or reimbursement. If you need to speak directly to your care coordinator to discuss your plan of care or if you are returning your care coordinator's call, the CSC will transition the call.
If you are faxing claims documentation to us for review, make sure to use our fax cover sheet.
Please include your claim number on each page. This will help us identify you if the transmission did not submit entirely and we need to contact you.
You may also submit documentation to us by email at claimsinfo@ltcpartners.com.
If you are submitting invoices or proofs of payment for reimbursement, you can do it online by logging into your My LTCFEDS account and going to your Claims dashboard.
Since the Federal Long Term Care Insurance Program is a tax-qualified long term care insurance plan, benefits you receive are not considered taxable income.
Yes. Claimants will receive a 1099-LTC for all payments that are made to you. We will also issue a 1099-MISC for payments that are made directly to a provider. These forms are mailed by the end of January for payments made in the previous year.
Please consult with your tax advisor or certified public accountant to determine your responsibilities for an informal caregiver.
IRS Publication 502, Medical and Dental Expenses, provides information about what expenses you can include as a deduction. You cannot include medical expenses that were paid for by the FLTCIP, whether they were paid to you or the provider of the medical services.
Note: This is not intended to provide tax advice. Always consult your tax attorney or certified public accountant when dealing with tax deductibility considerations.
Because conditions can change with time, we regularly monitor each claimant's eligibility status throughout the claims process. While you are receiving care, we will review your eligibility for benefits at least once every 12 months and sometimes more frequently depending on your specific condition(s).
If long term care eligibility criteria can no longer be documented, a claimant is determined to be "recovered" and therefore no longer eligible for reimbursement benefits for the current claim. The following are a few reasons why a claimant may no longer be eligible for benefits:
Federal Long Term Care Insurance Program (FLTCIP) applications were suspended effective December 19, 2022. Read Important Notice >
If you applied using the abbreviated underwriting application, you should receive a decision on your application within a few weeks. If you applied using the full underwriting application, it may take longer depending on if we needed to request copies of your medical records and/or schedule an interview with a nurse.
In general, your effective date of coverage will be the first day of the month after your application is approved. You'll receive a letter from us with your effective date and information about what may change that date. If you're an active workforce member applying with the abbreviated underwriting application, you must meet the actively at work requirement for your coverage to become effective.
Long Term Care Partners (LTCP), LLC makes all insurability decisions and those decisions cannot be appealed to the U.S. Office of Personnel Management (OPM). However, an applicant may ask LTCP to reconsider its insurability decision. If you apply and are denied coverage, your decision letter will include instructions on how to request a reconsideration of the denial.
It is your duty to inform us in writing or by secure email, if between the date your application is submitted and the date your insurance coverage is effective: 1) your health changes in a way that would cause any answer given on your application to no longer be correct, or 2) you receive medical advice or treatment from a physician or other health care practitioner for a condition that would affect an answer to any question on your application.
Underwriting is the process of reviewing medical and health-related information provided in an insurance application to determine if you present an acceptable level of risk to be considered insurable.
Underwriting is necessary to ensure the long term health of the program. The premiums charged for insurance coverage must be competitive with private sector policies. If we guaranteed standard coverage to everyone who applied, we would have to add the expected costs of those in poor health to the premiums charged for FLTCIP coverage.
Employees and members of the uniformed services who submitted an abbreviated underwriting application must be actively at work at least one day during the week immediately prior to the week that contains the original effective date shown on your schedule of benefits.
For members of the uniformed services, actively at work means that you are on active duty and are physically able to perform the duties of your position.
If you do not meet the actively at work requirement for your original effective date, you must contact us and we will issue a revised effective date. It will be the first day of the month after the date you return to being actively at work. For your coverage to become effective on the revised effective date, you must meet the actively at work requirement for that date. Your coverage will not go into effect until you meet the actively at work requirement.
No. The actively at work requirement is only for employees who are applying for coverage using the abbreviated underwriting application.
No. The actively at work requirement is only for employees who are applying for coverage using the abbreviated underwriting application.
No. The actively at work requirement is only for federal employees who are applying for coverage using the abbreviated underwriting application.
However, you must meet the actively at work requirement at your current employment site in order for your coverage to become effective.
Yes, it will, assuming your health hasn't changed in such a way as to change the answers to any questions on your application.
Yes, if your home or other telework site is an approved work location. You must meet the other actively at work requirements as well.
No. Preexisting conditions may prevent you from obtaining FLTCIP coverage in the first place, but if you are approved for coverage, they will not cause a denial of a claim for benefits, as long as they were appropriately disclosed on your application.
Yes, you can keep your FLTCIP coverage as long as you continue to pay your premiums. There is no government contribution toward your FLTCIP premiums.
Yes, you can keep your FLTCIP coverage as long as you continue to pay your premiums. There is no government contribution toward your FLTCIP premiums.
No. There is no provision in the law governing the FLTCIP that would allow your agency to pay your FLTCIP premiums.
No. You must keep your premium payments current in order to keep your coverage. There is no government contribution toward your FLTCIP premiums.
Under FEHB, you incur a debt to your agency, which pays both your portion and the government's portion of your premiums to your health benefits plan. Under the FLTCIP, your agency does not pay any portion of your premiums and has no legal authority to pay for you.
Yes. If you currently pay your premiums through payroll deduction, please call the BENEFEDS Customer Service Center and explain that your payroll location is changing. BENEFEDS administers the premium payment processes on behalf of the FLTCIP.
Your other options are to pay your premiums through automatic bank withdrawal (ABW) or we can bill you directly.
If you're deployed overseas, it might be hard to receive and pay direct bills on time, which means your coverage could be canceled. In this case, ABW may be the best option for you. To change your payment option to ABW, visit BENEFEDS.com and either register for or login to your My BENEFEDS account.
BENEFEDS administers the premium payment processes on behalf of the FLTCIP.
There is no war exclusion under the FLTCIP. This means 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.
However, the FLTCIP does not pay benefits for care or treatment you would receive in a government facility, including a Department of Defense or Department of Veterans Affairs facility, unless otherwise required by law.
The U.S. Department of Labor's Bureau of Labor Statistics defines inflation as, "the overall general upward price movement of goods and services in an economy."
The National Association of Insurance Commissioners (NAIC) states in the NAIC's A Shopper's Guide to Long-Term Care Insurance that, "Inflation protection can be one of the most important additions you can make to a long-term care insurance policy. Inflation protection increases the premium. However, unless your daily benefit increases over time, years from now you may find that it has not kept up with the rising cost of long-term care."
The current FLTCIP product, FLTCIP 3.0, offers a 3% automatic compound inflation option (ACIO). With this option, your daily benefit amount (DBA) and remaining portion of your maximum lifetime benefit (MLB) (as well as other remaining benefit amounts listed in your schedule of benefits) will automatically increase by 3% compounded every year. The increases occur on each anniversary of your original effective date of coverage (or the date you switch to one of these options) and are made even if you are eligible for benefits, without regard to your age, claim status, claim history, or the length of time your coverage has been in effect.
If you select ACIO, your premium is designed to include all future inflation increases you will receive each year while you are insured. Your premium does not increase annually as a result of this annual increase in benefits.
It's important to note that FLTCIP premiums are not guaranteed. Your premium will not change because you get older or your health changes or for any other reason related solely to you. However, premiums may increase if you are among a group of enrollees whose premium is determined to be inadequate. While the group policy is in effect, the U.S. Office of Personnel Management (OPM) must approve the change.
If we determine in the future that the cumulative actual rate of inflation in the cost of long term care services is significantly higher than the automatic compound inflation option rate shown on your schedule of benefits, compounded annually, we will determine a method to allow you to adjust your daily benefit amount. This method will account for the higher rate of inflation for an additional premium, if you are not then eligible for benefits.
The current FLTCIP product, FLTCIP 3.0, offers a future purchase option (FPO) for inflation protection. With this option, every two years we will offer an increase to your daily benefit amount (DBA) and remaining portion of your maximum lifetime benefit (MLB) (as well as other remaining benefit amounts listed in the schedule of benefits) based on the change in the U.S. Department of Labor's Consumer Price Index for All Urban Consumers, All Items (CPI-U). Your coverage must be in effect for at least 12 months in order for you to receive your first increase under this option. We will send notice of the increase to enrollees with this option every two years prior to the increase effective date.
If you accept the offer, your premium will also increase; the additional premium for each increase will be based on your age and the premium rates in effect at the time the increase takes effect. You do not have to take any action other than paying the additional premium. It will automatically take effect. Increases under this option do not require you to provide evidence of your good health and will be made regardless of your age. We will not increase your benefits if you are eligible for benefits.
If you do not want the FPO increase, we must receive your rejection before the date specified in the increase notice. If you decline a total of three increases, we will no longer offer them to you. If you wish to resume receiving increases, you must provide, at your expense, evidence of your good health that is satisfactory to us.
The 2023 Enrollee Decision Period lasted from September to November 2023 and provided FLTCIP enrollees personalized coverage options to help mitigate the impacts of a premium rate increase that became effective on January 1, 2024. This included mailing of letters and brochures to all impacted enrollees in September 2023, as well as online educational support throughout, to help support coverage decisions.
Impacted
Most FLTCIP enrollees were impacted by the premium increase that became effective January 1, 2024. In general, you were impacted if you have FLTCIP 1.0, FLTCIP 2.0, or FLTCIP Alternative Insurance Plan (AIP) coverage and were not eligible for benefits or waiting for a decision on a pending claim at that time.
There may have been exceptions to this depending on your issue age (the age you applied and were approved for coverage). If you were excluded from the premium increase, you should have received a letter indicating this.
Not impacted
If you have FLTCIP 3.0 coverage, you were not impacted by the premium increase.
If you were eligible for benefits or waiting for a decision on a pending claim and you have FLTCIP 1.0, FLTCIP 2.0 or FLTCIP AIP coverage, you were not impacted. In the event your condition improves so that you are no longer eligible for benefits, or your pending claim is not approved, then your coverage, if you have not exhausted your Maximum Lifetime Benefit, may be subject to a premium increase.
You may not have been impacted by the premium increase; however, this does not mean your premiums are guaranteed. Your premium will not change because you get older or your health changes, or for any other reason related solely to you. Premiums may only change if you are among a group of enrollees whose premium is determined to be inadequate and OPM approves the change.
Because long term care insurance is a complex, experience-based product, many factors are considered at the time premium rates are established. Examples include the frequency and duration of claims, expected lifespan of enrollees, length of time an enrollee is expected to keep their coverage, cost of care, estimated returns on investment, and overall program expenses. As the FLTCIP matures, these factors can change over time. Recent analysis of the program's actual and projected experience concluded that a premium rate increase was needed.
Yes, the 2023 Enrollee Decision Period ended for impacted enrollees in November 2023 with the new increased rates becoming effective January 1, 2024. If you reinstated your FLTCIP coverage after September 2023, you may still be subject to a premium increase. If you are subject to the premium increase, you will receive written notification that will include personalized options available to you to help mitigate the impacts of the premium increase.
Additionally, if you were eligible for benefits or waiting for a decision on a pending claim and you have FLTCIP 1.0, FLTCIP 2.0 or FLTCIP AIP coverage, you were not impacted. In the event your condition improves so that you are no longer eligible for benefits, or your pending claim is not approved, then your coverage, if you have not exhausted your Maximum Lifetime Benefit, may be subject to a premium increase.
If you were impacted by the premium increase that became effective January 1, 2024, you are eligible for a paid-up, limited benefit, referred to as the contingent benefit upon lapse in your FLTCIP Benefit Booklet. This benefit is a consumer protection feature that is built into your FLTCIP coverage and available under certain conditions when a premium increase occurs. It allows you to stop paying premiums and provides paid-up coverage with a reduced level of benefits.
If you cancel your coverage or stop paying your premiums, the contingent benefit upon lapse will automatically apply for a certain period of time after the decision period ends. Please refer to the letter we included with your updated Schedule of Benefits for specific details on this timeframe.
FLTCIP 3.0 was available for new applicants October 21, 2019 to December 18, 2022 when FLTCIP applications were suspended. FLTCIP enrollees who applied for coverage before October 21, 2019, are covered under a different plan (FLTCIP 1.0 or FLTCIP 2.0).
The FLTCIP 3.0 plan was introduced on October 21, 2019.
The current FLTCIP plan available to new applicants, FLTCIP 3.0, was introduced on October 21, 2019. Prior to that date, eligible applicants were able to apply for FLTCIP 2.0 since 2010. FLTCIP 1.0 was the original FLTCIP plan and was available to new applicants from 2002 through 2009.
No. If your FLTCIP 3.0 coverage is in force on the date of your death, any premium stabilization feature (PSF) amount available as a refund of premium death benefit will be paid to your estate or other designated beneficiary. However, if you are approved for FLTCIP 3.0 coverage and die within 30 days of receiving the benefit booklet, we will refund any premium you paid to your estate.
No. The premium stabilization feature (PSF) terminates, and no benefits are available under this feature if you lapse or cancel your coverage voluntarily, your coverage lapses for nonpayment of premiums, you elect the contingent benefit upon lapse, or your coverage terminates for reasons other than death.
The goal in establishing the premium rates is to calculate rates that will be sufficient to pay claims plus expenses, now and over the future lifetime of enrollees. Calculating premiums requires using a series of assumptions that quantify the risk that certain things will happen in the FLTCIP over the course of time.
The key risk assumptions relate to:
Go to the About Premiums section to learn more.
The FLTCIP experience fund is a separate account, held by John Hancock Life & Health Insurance Company (John Hancock), that is used to administer FLTCIP assets. The experience fund receives all the premiums collected from FLTCIP enrollees and the fund's investment earnings. The experience fund belongs solely to the FLTCIP. The FLTCIP is sponsored and regulated by the U.S. Office of Personnel Management (OPM) and insured by John Hancock under a group long term care insurance policy. The money in the experience fund can only be used to pay claims and cover expenses and fees for the FLTCIP. If the FLTCIP ever changes its insurer, then the fund will move to the new insurer.
John Hancock invests the fund's assets according to an investment strategy approved and monitored by OPM. Any fund gains from investment returns that generate net income beyond target levels or claims payments and expenses that fall below projected levels are retained by the experience fund, not John Hancock.
Go to the About Premiums section to learn more.
Yes. The FLTCIP had premium rates increase for existing enrollees, effective in 2010, 2016, and 2024. Here is an overview of the FLTCIP's premium rate increase history:
| Benefit booklet series | Years available | Year of increase |
|---|---|---|
| FLTCIP 1.0 | 2002-2009 | 2010 |
| FLTCIP 1.0 |
Go to the About Premiums section to learn more about what factors lead to possible premium increases.
Coverage under the FLTCIP is guaranteed renewable. This means FLTCIP coverage cannot be canceled based on a change in an enrollee's health or age. As long as premiums are paid and benefits have not been exhausted, coverage will continue. However, it is important to note that premiums may increase in the future if you are among a group of enrollees whose premium is determined to be inadequate.
Long term care insurance is a complex, experience-based product. Because of this, assumptions are made about many factors at the time premiums are established. Examples include frequency and duration of care needed due to certain medical conditions, expected lifespan of enrollees, length of time enrollees keep their coverage, cost of care, estimated returns on investment, and overall program expenses. As the program matures and actual experience is realized, these assumptions and market conditions can change over time and a premium rate increase may become necessary.
Go to the About Premiums section to learn more.
FLTCIP premiums are not guaranteed. Your premium will not change because you get older or your health changes or for any other reason related solely to you. Premiums may only increase if you are among a group of enrollees whose premium is determined to be inadequate.
John Hancock Life & Health Insurance Company, as contractor under the FLTCIP, is required to monitor FLTCIP experience and report to the U.S. Office of Personnel Management (OPM) when experience indicates that a corrective action may be needed.
Recent analysis of the program's actual and projected claims costs concludes that most FLTCIP enrollees will be subject to a premium rate increase effective January 1, 2024. Enrollees in FLTCIP 3.0 will not be impacted by this premium rate increase. For more information, go to the 2023 Enrollee Decision Period help section above.
In May 2023, the U.S. Office of Personnel Management (OPM) extended the FLTCIP contract with John Hancock Life & Health Insurance Company for another seven-year term, effective May 1, 2023 through April 30, 2030. Long Term Care Partners (LTCP), LLC, a wholly owned subsidiary of John Hancock Life & Health Insurance Company, will continue to administer the FLTCIP. This is the fourth FLTCIP contract term.
The FLTCIP law limits OPM's contracts with insurance carriers to seven years.
Long Term Care Partners, LLC, a wholly owned subsidiary of John Hancock Life & Health Insurance Company, has administered the FLTCIP since its inception.
Long Term Care Partners (LTCP), LLC, is the administrator of the FLTCIP and handles all inquiries related to the program. You may contact the FLTCIP Customer Service Center by phone or email if you have questions.
John Hancock brings significant experience in the long term care insurance marketplace, maintaining some of the strongest financial and claims payment ratings. Go to the About Us section of our website to view up-to-date financial strength ratings.
Because the FLTCIP was established under Federal law, the states play no role in approving premium rates or otherwise regulating the insurance coverage.
The FLTCIP has numerous consumer protections, including a contingent benefit upon lapse, inflation protection options, portability, and guaranteed renewability (the insurance company cannot cancel coverage except for nonpayment of premiums).
The contingent benefit upon lapse is a consumer protection built into your FLTCIP coverage and is available under certain conditions when a premium increase occurs. It allows you to stop paying premiums and provides you with a reduced level of benefits. Your new Maximum Lifetime Benefit (MLB) will be reduced to the total amount of premiums you have paid for your coverage, or 30 times your daily benefit amount, whichever is greater. Note: If you had previously received benefits under your plan and then recovered, no benefits will be paid in excess of your remaining MLB.
| Your age | Percent increase over initial premium | |
|---|---|---|
| 29 and under | 200% | |
| 30–34 | 190% | |
| 35–39 | 170% | |
| 40–44 | 150% | |
| 45–49 | 130% | |
| 50–54 | 110% | |
| 55–59 | 90% | |
| 60 | 70% | |
| 61 | 66% | |
| 62 | 62% | |
| 63 | 58% | |
| 64 | 54% | |
| 65 | 50% | |
| 66 | 48% | |
| 67 | 46% | |
| 68 | 44% | |
| 69 | 42% | |
| 70 | 40% | |
| 71 | 38% | |
| 72 | 36% | |
| 73 | 34% | |
| 74 | 32% | |
| 75 | 30% | |
| 76 | 28% | |
| 77 | 26% | |
| 78 | 24% | |
| 79 | 22% | |
| 80 | 20% | |
| 81 | 19% | |
| 82 | 18% | |
| 83 | 17% | |
| 84 | 16% | |
| 85 | 15% | |
| 86 | 14% | |
| 87 | 13% | |
| 88 | 12% | |
| 89 | 11% | |
| 90 and over | 10% | |
1 National Association of Insurance Commissioners, "Long-Term Care Insurance Model Regulation," http://www.naic.org/store/free/MDL-641.pdf (accessed September 2019).
It means that once you enroll, you will remain enrolled as long as you pay your premiums. It doesn't matter if you leave federal service, divorce your federal spouse, or otherwise lose the affiliation that made you eligible to apply for coverage under the FLTCIP.
When you enroll, you have the opportunity to designate a person who will be sent a notice if your coverage is about to lapse for nonpayment of premiums. This person is not responsible for making your payments. It may be a good idea to choose someone living outside of your household. You may also designate someone, or change your designation, at any time through the "Billing" dashboard within your My LTCFEDS online account.
Coverage under the FLTCIP is guaranteed renewable, which means the only time the insurance company may cancel your coverage is if you don't pay your premiums. To help ensure that this doesn't happen, we have a 30-day grace period for late payments. And, if you designate someone to be your protection against unintended, we will notify them if you're about to lapse due to nonpayment of premiums.
The insurance carrier may transfer your coverage to another carrier if the U.S. Office of Personnel Management (OPM) selects a different carrier to insure the FLTCIP. They may also void your coverage if you misrepresent facts in completing your application.
Yes. You can request a decrease in your coverage at any time. You can decrease to any plan options that are available under your FLTCIP group policy, and your premiums (which are based on your age at purchase) will also decrease. You do not have to undergo new underwriting in order to decrease your coverage.
Federal Long Term Care Insurance Program (FLTCIP) applications were suspended effective December 19, 2022. Read Important Notice >
All denials are reviewed internally at Long Term Care Partners (LTCP), LLC before they are ever issued. If you receive a denial, the denial letter will let you know how to request a review of the decision. If the denial is reviewed and upheld, you may request an appeal. The letter upholding the denial will explain the appeal process to you.
All appeals are reviewed by an appeals committee composed of one or more representatives of John Hancock Life & Health Insurance Company and other person(s) mutually agreed upon by the U.S. Office of Personnel Management (OPM) and LTCP.
If the appeals committee upholds the denial, you may have the right to request a review by an independent third party. The letter upholding the denial will give you the details on requesting a review by an independent third party. The decision by the independent third party is final and binding on LTCP.
The Long-Term Care Partnership Program is a federally-supported, state-operated initiative that allows you to protect a portion of your assets that you would typically need to spend down prior to qualifying for Medicaid if you purchase a qualified long term care insurance policy or coverage.
Once you purchase a partnership policy and use some or all of the benefits, the amount of the benefits used will be disregarded for purposes of calculating eligibility for Medicaid. This means that you are able to keep your assets up to the amount of policy benefits paid under your coverage. For example, in a state that chooses to participate in the Long-Term Care Partnership Program, once you have used part or all of your maximum lifetime benefit (MLB), your assets would be protected up to the amount paid under the policy. You would not need to spend those assets before qualifying for that state's Medicaid program.
The Long-Term Care Partnership Program originated in the late 1980s to address the increasing cost of state Medicaid expenditures for long term care. During this time, only four states were able to implement a Partnership Program (California, Connecticut, Indiana, and New York) due to federal law constraints. These four states are known as "grandfathered" partnership states.
Effective February 8, 2006, the Federal Deficit Reduction Act of 2005 (DRA) allowed for the nationwide expansion of the Long-Term Care Insurance Partnership Program and asset protection on a dollar-for-dollar basis. This means that for each dollar of benefits paid under the policy, the individual will get one dollar of asset protection, up to the maximum benefits paid out under the policy. Each state can elect to implement a DRA Partnership Program for the citizens of that state. The DRA does not require states to participate. In turn, insurance companies need to decide if they will offer partnership policies, and the policies must be certified as qualifying as partnership policies.
The law specifies that anyone who purchases a tax-qualified long term care insurance policy that meets stringent consumer protection standards and certain inflation requirements under the Partnership Program would qualify for asset protection, on a dollar-for-dollar basis, up to the policy maximum.
It is important to note that the purchase of DRA Partnership coverage does not automatically qualify the coverage holder for Medicaid. In addition, all other Medicaid eligibility criteria and requirements will apply at the time an individual applies for Medicaid.