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The Federal Benefits FastFacts provides basic information about the Federal Benefits Programs administered by the Insurance Services Programs at OPM. We will issue FastFacts throughout the year so be sure to check back with us. Please note: before making any final decisions, please visit the home page for more specific information.
The Office of Personnel Management is responsible for administration and oversight of the Federal Long Term Care Insurance Program (FLTCIP). These pages contain the Benefits Administration Letters (BALs) that provide guidance to agencies on FLTCIP.
The Federal Long Term Care Insurance Program was established by Public Law 106-265, The Long-Term Care Security Act. It is codified in Title 5, Part III, Subpart G, Chapter 90, of the U.S. Code. Chapter 90 has subsequently been amended by several additional laws, mostly pertaining to the groups eligible to apply for insurance under the program.
The links below lead to a current copy of this portion of the U.S. Code and to the original and amending laws.
This part is written as if the reader were an applicant or enrollee. Accordingly, the terms "you," "your," etc., refer, as appropriate, to the applicant or enrollee.
In this part, the terms annuitant, employee, member of the uniformed services, retired member of the uniformed services, and qualified relative have the meanings set forth in section 9001 of title 5, United States Code, and supplement the following definitions:
Abbreviated underwriting is a type of underwriting that asks fewer questions about your health status than with full underwriting to enable the Carrier to determine whether your application for coverage will be approved. The Carrier may also require review of your medical records, a phone interview, or an in-home interview.
Actively at work means:
Carrier means a qualified carrier as defined in section 9001 of title 5, United States Code, with which OPM has contracted to provide long term care insurance coverage under this section. A Carrier may designate 1 or more administrators to perform some of its obligations.
Eligible individual means an annuitant, active workforce member, member of the uniformed services, retired member of the uniformed services or qualified relative, as defined in section 9001 of title 5, United States Code.
Enrollee means an eligible individual whose application for coverage the Carrier has approved and whose coverage is in effect.
FLTCIP means the Federal Long Term Care Insurance Program.
Free look means that within 30 days after you receive the Benefit Booklet, you may cancel your coverage if you are not satisfied with it and receive a refund of any premium you paid. It will be as if the coverage was never issued.
Full underwriting is the more comprehensive type of underwriting under the FLTCIP, which requires that you answer many questions about your health status to enable the Carrier to determine whether your application for coverage will be approved. The Carrier may also require review of your medical records, a phone interview, or an in-home interview.
Stepparent means any person, other than your mother or father, who is currently married to one of your parents, or, if one of your parents is dead, a person who was married to that parent at the time of that parent's death.
Underwriting requirements means the information about your current health status and history and other information that you must provide to the Carrier with your application for coverage to enable the Carrier to determine your insurability.
Workforce member means a Federal civilian or Postal employee, member of the uniformed services, Federal annuitant, retired member of the uniformed services, or member of any other eligible group, as defined in section 9001 of title 5, United States Code. An active workforce member is one who is currently employed or is on active duty.
You must submit your benefit claims to the FLTCIP Carrier or its designee.
Yes, if you file a claim for benefits, the Carrier needs to have a valid authorization from you to release your medical records.
OPM may order correction of administrative errors after reviewing evidence and finding that it would be against equity and good conscience not to do so.
Federal agencies and uniformed services establishments are responsible for:
Consistent with the authority and discretion given to OPM by the FLTCIP law, OPM's responsibilities include those functions typically associated with, and preemptive of, State insurance regulatory authorities such as:
If the Carrier approves your application for coverage, OPM and/or the Carrier will make available to you a benefit booklet and schedule of benefits with complete coverage information, which will serve as your proof of insurance. You will also get a copy of your approved application for coverage.
For the purpose of making findings of fact and to the extent that conclusions of law may be required under any proceeding conducted in accordance with the provisions of the disputes clause included in the FLTCIP master contract, OPM delegates this function to the Armed Services Board of Contract Appeals.
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If you are a Federal annuitant, including a survivor annuitant, a deferred annuitant, or a compensationer, you are eligible to apply for coverage. Separated Federal employees with title to a deferred annuity may apply for coverage, even if they are not yet receiving that annuity.
If you have separated from service under the FERS Minimum Retirement Age and 10 years of service (MRA+10) provision of 5 U.S.C. 8412(g), and have postponed receiving an annuity under that provision, you are eligible to apply for coverage under this part. For underwriting purposes, you will be considered an annuitant.
You may not apply as a qualified relative if the workforce member on whom you are basing your qualified relative status died prior to the time you apply for coverage, unless you are receiving a survivor annuity as the spouse or an insurable interest annuity as the domestic partner of a deceased workforce member. In this case, your adult children and your current spouse or domestic partner are also considered to be qualified relatives.
Yes, there is a minimum application age. You must be at least 18 years old at the time you submit an application for coverage.
a. You may apply for coverage as a qualified relative if you are a domestic partner, as described in section 875.101 of this chapter. As prescribed by OPM, you will be required to provide documentation to demonstrate that you meet these requirements, and you must submit to full underwriting requirements. However, as explained in section 875.210 of this chapter, if you lose your status as a domestic partner, and therefore a qualified relative, before your coverage goes into effect, you are no longer eligible for FLTCIP coverage.
Final Regulations (June 1, 2010)
There is no Government premium contribution toward the cost of long term care insurance.
The Carrier must keep account of all funds received under this section separate from all other funds. The Carrier may use FLTCIP funds only for purposes specifically related to the FLTCIP.
If you are eligible for coverage, you may submit an application at any time outside of an Open Season. You will be subject to full underwriting requirements. The only exceptions to the full underwriting requirements outside of an Open Season are described in §875.206 and §875.405.
The Carrier determines the insurability of all applicants. The Carrier's decision may not be appealed to OPM.
You must provide the Carrier with an authorization to release medical information when requested. The Carrier may deny a claim for benefits or void your coverage if the Carrier does not receive an authorization to release medical information within 3 weeks after its request (4 weeks for those outside the United States).
If you are an active workforce member, your coverage will automatically continue when you leave active service, as long as the Carrier continues to receive the required premium when due. However, once you leave active service, you are no longer eligible for any abbreviated underwriting provided during any future Open Season.
If you are already enrolled as a qualified relative, you may continue your FLTCIP coverage if you subsequently lose qualified relative status (such as upon divorce), as long as the Carrier receives the required premium when due.
Except as provided in paragraph (e) of this section, your coverage will terminate on the earliest of the following dates:
(However, in this event, care coordination services will continue.)
e. Termination of a domestic partnership does not terminate insurance coverage as long as the Carrier continues to receive the required premium when due.
Yes, benefits will be coordinated with other plans, following the coordination of benefits (COB) guidelines set by the National Association of Insurance Commissioners. The total benefits from all plans that pay a long term care benefit to you should not exceed the actual costs you incur. The other plans that are considered for COB purposes include government programs, group medical benefits, and other employer-sponsored long term care insurance plans. Medicaid, individual insurance policies, and association group insurance policies are not taken into consideration under this provision.
Sec. 9001. Definitions.Sec. 9002. Availability of insurance.Sec. 9003. Contracting authority.Sec. 9004. Financing.Sec. 9005. Preemption.Sec. 9006. Studies, reports, and audits.Sec. 9007. Jurisdiction of courts.Sec. 9008. Administrative functions.Sec. 9009. Cost accounting standards.
For purposes of this chapter:
The district courts of the United States have original jurisdiction of a civil action or claim described in paragraph (1) or (2) of section 9003(c), after such administrative remedies as required under such paragraph (1) or (2) (as applicable) have been exhausted, but only to the extent judicial review is not precluded by any dispute resolution or other remedy under this chapter.
‘The cost accounting standards issued pursuant to section 26(f) of the Office of Federal Procurement Policy Act (41 U.S.C. 422(f)) shall not apply with respect to a long-term care insurance contract under this chapter.’.
90. Long-Term Care Insurance
The Office of Personnel Management shall take such measures as may be necessary to ensure that long-term care insurance coverage under title 5, United States Code, as amended by this title, may be obtained in time to take effect not later than the first day of the first applicable pay period of the first fiscal year which begins after the end of the 18-month period beginning on the date of the enactment of this Act.
[View the Entire Law]
AT THE SECOND SESSION
Begun and held at the City of Washington on Wednesday, the twenty-third day of January, two thousand and two
To authorize appropriations for fiscal year 2003 for military activities of the Department of Defense, for military construction, and for defense activities of the Department of Energy, to prescribe personnel strengths for such fiscal year for the Armed Forces, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
. . . . .
(D) an employee of a nonappropriated fund instrumentality of the Department of Defense described in section 2105(c),'.
‘(b) DISCRETIONARY AUTHORITY REGARDING NONAPPROPRIATED FUND INSTRUMENTALITIES- The Secretary of Defense may determine that a nonappropriated fund instrumentality of the Department of Defense is covered under this chapter or is covered under an alternative long-term care insurance program.’.
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