Civil Service 

Retirement 

System 

Federal Employees’ 

Group Life 

Insurance Program 

Federal Employees 

Health Benefits 

Program 

Federal Employees 

Retirement 

System 

Federal Long 

Term Care 

 Insurance 

Program 

United States 

 

Office of 

Personnel Management 

The Federal Government’s Human Resources Agency

Retirement and Insurance Service 

Benefits Administration Letter 

Number: 02-907 Date: June 25, 2002 

Subject: Federal Long Term Care Insurance Program: 

 Information for Employing Offices 

This letter provides information to employing offices on rules governing the Federal Long Term 

Care Insurance Program (FLTCIP) and other aspects of the Program’s roll-out. We’ll publish 

regulations on the Program at 5 CFR Part 85 as soon as we can, probably later this summer. 

As you can see, this letter is a long one, and we strongly encourage you to read carefully so you 

don’t miss anything. Please pay particular attention to the section on Program Educational 

Meetings. Scheduling these meetings is absolutely critical to the success of this Program and we 

need your support. 

OPEN SEASON 

What are the Open Season dates? 

Open Season begins on July 1 and ends on December 31, 2002. 

How will employees be told about Open Season? 

Employees will receive an announcement of Open Season that will encourage them to call Long 

Term Care (LTC) Partners (the company formed by John Hancock and MetLife), visit the LTC 

Partners web site, or possibly to return a postage-paid card to request an Open Season Information 

Kit and application (Open Season Kit). The response method will depend on the form the 

announcement takes, as we discuss below. 

The announcement may take the form of a printed brochure (copy attached), an email message, a 

paystub message, etc., depending upon the communication vehicles used within a particular 

agency/department/ uniformed service. Agency headquarters implementation coordinators are 

specifying their preferred distribution method(s) to LTC Partners, who will honor their preferences. 
2

LTC Partners will bulk ship Open Season announcement brochures to 

agencies/departments/uniformed services that wish to use this type of communication. LTC 

Partners will provide an email announcement for forwarding to employees to those 

agencies/departments/uniformed services that wish to use email communication for Open Season 

information. And, LTC Partners will provide messages for paystubs and other communications 

vehicles depending on each implementation coordinator’s request. 

Although as we noted, implementation coordinators can specify the form of the Open Season 

announcement (brochure, email, paystub message, etc.) for their employees, we strongly encourage 

the use of the brochures to give more prominence to this important opportunity. We do not endorse 

the use of paystub messaging only. Emails are great, but much more effective if used in conjunction 

with the brochures. 

LTC Partners will be staggering the delivery of Open Season announcements. They’ve developed a 

schedule to spread the deliveries across agencies/departments/uniformed services and geographic 

areas to help control the volume of requests for the Open Season Kit. The account managers at 

LTC Partners are communicating the agency/geographic strategies to the implementation 

coordinators and are working with them to finalize the details on this roll-out. 

Employing offices are responsible for distributing or forwarding the Open Season announcement (in 

whatever form) once they receive them, to individual employees on a timely basis. This is really 

critical, because this is how they will find out about the Program and the upcoming Open Season. 

We are not issuing any other Open Season notice/letter as we traditionally do for the Federal 

Employees Health Benefits (FEHB) Program. 

A few agencies have provided LTC Partners with the home addresses of employees, and in those 

cases Open Season brochures will go directly to employees’ homes. LTC Partners will NOT 

distribute materials this way without a request to do so from the agency. 

The Open Season announcement asks interested recipients to request an Open Season Kit within 10 

days of receiving the announcement, by: 

returning a postage-paid card (applicable to the brochure form of the announcement only), 

or 

calling the toll-free number (1-800-LTC-FEDS) (1-800-582-3337) (TDD for the hearing 

impaired: 1-800-843-3557), or 

visiting the website (www.ltcfeds.com) 

The Open Season Kits, in turn, request that the individual return a completed application within 60 

days of receiving the Kit. These dates are designed to help LTC Partners balance the tremendous 

workload that will result from this new Program. While it is true that eligible individuals can 

submit applications anytime during Open Season, we strongly encourage people to apply during 

their designated 60-day “window”. 

No one will receive a Kit automatically – anyone who wishes to have a Kit must request one by 

one of the three methods discussed above. By only sending the Kit to persons who are truly 
3

interested, we can help keep Program administrative costs and premiums down. And, personal 

requests allow the Kits to contain personalized rate quotes based on the requestor’s age. 

How will annuitants be told about Open Season? 

Annuitants will receive the Open Season announcement at their correspondence address in the form 

of the printed brochure containing the postage-paid return card. As with employees, they will not 

all receive this announcement at the same time – mailings are being staggered across several 

months. 

Will there be other supporting educational materials during Open Season? 

Yes. LTC Partners will continue to provide periodic collateral materials, reminder posters, 

reminder emails, posters announcing meetings, etc., through the implementation coordinators, 

throughout Open Season. Employing offices are responsible for distributing those as well. 

Will employing offices receive (or can they request) bulk quantities of the Open Season Kits 

and applications? 

No. The Open Season Kit is quite comprehensive, and it is cost-prohibitive to make mass 

distributions to agencies. The Kit is also designed to provide a personalized rate quote based on the 

requestor’s age. However, employing offices will receive bulk quantities of a Program Overview 

Brochure (which contains general information about the Program and is different from the Kit and 

the Open Season announcement). LTC Partners is working with the agency headquarters 

implementation coordinators on the details of distributing the Program Overview Brochure. 

 

Open Season Kits with applications will be available at www.ltcfeds.com starting on July 1. During 

Open Season, most individuals eligible to apply using the abbreviated underwriting application will 

be able to submit their application electronically through the website. Those who apply for the 

unlimited benefit period using the abbreviated underwriting application, and all who use the full 

underwriting application, can complete the application online and print it out, sign and mail it, or 

simply print it out, complete it manually and mail it. Please allow access to the Internet and official 

time for this purpose. 

Employees and others in the Federal Family eligible to apply for the Program can put their name on 

the mailing list to receive a hard copy of the Open Season Kit by calling 1-800-LTC-FEDS (1-800-

582-3337) (TDD for the hearing impaired: 1-800-843-3557). On July 1, LTC Partners will mail 

Open Season Kits to those on the mailing list and will continue mailing Kits to those who request 

them throughout Open Season. 

What’s the advantage of applying during Open Season? 

During the Open Season, Federal civilian and Postal employees, members of the uniformed 

services, and their spouses, can apply for the Program using an abbreviated underwriting application 

that asks only a few health-related questions. After Open Season, they must use a full underwriting 

application that contains more health-related questions. 

Another advantage is that all Open Season applicants will have premiums based on their age on 

July 1, 2002, no matter when during Open Season they apply. For example, someone who turns age 

55 in August applying for coverage in October will get age 54-based premiums, since that was 

his/her age on July 1. 
4

What is underwriting? 

Underwriting is the process of reviewing medical and health-related information furnished in an 

insurance application process to determine if the applicant presents an acceptable level of risk 

and is insurable. 

What is abbreviated underwriting? 

In this type of underwriting, the application has several health-related questions designed to 

determine who may be immediately eligible for benefits, or likely to be eligible for benefits 

within a relatively short period of time. Employees and members of the uniformed services who 

apply for the insurance coverage will answer seven questions, and their spouses who apply will 

answer nine. Those applying for the unlimited benefit period will have to answer a few 

additional questions, sign a release giving access to medical records, and perhaps have an 

interview with a nurse. 

What is full underwriting? 

In this type of underwriting, there are quite a few more health-related questions. It may also 

include a review of medical records and perhaps an interview with a nurse. This is the same level 

of underwriting that those who purchase individual policies in the private market undergo. 

Some employees didn't apply during Early Enrollment because they knew they wouldn’t 

pass underwriting and the application told them not to send in the application if they 

answered yes to any of the questions. Should they consider applying during Open 

Season? 

Absolutely, because there are more options available during Open Season for persons who won’t 

pass the underwriting. There is an alternative insurance plan for some employees and spouses who 

are denied the coverage they applied for. It provides more limited insurance coverage (nursing 

home-only coverage, with a 180-day waiting period). There is also a service package for all who 

are declined insurance coverage (access to care coordination services and provider discounts for a 

small annual fee). 

What happens after Open Season? 

After Open Season, eligible persons can still apply for FLTCIP coverage, but all who apply must 

complete a full underwriting application. Premiums will be based on the applicant’s age at the time 

LTC Partners receives the application. New employees, employees in newly eligible positions, and 

their spouses can apply using the abbreviated application within 60 days of becoming eligible to 

apply. After that 60 days, they would have to use the full underwriting application. 

Will there be annual Open Seasons? 

No, we will not hold annual Open Seasons. We will hold future Open Seasons, but not on a regular 

or frequent basis. We don’t know when the next one will be. We need to get through this Open 

Season first and evaluate the results. 

Why should we tell employees to contact LTC Partners with their questions? Why can’t we 

help them? What information will we receive about our employees who apply? 

Long term care insurance is a complicated subject. It’s not practical for employing office personnel 

to become well versed in long term care insurance without extensive training to counsel employees 
5

properly. LTC Partners has certified long term care insurance specialists available to help eligible 

members of the Federal Family make informed decisions on FLTCIP coverage. 

Employing offices will not get a listing of their employees who have applied and been approved for 

coverage (or been denied). LTC Partners will not release information on an employee’s application 

with agencies. That information is private and protected. Employees with questions on coverage 

should go directly to LTC Partners. 

PROGRAM EDUCATIONAL MEETINGS 

Will there be worksite meetings about FLTCIP? 

Yes. LTC Partners will be conducting around 2,000 Program Educational Meetings throughout the 

country beginning on July 15 and continuing through November. LTC Partners has been working 

with many of the agency implementation coordinators to develop a schedule of these meetings. It is 

absolutely critical that you give top priority to any requests you receive from LTC Partners’ 

personnel to schedule meetings at your site. 

The schedule of meetings will be available at www.ltcfeds.com beginning July 1. It will be updated 

continuously, as more meetings are finalized. 

As with other Federal employee benefit programs, we strongly encourage employing offices to 

grant administrative leave for employees to attend such meetings. LTC Partners is requesting that 

people register in advance of attending a meeting, which can be done on the web site or by calling 

1-800-LTC-FEDS (1-800-582-3337) (TDD for the hearing impaired: 1-800-843-3557). Although 

registration is strongly recommended, it is not required in order to attend a meeting. 

Employees may attend any meeting to which they have access. The access issue is important 

because there will be meeting locations with security restrictions. For example, some agencies may 

only allow employees of their agency to attend meetings at their agencies. That information will 

appear in the meeting registration site on the web, and will be available at the toll-free number, as 

long as agencies let LTC Partners know about the restrictions. 

Why should we grant access to our building to those conducting these meetings? We don’t 

allow private insurance companies to speak to our employees. 

Please keep in mind that the FLTCIP is the only long term care insurance program authorized to be 

offered as part of the Federal workforce benefit package. LTC Partners is the contractor that we 

have chosen to provide this insurance benefit to the Federal Family. Thus, it is entirely appropriate 

for LTC Partners and its contractors to conduct Program Educational Meetings on Federal property 

to educate the Federal workforce about this Federal Program. Please provide them the same access 

to your buildings and employees as you would any health plan that participates in the FEHB 

Program. 

Meeting presenters who represent the FLTCIP will have OPM identification badges and are the 

only persons authorized by OPM to speak for the FLTCIP at such meetings. Employing offices 

should ask for this identification to ensure that the FLTCIP is being represented properly. These 

meeting presenters will only use materials that OPM has approved. 
6

Should we allow other insurance agents such access to our employees? 

You may get calls and visits from private insurance agents attempting to reach your employees with 

information on long term care insurance policies that they sell. While it is the employing office’s 

decision on whom to allow on agency grounds, we recommend limiting or declining access by such 

agents, at least when Program Educational Meetings are taking place. We do encourage employees 

to compare the FLTCIP to other policies available in the private market, but the Program 

Educational Meetings are not the appropriate place for this shopping. As with the FEHB and 

FEGLI Open Seasons, the focus should be on the benefit program sponsored by the Federal 

Government on employees’ behalf. 

We’re not scheduled for a worksite meeting. What else is available? 

Although LTC Partners is scheduling about 2,000 Program Educational Meetings, it’s not possible 

to visit every Federal worksite. And, meetings will not be held outside the United States. There are 

other options for those without access to a meeting, including our members of the Federal Family 

who are overseas. Employing offices can request videotapes of a Program Educational Meeting, 

and can make arrangements to have an LTC Partners representative answer questions live at the end 

of the showing. If you are interested in this option, please send an email with your request to 

account.management@ltcpartners.com. 

Another option is the online version of the Program Educational Meeting (a “webinar”), which can 

be viewed on the LTC Partners web site at www.ltcfeds.com starting in July. The webinar provides 

the same information about the Program as a worksite meeting. A written transcript of the webinar 

will be on the web as well. LTC Partners is also exploring posting a streaming video copy of a 

meeting. 

ELIGIBILITY 

Who is eligible to apply for coverage in the FLTCIP? 

Federal Civilian and Postal employees 

Federal civilian and Postal employees are eligible to apply for FLTCIP coverage if they are in a 

position that conveys eligibility for FEHB coverage. An employee does not need to be enrolled in 

FEHB, just eligible to enroll. You can find a complete listing of the types of civilian positions that 

are and are not eligible for FEHB in the FEHB Handbook, at 

www.opm.gov/insure/handbook/FEHB06.htm. 

There are two exceptions: Tennessee Valley Authority employees and retirees are eligible to apply 

for insurance coverage under the FLTCIP, even though they may not be eligible for FEHB. District 

of Columbia employees and retirees are not eligible, even though some may be eligible for FEHB. 

Note that the information shown in the FEHB Handbook about TVA employees and DC 

Government employees is not applicable to the FLTCIP. 

Employees must be in a position that conveys eligibility for FEHB at the time they apply for 

FLTCIP coverage. If an employee has FEHB coverage due to previous eligibility and continuity of 

coverage provisions, but the employee’s current position does not convey FEHB eligibility, the 

employee is not eligible to apply for FLTCIP coverage. 
7

Temporary employees are eligible to apply for FLTCIP coverage under the same rules as FEHB. 

Once a temporary employee has completed one year of continuous current employment, he/she has 

60 days from the date of first eligibility to apply for coverage using an abbreviated underwriting 

application. 

Non-Federal employees with FEHB eligibility 

Some employees are no longer Federal employees, but are now working for a private entity, and yet 

they still have eligibility for FEHB. For example, this applies to some employees of the 

Metropolitan Washington Airports Authority, and certain of the financial institutions. Those 

employees are not eligible to apply for FLTCIP. In order to be eligible to apply for the FLTCIP as 

Federal civilian employees, they must be current Federal or Postal employees in a position that 

conveys eligibility for the FEHB Program. 

Non-appropriated fund (NAF) employees 

NAF employees are not eligible to apply for FLTCIP coverage. 

Members of the uniformed services 

Members of the uniformed services are eligible to apply for coverage when they are on active duty 

or full-time National Guard duty for more than a 30-day period. Members of the Selected Reserve 

are eligible to apply. This consists of: 

Drilling Reservists and Guardsmembers assigned to Reserve Component Units; 

Individual Mobilization Augmentees who are Reservists assigned to Reserve component 

billets in Active Component units (performing duty in a pay or nonpay status); 

Active Guard and Reserve members who are full-time Reserve members on full-time 

National Guard duty or active duty in support of the National Guard or Reserves. 

Members of the Individual Ready Reserve are not eligible to apply for coverage. This includes 

Reservists who are assigned to a Voluntary Training Unit in the Naval Reserve and Category E in 

the Air Force Reserve. 

Annuitants and retired members of the uniformed services 

Federal civilian annuitants, including surviving spouses, other survivor annuitants, FERS MRA+10 

annuitants, deferred annuitants (when they are receiving annuities), and compensationers, are 

eligible to apply for the insurance coverage. There is no “five-year rule” for the FLTCIP, as there is 

for the FEHB Program. 

Retired members of the uniformed services are eligible when they are entitled to retired or retainer 

pay (including disability retirement pay). Retired (“gray”) reservists are eligible when receiving 

retirement pay, which is generally at age 60. 

What qualified relatives are eligible to apply? 

The current spouse of an eligible person noted above may apply for coverage. This includes a 

surviving spouse of a member or retired member of the uniformed services who is receiving a 

survivor annuity. Receipt of Dependency and Indemnity Compensation (DIC) from the Department 

of Veterans Affairs qualifies as a survivor annuity. 
8

A former spouse is not eligible, even if he/she is eligible for FEHB coverage and/or is eligible for or 

receiving an apportionment of a survivor annuity. 

The parents, parents-in-law, and stepparents of living employees or living members of the 

uniformed services are eligible to apply (but those of annuitants and retired members of the 

uniformed services are not). Parents-in-law include the parents of a deceased spouse, as long as the 

employee or member of the uniformed services has not remarried. A stepparent is the person who is 

currently married to the employee’s parent, or if the parent is dead, the person who was married to 

the employee’s parent at the time of his/her parent’s death. 

The adult children (age 18 or over) of living employees, living annuitants, or living members or 

living retired members of the uniformed services are eligible to apply. This includes natural 

children, adopted children and stepchildren. Foster children are not eligible to apply. 

There are no self and family enrollments in the FLTCIP. Each person must submit his/her own 

application and pass underwriting on their own. However, payment of premiums can be 

consolidated (e.g., employees may choose to pay the premiums for their spouses by payroll 

deduction). 

Qualified relatives may apply even if the employee, annuitant, member or retired member of the 

uniformed services to whom they are related does not apply or applies and is not approved for 

coverage. 

How does someone show eligibility? 

The FLTCIP relies on self-certification of an applicant’s eligibility. The application asks the 

applicant to designate his/her eligibility category. The applicant’s signature in the Agreement and 

Authorization section of the application signifies that the answers the applicant has given on the 

form (including his/her status as an eligible individual) are true and complete. This signature also 

attests that the applicant understands that if he/she is approved for coverage, but shouldn’t have 

been because one or more answers are not true, LTC Partners has the right to deny benefits or 

cancel the insurance. 

An enrollee who misrepresents his/her inclusion in an eligible group on the application risks losing 

coverage, and there is no time limit on this. Incontestability doesn’t apply in this case (see the 

section on Incontestability near the end of this letter, in the Miscellaneous section). 

Should we check or verify employees’ eligibility? 

No. Employing offices are not expected to check or verify an applicant’s eligibility status, but 

should give guidance to employees who may ask if they are eligible to apply for the FLTCIP. 

Employing offices are not expected to inform LTC Partners about the eligibility or ineligibility of an 

applicant. However, if an employee submits a claim for benefits, LTC Partners may have a 

question about eligibility and may contact the agency for assistance. We expect that you would 

cooperate with LTC Partners on such a request. 

Can an employee in nonpay status apply? 

An employee should not apply for FLTCIP coverage while in nonpay status. The coverage will not 

become effective as long as the employee is in a nonpay status. And the application may no longer 
9

be valid by the time the employee returns to pay status, because health and eligibility may have 

changed. It is simpler to wait to apply until after returning to a pay status. 

An employee returning to pay status during the Open Season will have 60 days from the date he/she 

returns to pay status, or until the end of the Open Season, whichever provides more time, to apply 

for coverage with abbreviated underwriting. For example, employees who return to pay status on 

October 15 still get until December 31 to apply with abbreviated underwriting. Their age for billing 

purposes would be their age on July 1, because they are applying during Open Season. Employees 

who return on November 15 will have until January 14 to apply. If they apply after Open Season 

ends, their age for billing purposes would be their age on the date that their application is approved. 

An employee returning to pay status after the end of Open Season will have 60 days from his/her 

return to apply for coverage with abbreviated underwriting. 

Both of these 60-day periods only apply if the employee has been in nonpay status in aggregate for 

over one-half of the Open Season. An employee who has been actively at work for at least half of 

the Open Season has already had ample opportunity to get information about the Program and to 

apply for coverage without the need for these special provisions. 

Can someone apply after Open Season? 

LTC Partners will accept full underwriting applications from eligible individuals at any time. After 

Open Season ends, employees, members of the uniformed services, and their spouses (other than 

new employees) will no longer be eligible for abbreviated underwriting. They must complete the 

full underwriting application. 

Are new employees eligible to apply? 

A new employee or new member of the uniformed services and his/her spouse will have 60 days 

from becoming eligible to apply for coverage with abbreviated underwriting. This 60-day 

opportunity also applies when an employee is for the first time entering a position that conveys 

eligibility for FLTCIP, and when an employee returns to service after a break in service of 180 days 

or more. 

The employing office is responsible for letting a new employee know about eligibility to apply for 

the FLTCIP when it counsels the employee on other benefits, such as FEHB and FEGLI. We will 

publish an informational pamphlet that employing offices can hand out to new employees that will 

describe the Program. This will be available after the Open Season ends. 

What if a new employee misses this 60-day period? 

The employing office may authorize a belated new employee application when an employee can 

show that he/she was unable, for causes beyond his/her control, to submit an application within the 

initial 60-day eligibility period. The employing office must make this determination within 6 

months from the first day the employee became eligible. The employing office must make this 

authorization in writing so that the employee can submit that documentation with his/her 

application. 

We suggest the following wording for the authorization: “(Employee’s name) became eligible for 

FLTCIP on (date). We have determined that (employee’s name) was unable to submit an 
10

abbreviated underwriting application during the 60-day eligibility period because (give specific 

reason why).” An employing office official should sign and date the authorization and give a copy 

to the employee. Retain a copy for your records in case LTC Partners has a question about the 

authorization. 

The employing office should use this authority sparingly, only in instances where the cause for not 

submitting an application was truly outside the employee’s control. An example is when you can 

positively verify that an employee was not made aware of the Program until after the initial 

eligibility period was over. 

Do employees’ new spouses get a 60-day period to apply? 

Yes. When an employee or member of the uniformed services marries, the new spouse has 60 days 

from the date of the marriage to apply for coverage using an abbreviated underwriting application. 

However, if the employee or member of the uniformed services wants to apply as well, he/she must 

apply with the full underwriting application. That’s because the employee/member already had an 

opportunity to apply using an abbreviated underwriting application. 

What about other new qualified relatives? 

Other new qualified relatives of an employee or annuitant, or member or retired member of the 

uniformed services, may apply for coverage at any time using a full underwriting application. 

EFFECTIVE DATES 

When will coverage become effective?

Once LTC Partners approves an application for coverage, it will send notice of the approval to the 

applicant and provide an “original effective date” of coverage. An employee or member of the 

uniformed services must be actively at work for at least half of his/her regularly scheduled work 

hours on that date for coverage to take effect (or on the last workday before that date, if it falls on a 

weekend or holiday). 

If employees work other than a full-time schedule, and the original effective date falls on a date that 

they are not scheduled to be at work, then they must meet the actively at work requirement on their 

closest workday before that original effective date. 

Applicants are solely responsible for letting LTC Partners know if they do not meet the actively at 

work definition on the original effective date. Employing offices should not attempt to police or 

verify that an employee is actively at work on his/her original effective date. 

Applicants are also solely responsible for letting LTC Partners know if their health changes from the 

time they completed their application until the effective date of their coverage. If it does, and if that 

change in health is such that they would now answer one or more questions differently on the 

application, they have a duty to inform LTC Partners. LTC Partners will then determine if they are 

still approved for coverage. If they do not inform LTC Partners of this change in health, then LTC 

Partners may have the right to deny a claim for benefits or rescind coverage. 
11

The rules on coverage effective dates are explained in the Benefit Booklet that LTC Partners sends 

to applicants upon approval for coverage. 

Actively at work definition 

Actively at work means that a Federal civilian or Postal employee meets all of the following 

conditions: 

the employee is reporting for work at the usual place of employment or other location to 

which Government business requires him/her to travel; and

the employee is able to perform all the usual and customary duties of employment on his/her 

regular work-schedule; and 

the employee is not absent from work due to sickness, injury, annual leave, sick leave or any 

other leave. (An employee is not considered to be on leave on his/her alternate work 

schedule’s scheduled day off.) 

A member of the uniformed services is actively at work when he/she is on active duty and 

physically able to perform the duties of his/her position. 

What happens if the employee is not actively at work on the original effective date? 

If the employee does not meet the actively at work definition on the original effective date, he/she is 

obligated to contact LTC Partners with that information. LTC Partners will then issue a revised 

effective date, which is the first day of the month after the date the employee returns to being 

actively at work. However, for coverage to become effective on the revised effective date, the 

employee must meet the actively at work requirement on that date as well. An employee’s coverage 

will not become effective until he/she meets the actively at work requirement on the coverage 

effective date issued by LTC Partners. If LTC Partners discovers that an employee was not actively 

at work on the “effective” date of his/her coverage, benefits will never be paid because coverage 

never went into effect. 

Employing offices are not expected to monitor or report to LTC Partners on employees’ work status 

on their original effective dates. However, if an employee submits a claim for benefits, LTC 

Partners may have a question about eligibility and may contact the agency for assistance. We 

expect that you would cooperate with LTC Partners on such a request. 

Are effective dates always on the first day of a month? 

Yes. Effective dates will always be on the first day of a month. If a coverage effective date falls on 

a weekend or a holiday, the employee must be actively at work on the last workday before that date. 

Many employees will have original effective dates of October 1, 2002, since that is the first date that 

an Open Season enrollment can take effect. November 1, December 1, and January 1 will also be 

common original effective dates. Since coverage will not become effective when the employee is 

not actively at work on his/her original effective date, employees may wish to consider carefully 

before scheduling leave on that date. Since December 1 falls on a weekend, an employee must be 

actively at work on November 29 for coverage to take effect with a December 1 original effective 

date. For a January 1, 2003, effective date, an employee must be actively at work on December 31, 

2002, for coverage to take effect, since January 1 is a holiday. 
12

Examples 

Joe is approved for coverage and LTC Partners gives him an original effective date of October 1, 

2002. Joe is at work on that date for the entire day and is performing the usual duties of his 

position. Since he meets the actively at work requirement, his coverage goes into effect on that date. 

Jacinda also has an original effective date of October 1. However, she takes sick leave on 

October 1. She is obligated to report to LTC Partners that she is not actively at work on her original 

effective date. Her coverage does not go into effect on October 1. LTC Partners issues her a 

revised effective date of November 1. She is at work on that date performing the usual duties of her 

position. Her coverage goes into effect on November 1. 

Bob has an original effective date of December 1. He is at work for only two hours on November 

29, so he does not meet the actively at work requirement because he is a full-time employee and a 2 

hour period is less than one-half of his regularly schedule work hours for that day. He reports this to 

LTC Partners and gets a revised effective date of January 1. He is actively at work for the entire 

day of December 31, so his coverage goes into effect on January 1. 

What happens if an employee’s eligibility status changes before the coverage effective date? 

If an employee retires after applying for coverage but before the coverage becomes effective, the 

coverage will not go into effect. If the employee still wishes to have the coverage, he/she must 

reapply for coverage using the full underwriting application required of annuitants. An employee 

applying for FLTCIP coverage who is considering retirement may wish to consider delaying 

retirement until after his/her FLTCIP coverage has gone into effect. 

Since October 1, 2002, is the first date that an Open Season enrollment can become effective, any 

employee who applies for coverage and then retires before that date will have to reapply with full 

underwriting, regardless of when he/she applied during the Open Season. Or, the employee may 

choose to wait until he/she has retired and then complete the full underwriting application. 

An employee who otherwise separates from service (i.e., not through retirement) after he/she 

applies for coverage, but before the coverage becomes effective, loses eligibility to apply for 

insurance coverage under the FLTCIP. The coverage applied for will not go into effect (note that 

the employee has a positive obligation to notify LTC Partners in such an instance). An employee 

applying for FLTCIP coverage who is planning to separate from service may wish to consider 

delaying his/her separation date until after his/her FLTCIP coverage has gone into effect. 

There is an exception to the above rule when an employee is involuntarily separated, such as 

through a reduction in force. Coverage will go into effect as if the employee hadn’t separated. 

However, if the separation is due to the employee’s misconduct, he/she loses eligibility and 

coverage will not go into effect. 
13

MISCELLANEOUS 

Who makes insurability decisions? 

LTC Partners makes all insurability decisions, and those decisions cannot be appealed to OPM. 

However, an applicant may ask LTC Partners to reconsider its decision. This is similar to FEGLI 

Program requirements, where decisions to deny life insurance coverage cannot be appealed to OPM. 

What is incontestability? 

Incontestability is an insurance term and is part of the Program. LTC Partners cannot use any 

statement made by an enrollee which relates to insurability to contest the validity of the 

enrollee’s coverage or to deny an otherwise valid claim, unless the statement was contained in 

writing and signed by the enrollee, and LTC Partners provided the enrollee with a copy of the 

form containing the statement in question (e.g., the application). 

If coverage has been in force for less than 6 months, LTC Partners may contest the validity of 

coverage (cancel coverage and return premiums) or deny an otherwise valid claim if they can 

show that the enrollee misrepresented information in the application process. 

If coverage has been in force for at least 6 months but less than 2 years, LTC Partners may 

contest the validity of coverage or deny an otherwise valid claim if they can show that the 

enrollee misrepresented information relevant to the condition that is the basis for the enrollee’s 

claim. 

If coverage has been in force for 2 years or more, LTC Partners may contest the validity of 

coverage or deny an otherwise valid claim only upon a showing that the individual knowingly 

and intentionally, by statement or omission, provided inaccurate information that was material to 

the decision to issue the insurance. 

Incontestability does not apply to statements made about eligibility --- being included in a group 

eligible to apply for the coverage (such as misrepresentation that you are an employee or that you 

are the adult child of an annuitant). Such misrepresentations can cause coverage to be 

invalidated with no time limit. 

Is coverage portable? 

Yes, once it is effective, FLTCIP coverage is fully portable. An enrollee can continue coverage as 

long as he/she pays premiums. This includes when an employee separates or retires from Federal 

service, or when a qualified relative loses eligibility status (such as through divorce). There are no 

requirements to carry it for any length of time before retirement or separation. For example, an 

employee whose coverage became effective on October 1 can retire on October 2 and carry 

coverage into retirement with no additional underwriting. The employing office does not need to 

take any action to ensure portability. Premiums do not change just because an employee retires or 

leaves an eligible group. 

THANKS FOR YOUR HELP! 

Thank you for your support as this exciting new benefit program gets underway. If you or your 

employees have any questions about the Program, please contact Long Term Care Partners at 
14

info@ltcpartners.com, or call 1-800-LTC-FEDS (1-800-582-3337) (TDD for the hearing impaired: 

1-800-843-3557). 

Beginning July 1, the hours to reach the certified long term care insurance consultants at the toll-free 

number increase to 8:00 am to midnight, 7 days a week, Eastern time. The voice response system is 

available 24 hours, 7 days a week. 

Please refer to BAL 02-313 for details on payroll issues for the Program. 

You can also find a wealth of information about the Program at www.ltcfeds.com and on our 

website at www.opm.gov/insure/ltc. The ltcfeds.com website will be updated extensively on July 1. 

AND FINALLY DON’T FORGET ... 

Our third and final satellite broadcast will take place on Wednesday, July 17th, from 12:30 – 1:30 

pm, Eastern Time. We’ll send you more details and the satellite coordinates as soon as we have that 

information. 

 

 Frank D. Titus 

 Assistant Director 

 for Long Term Care Insurance 

Attachments 

 Brochure announcing Open Season, including letter from Director Kay Coles James