Federal Diary Live
With Stephen Barr
Washington Post Staff Writer
Wednesday, March. 27, 2002; Noon EST
Are you interested in early enrollment in the government's long-term care insurance program? Do you understand how the benefits and options work? Do you have questions about premiums?
Laura Lawrence, project leader for the long-term care insurance program at the Office of Personnel Management, joined The Post's Stephen Barr, who writes the Federal Diary column, to discuss the new benefit unveiled this week for government employees and retirees.
About 20 million people are eliglible to apply for the coverage, OPM estimates. Eligible groups include federal employees, military personnel, retirees, survivors, spouses and certain other family members. The early enrollment period started Monday and will run through May 15. A regular "open season" will begin July 1 and run through Dec. 31.
The program is intended to help government employees and retirees obtain insurance to cover such costly services as nursing home care, assisted-living care, adult day care and other long-term care. It represents the first large benefit program created by Congress for federal workers since the establishment of the Thrift Savings Plan in the 1980s.
The transcript follows.
Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Stephen Barr: My thanks to all of you for joining us today, and a special thanks to Laura Lawrence of the Office of Personnel Management, her team at OPM and her colleagues at Long Term Care Partners LLC, which is providing the long-term care insurance to federal employees and retirees.
Laura, I've looked at all the material you've produced and feel like I'm trying to tie up the ends of spaghetti -- so many choices and decisions to make. What three things should federal employees and retirees keep in mind as they look at the program and the benefits it offers?
Again, thanks for taking time from your busy schedule today.
Laura Lawrence: Thanks, Steve. Great to be here. I always appreciate the invitation to join you. Today, we have Roger Gagne, Actuarial Director at John Hancock, and Irene Juthnas, Director of Underwriting, at Long Term Care Partners with us to also answer questions.
Let's see... spaghetti is good for dinner, but not in deciding benefits! Wow, just three things -- here's one and then two points under another.
1. If you haven't determined you're a candidate for long term care insurance at this point, you're probably not. You should wait for the education and information that we'll be providing in the coming months so that you can make an informed decision for open season starting July 1. Early enrollment is not for everyone, even those who may have a birthday coming up, before July 1st.
If you've determined that you ARE a candidate for long term care, and you're comparing the Federal program with others, keep the following two points in mind:
1 -- Under the Federal program, OPM is on your side and will remain on your side for the rest of your life. This means the Program benefits will always be contemporary. Who knows, maybe in 20 years robots will be the primary providers of care -- we'll cover them! And if you have any problems with your insurance or the contractor (not that we anticipate that), call us. We're there to help you.
2 -- Some of you may be submitting questions during this forum that take issue with our premiums and cite "comparable" plans with cheaper premiums. Be SURE that the benefits are comparable. Our bet is that they are not. You have to look behind the benefits too. For example, knowing that the non-Federal policy covers informal care isn't enough -- does it cover care from family members, neighbors, others not from a home care agency? Our program DOES. Many plans do not, even if they cite "coverage for informal care."
Fairfax, Va.: I am a federal employee and want to sign up for LTC during the early enrollment period because both my wife and I have birthdays in April. We are both age 55. While I understand the options, I do not know which inflation protection -- automatic compound or future purchase -- would be the most cost-effective for us. Any ideas to help me decide?
Laura Lawrence: Hi, Fairfax. Yes, there are two options -- automatic compound and future purchase. The automatic compound is more expensive initially, but you don't have to worry about inflation. It's built in at 5% compounded each year. AND you get the increases even if you're not in good health or even if you're claiming benefits. FPO is less expensive initially, BUT every other year you have to make a choice to do nothing and get the increase (based on Medical CPI) or to reject it. After a bit, FPO really becomes much too expensive, because the increases are based on your CURRENT age. And you do NOT get these offers if you're eligible for benefits.
the choice is yours, but you should consider how much money you have, how risk adverse you are, and what your chances are of staying in good health.
Fredericksburg, Va.: Why is the federal LTC plan more expensive than going outside for equivalent coverage? Why isn't there a spousal discount available? OPM has said that the premiums would probably be 15 to 20 percent less expensive than existing private plans, so what went wrong?
Laura Lawrence: Our research shows that the Federal LTC Program is roughly 15-20 percent less expensive than comparable policies now available on the retail market. We arrived at this conclusion by examining several of the leading policies available and making actuarial adjustments for provisions that were not equal to those of the Federal Program. I must emphasize that there are often significant differences between different plans that can affect their cost, and that a valid "apples-to-apples" comparison is very difficult to do.
It is true that for some people rates in the retail marketplace can be reduced by spousal and preferred health discounts. The Federal Program chose not to offer spousal discounts or preferred health rates. Rather, the aim is to offer the lowest possible rates to all who qualify under the underwriting standards.
Olney, Md.: One of the main reasons people take out Long Term Health Care Insurance is to ensure that their families are able to maintain accumulated nest eggs. The 5 percent compounded inflation option is supposed to ensure that you can do just that. However, I am wondering if that is so. In 20 years, will the daily benefit still be covering the same proportion of daily nursing home costs? Or are the costs likely to rise much more than the 5 percent compounded, and leave the policy holder using the nest egg to supplement the daily rate? Thank you.
Laura Lawrence: Hi, Olney. You're right, with the ACI, the 5 percent is a guess. We are assuming that over time, the increase of 5 percent compounded yearly will cover the actual increases in inflation. But it might not. And we're committed to looking at ways to "even up" if indeed ACI is not sufficient. But not this year! Gotta get through this first year.
Washington, D.C.: Why do you provide only 75 percent reimbursement for home care? That's what most people want, isn't it?
Laura Lawrence: Of course with a group policy there are trade-offs to be made. We could have gone with 100 percent for home care, but of course that has a direct impact on premiums. And, home care tends to be less expensive that nursing home care. So we decided to balance the two and offer it at 75 percent. If you are absolutely committed to needing 100 percent reimbursement for home care, you will likely not be satisfied with this group plan and should check other plans.
Arlington, Va.: I will be retiring at the end of May. My husband is a federal employee and will continue to work for several years. Am I correct in assuming that if we wait for the regular open season for long term care insurance, I can apply as a spouse, even though I will be a retiree? I noticed that to qualify, employees only have to answer 7 questions and spouses 9 questions, but retirees have a slew of questions. We would prefer to wait for the regular open season to take advantage of the enhanced options, but if I would have to apply as a retiree, I would rather sign up now to take advantage of the favorable underwriting requirements for employees. Thank you.
Laura Lawrence: Hi. Great question. YES, if you wear two hats, (spouse of a Fed and a retiree), use the hat that gives you the best underwriting! You can apply as the spouse of a Federal employee and answer only 9 questions for the benefits offered during early enrollment. During open season, anyone electing unlimited will have more underwriting.
Washington, D.C.: Thank you for today's discussion. Regarding the two inflation options: I'm 50 years old--if I start with the future purchase option to get the lower premium, at what point in time do I need to cross over to the full inflation protection?
Roger Gagne: You should consider switching to the full inflation protection whenever you feel you can afford it. In other words, there is no financially "best" time to do so. When you switch, your new premium will be based on your age at that time and the amount of premium you have paid into the program already - it will not be equal to the rates shown in the rate tables for someone who is just getting coverage for the first time.
Keep in mind that you will be able to switch only if you have not passed up more than two future purchase option offers in your lifetime!
Falls Church, Va.: If you have already an LTC plan, can you draw benefits from the Government one if you join it? And what are the advantages and disadvantages of joining the Government LTC plan during the early-enrollment period?
Laura Lawrence: Hi. If your other plan is an individual policy (as opposed to a group plan), our program will not coordinate benefits with it. That means you could indeed collect from that one and ours.
Advantages of applying during early enrollment...let's see...you'd have the coverage earlier, you'd have coverage now and you might have a change in health before open season and not be eligible for coverage then. BUT, you need to know about long term care and ltc insurance -- you'll miss the educational opportunities.
Grasonville, Md.: I am a military retiree, aged 54. I experienced caring for my elderly mother for 6 years and it cost us about $30,000 a year for at-home caregivers. My mother had dementia. So, I am very cognizant of the need. I would like to know when I will be receiving information about my eligibility and enrollment options. Will I receive something in the mail as a military retiree? I am not interested in early enrollment, but reading Stephen's column gave me the impression that people have received information directly.
Laura Lawrence: Hi. Sorry about your mom. You're right -- very tough situation and really makes us think about ourselves, doesn't it. We made an initial mailing to all the military retirees that the Department of Defense sent us addresses for. Did you receive a yellow and green postcard, Get Smart About Your Future? We'll also have meetings at TROA chapters, etc., to get the word out, and there will be a national campaign to educate people. The best place is the web -- www.ltcfeds.com and www.opm.gov/insure/ltc And of course call the certified specialists and talk about the program - 1-800-582-3337.
Bethesda, Md.: If someone were to sign up for one of the options that specify a 3 year time period for benefits, does that mean you could go into a nursing home for separate periods not totaling more than the 3 years?
If that is the total time, a person would, of course, be able to stop premiums after the 2 year period if they had left the nursing home because there would be no more benefit under that contract -- is this true?
(We understand that while still eligible for benefits and in a nursing home, no premiums would be due).
What are the arrangements for changing the option selected after the contract is executed and does this vary for retirees versus employees and what are the other factors affecting the ability to switch and the differing costs if any?
Laura Lawrence: Whew, lots of questions here. Let me try to answer some of them. the benefit period is strictly a multiplier to figure our your maximum lifetime benefit. Let's say you choose a $100 daily benefit amount and a 3 year benefit period. $100 x 3 years x 365 days per year = $109,500. That's your maximum lifetime benefit -- what you're able to access if you become eligible for benefits. Now forget the 3 years -- not relevant anymore.
It might take you 10 different stays in nursing homes over a period of 4 or more years to use up the $109,500 (your maximum lifetime benefit in this example).
Bethesda, Md.: Does the 5 percent inflation bump occur regardless of the actual "reported" increase in inflation?
Laura Lawrence: Yes, if indeed you're talking about the automatic compound inflation option -- a set 5 percent per year compounded increase, regardless of the actual inflation.
Washington, D.C: If a qualified family member were to apply for benefits on my policy using up $100,000, and if my maximum lifetime benefit was $250,000, would that mean that I would only have a remaining $150,000 to use on myself?
Laura Lawrence: Hmmm... some confusion here. A family member cannot claim benefits on YOUR policy. Each person is insured individually. Only you can claim benefits under your policy.
Alexandria, Va.: The online information about the method of inflation protection known as Future Purchase Option (FPO) states that you will receive notification of the FPO every two years provided that you have not declined 3 FPO notifications in the past and are not eligible for benefits. The information also states that you can switch to the Automatic Compound Inflation Option without proof of good health when you receive your FPO notification if you have not declined 3 FPO notifications in the past and are not eligible for benefits.
But what if you HAVE declined 3 FPO notifications in the past? Can you still apply for FPO even if you don't receive the notification? And can you still switch to the ACI option even if you don't receive the notification -- i.e., if you initiate the switch?
Also, is it likely that your total cost if you use the FPO will turn out to be the same as if you had signed up for the ACI option in the first place -- i.e., is the program structured that way?
Roger Gagne: If you have declined three FPO offers, you can still apply for future inflation increases by supplying satisfactory evidence of insurability. Once you do this, you will again begin receiving FPO offers and may switch to the ACI option at that time.
Yes, the program is priced so that we expect the total cost will be the same if you sign up for FPO as if you sign up for ACI. It is really more a matter of what pattern of premiums you prefer, and whether you favor the flexibility of the FPO offers over the predictability of the ACI structure.
Silver Spring, Md.: How long after one begins paying premiums does coverage begin?
Laura Lawrence: Coverage begins on the effective date of coverage -- for early enrollment the earliest effective date is May 1. So you'd begin to pay premiums based on that effective date.
Do you mean when can benefits be paid? If you are eligible for benefits and meet the waiting period, you could begin to claim benefits after only 1 or even zero premiums paid.
Hope that's clear.
Rockville, Md.: I saw your reference to a web site. Is that the place where one can see the full table of rates with various options? Could you list who is eligible to apply, i.e., are adult children of federal retirees eligible?
Laura Lawrence: Take a look at www.opm.gov/insure/ltc. Then click on Calculator on the left-hand side. Then choose accessible rates. There is a 140 page PDF that lists all the rates. But the calculator is much easier to use.
Spouses of the employee and retiree groups
Adult children (18 years or older) of the employee and retiree groups
Parents, parents in law and stepparents of the employee groups.
Washington, D.C.: The quotes for the premiums are for monthly payments. Can payments be made bi-weekly for those who decide to sign up for the insurance and are still in the workforce?
Laura Lawrence: Payments are monthly for early enrollment. During open season you can choose to pay bi-weekly by having a deduction from your annuity or paycheck (you mentioned you're an employee).
Columbia, Md.: Will the new LTC insurance pay for services delivered out of the USA, e.g., a retiree living in Mexico or Europe?
Roger Gagne: Yes, the program provides benefits for services you receive outside of the U.S. However, benefits for such services are limited to 80% of the daily benefit amounts available for services in the U.S. Also, the maximum payable during your lifetime outside the U.S. is limited to 80% of your maximum lifetime benefit.
Washington, D.C.: I enlisted in the Navy in 1954. As an enlisted man, I earned approximately $75.00 a month. Yes $75.00 a month. I retired from the Navy in 1975.
I subsequently became a civil servant in 1975 and subsequently retired in 1995.
Considering the monumental difference in wages between being an enlisted person
in the military and a civil servant, can you please inform me whether this fact has
been taken into consideration for personnel applying for the long-term care insurance under the new federal program!
Will there be different rates for military and civilian retirees?
Laura Lawrence: The premiums are based on your age and the benefits you choose. They are not based on whether you are a retiree or employee or how much retirement income you have.
Derwood, Md.: How does the plan calculate elimination periods for home health care? Does one day of service/week count as 7 days? Can we obtain actual contracts to read? Thanks, Laura.
Laura Lawrence: The waiting period (deductible or elimination period) counts days you receive care. So if you receive care on one day, that counts as one day. One day doesn't equal 7 days.
You can request a copy of the benefit booklet which contains a contractual statement of the benefits by calling 1-800-582-3337.
You're welcome, Derwood!
Leesburg, Va.: If I switch to the Government LTC Insurance will the LTC-Partners allow a current John Hancock Long Term Policy holder to use the policy holder's age when they purchased their original policy as the age in determining the cost of the Government LTC Insurance? For example: My current policy with John Hancock is two years old--can I subtract 2 years from my current age to calculate the cost of the LTC Partners Insurance? Thank you in advance for obtaining the answer to this question.
Roger Gagne: No, you will enter the Government LTC program at your current age. You may keep your current coverage or choose to drop it, but you cannot carry over any credits from private coverage, even if it is with John Hancock or MetLife.
An explanation for why this is so can be found at the OPM web site, at opm.gov/insure/LTC, in the "frequently asked questions" section.
McLean, Va.: Laura, is there any plan to offer a lifetime benefit in the federal long-term care program? If so, can I assume the premiums will be steep?
Laura Lawrence: Yes, we will have an unlimited benefit during open season. The premiums will be higher than the 5 year benefit period.
Takoma Park, Md.: Will there by categorical exclusion for individuals with chronic illnesses (regardless of their ability to work and the state of their illness)? If so, why aren't higher premiums an option for such individuals who want a LTC product? And, what research did you use to exclude individuals with chronic conditions such as MS? Previous program information had underwriting questions, but I don't see that on OPM's site now? Has there been a change, or just less information?
Irene Juthnas: Some chronic conditions will not be eligible for coverage. These are conditions that have a high risk of long term care utilization based upon LTCI industry experience. During open season which begins July 1 there will be alternate forms of coverage available. Please go to www.ltcfeds.com for applications for early enrollment.
Washington, D.C.: Am I eligible for federal LTC? I am the ex-spouse of a 38-year federal employee. I receive nearly 50 percent of his annuity.
Laura Lawrence: Hi. Sorry, former spouses are not eligible to apply for this insurance, even if they are receiving an annuity or portion of an annuity, and even if they are eligible for health benefits.
Washington, D.C.: I am a federal employee who will be retiring shortly (next 3 months) and I am interested in signing up for the fed LTC insurance before I retire. My wife and I will be immediately relocating to the Tampa-Clearwater area of Florida permanently upon retirement, but I don't have any idea what the daily nursing home costs are in that area. I need to know to determine which level of daily coverage we elect. Where can I obtain that information? Thank you.
Laura Lawrence: Hi. Congrats on the upcoming retirement! Go to the www.ltcfeds.com Web site. Click on the Apply Now link. You'll see a little box in the upper right that says something like Cost of Care in My Area. Check out what it tells you about Florida and enjoy the ocean!
Washington, D.C.: Can you please provide information on what is available for retired annuitants who have a disability that presently precludes them from procuring the OPM LTC?
Laura Lawrence: If you're not insurable right now (don't qualify for the early enrollment because of the answers to the questions on health), you can apply during open season when a services-only (non-insurance) option will be available.
Washington, D.C.: I am in my early 30's and give myself about a 50/50 chance of staying with the government through retirement. When do most people start looking into LTC coverage?
Laura Lawrence: First of all, just have to mention that you don't have to worry about leaving the Government. If you apply for the coverage while you are still a Federal employee (or still in any of the other eligible groups) and it becomes effective, you keep it, whether or not you stay with the Government as long as you continue to pay premiums.
Hmmm.... the age to purchase -- it really depends on how risk adverse you are and how much chance you want to take that you'll still be healthy to purchase it later. Early 30s is most definitely not too young to purchase. Your premiums will never be lower than they are now.
Washington, D.C: I understand that the effective date of enrollment is May 1. And one must be on board on that time to benefit form the early options offered (using the short form for instance). A FERS retiree must retire on April 30 in order to receive a May annuity. On the other hand, a Civil Service retiree has until May 3 to retire in order to receive a May annuity. I believe you have unwittingly discriminated against FERS employees. The standard should be the same. You need to move the first enrollment date to April 30 so FERS people planning to retire and get a may annuity are treated the same as Civil Service people planning to retire and get a May annuity. Can this be done? If not, why not? I realize that this is just probably something no one thought about.
Laura Lawrence: Coverage effective dates are the first of the month. I hear what you're saying, but you certainly could wait until May 31 to retire, and then there wouldn't be a problem.
Grasonville, Md.: Thanks for the discussion. One more question -- if you have a disability rating from the VA, does that impact the rates you would pay for the government LTC even if you are in otherwise good health?
Laura Lawrence: A disability rating doesn't affect your rates. Everyone the same age with the same benefits pays the same rates. But, depending on your disability, you may not qualify for the insurance.
Washington, D.C.: Time out, folks. I'm confused. What are the definitions and differences in the two inflation options we may select?
Roger Gagne: Sorry for the confusion -- we insurance people can't seem to get away from acronyms!
The automatic compound inflation choice (ACI) allows you to pay a premium that stays level even though your amount of benefits rises each year.
The future purchase option choice (FPO) offers you a choice every two years of whether you want your benefits to increase. If you do not refuse this offer, your benefit amounts will rise and your premium will also.
With either choice, you can keep your benefit levels current with inflation. The main difference is in the pattern of premiums you pay. With the ACI, you pay a premium that is intended to remain level over time. With the FPO, you begin with a much lower premium than you would pay if you had elected the ACI, but your premium will rise every two years as your benefit level increases.
The Outline of Coverage available on the LTCFEDS Web site (or by phone) supplies several graphs illustrating these two different inflation protection choices.
Takoma Park, Md.: Why is the denial of coverage not explicit if it is unilaterally based on a diagnosis? Previously, the OPM Web site had more detailed information on underwriting. Why has this changed?
Laura Lawrence: Yes, before on the web in the FAQs we listed possible, potential questions that might be asked with short form underwriting. Now, we've defined what the underwriting terms mean and direct you to the actual application to read the underwriting questions themselves. This is not less information, it is just information in a separate place -- the actual application.
Thanks for the great question. Don't want to mislead anyone.
Bethesda, Md.: You just said that I can request a copy of the benefit booklet which contains a contractual statement of the benefits by calling 1-800-582-3337. I called that number and they did not know what I was talking about. They said that the benefits booklet was the outline of coverage and other material in the enrollment kit. I thought it was different. Advice?
Laura Lawrence: Thanks for the heads up. That should not have happened. Please call back tomorrow and they will put your name on the list to mail the benefit booklet. So sorry that happened.
Springfield, Va.: If I'm not interested in LTC at this time, how will I learn about the additional information needed to apply at the July date?
Laura Lawrence: Hi. There will be LOTS of information available during the educational phase. And of course our good friend Steve Barr will continue to devote many columns to our Program as it unfolds. If you're an employee you'll get information from your worksite. And of course anyone can sign up to get on the mailing list for the bulletin series which will have increasingly more coverage about our program with each issue. Go to www.ltcfeds.com and click on Request Info, or call 1-800-582-3337.
Springfield, Va.: I want to sign up during the early enrollment period for Plan B. I am 61 and have been in civil service for 24 years. I was diagnosed in 1993 as having PPS (Post Polio Syndrome). Does that disqualify me?
Irene Juthnas: I assume you are still an employee with regular hours of the civil service. If that is correct you would qualify for coverage during early and open enrollment.
Arlington, Va.: My dad is a federal retiree and he is approaching his 80th birthday. It seems to me that this long-term care program is something he should think about. If he enrolled right away, how many years would it be before he was eligible for benefits? Does he need a physical to enroll?
Laura Lawrence: If he applies and is accepted, his coverage will begin the later of May 1 or the first of the month after his application is approved (for early enrollment). So then he could become eligible for benefits and they would be payable after any applicable waiting period. There's no minimum time that you have to be enrolled before being eligible for benefits.
He has to answer the full underwriting questions. Long Term Care Partners will send a nurse to his home to talk to him, and he will have to authorize release of his medical records for review. But no physical required.
Fairfax, Va.: Will the LTC premiums be increasing periodically, as do the government health insurance premiums during the "open season"?
Laura Lawrence: No they do not increase periodically (unless of course you're talking about the inflation increases under the future purchase option). The rates have been set with the rate stability guidelines of the National Association of Insurance Commissioners and are intended to be level for life.
Washington, D.C.: I am currently an employee and have a mild case of multiple sclerosis, which is one of the questions on the short form. I am not disabled and have been minimally affected by the disease in more than 20 years. I infer from the Federal Diary today that I would not qualify for the LTC insurance. Is this the case? Thank you.
Irene Juthnas: Those applicants with a diagnosis of Multiple Sclerosis would not be eligible for coverage at this time. However, you can apply during open season which begins July 1. At that time alternate forms of coverage will be available.
Alexandria, Va.: Thanks for taking all these questions, Laura. Is there any overlap between LTC and Medicare coverage? What is the difference between LTC and Medicare coverage for Long Term and what options does the LTC provide that Medicare does not? Is this insurance something folks should take only until they reach the magic age for Medicare coverage?
Roger Gagne: There is little overlap between what Medicare covers and what the Federal LTC program covers.
Medicare does cover certain types of skilled care for a limited period of time, but only if the care begins within three days of discharge from a hospital and only if the provider is approved by Medicare. Medicare is designed to cover acute care needs, not long-term chronic care needs.
Indiana: I am an approximately average age employee, with elderly parents. They will not be able to afford the long term care insurance for themselves. I am planning to sign up for myself, however. Please review the benefits that will available to me when (if) my parents need long term care.
Laura Lawrence: Great question (as they've all been). Thanks.
Yes we will have care coordination benefits available to enrollees' qualified relatives. So let's say you apply and are enrolled -- you could call the care coordinators and get advice and information on services for your parents. Additional services such as an on-site assessment and assistance with writing a plan of care will also be available to enrollees' qualified relatives, at an additional cost.
Kensington, Md.: Why aren't the ex-spouses included?
Laura Lawrence: The law didn't cover them (and we're all divorced) JUST KIDDING!!!!
Really, the law didn't cover them, and so they aren't included.
Hyattsville, Md.: I am a 51 year-old African American woman with 21 years of service. I plan to work an additional eight more years before retirement. I've been diagnosed with Diabetes but control it with diet and exercise. I've had two TIA's (Transit Ischemic Attacks -- predecessors to strokes) and am currently taking a medication to prevent others. Would I be eligible for long-term care?
Irene Juthnas: Federal employees with a history of more than one TIA would not be eligible for coverage at this time. You can apply during open season which begins July 1. Alternate forms of coverage will be available at that time.
Columbia, Md.: A very helpful dialog, folks. If an eligible relative is living out of the country at this time can they still apply for coverage under the LTC program?
Roger Gagne: Yes, they can.
The maximum amount of benefits payable, however, will differ depending on whether care is received in the U. S. and its territories or whether it is received elsewhere.
The Outline of Coverage gives more details in the section entitled, "International Benefits".
Laurel, Md.: Do you believe that the LTCI is going to be a real possibility for the lower GS employees, (below grade 9, close to age 60) with the high premium cost? The concept is good but the cost is too high for coverage that might be of some benefit in the future. The real benefit would be if the government would pick up a part of the premium.
Laura Lawrence: Well, of course someone who cannot afford the premiums should think seriously about whether they should be buying long term care insurance in the first place. This is a subject that will be covered at some length during the open season beginning July 1. The last thing we want to do is encourage someone to purchase this coverage who shouldn't be purchasing it.
The law did not provide a Government contribution.
McLean, Va.: You earlier mentioned a non-insurance option that will become available during open season. What do you mean by that?
Laura Lawrence: We were referring to the services only package of benefits. We're still working on the details. But we know it will include access to care coordinators, and discounts on services.
Washington, D.C.: I spent 16 years working for the federal government and retired on a deferred annuity, which I won't receive until 56. I am ineligible for the LTC program. Yet current and retired federal workers (on immediate annuity) can enroll dependents, including their parents (even if they never worked a day for the federal government) in the new program. This isn't fair to people who devoted substantial years yet did not leave on an immediate annuity. Any chance the rules could be changed?
Laura Lawrence: Deferred annuitants will be eligible to apply for this program when they are receiving their annuity. This is part of the law. It's the same treatment that the gray reservists in the uniformed services have.
Arlington, Va.: Who gets to decide when I can start receiving LTC benefits? My doctor, or your doctor? And thanks for coming on Stephen's program to answer all these questions!
Laura Lawrence: You're welcome. Steve does a great job and we enjoy being on his program!
Your doctor can certify that you're eligible for benefits, but Long Term Care Partners must agree with that certification. There is an appeal process, if you disagree with LTC Partners' decision on eligibility.
Burke, Va.: A quick question on whether LTC makes sense for young people. I'm 31, single with no dependents and my parents who would be logical choice for such coverage already have it. I'm thinking that baring catastrophic accident, it doesn't make sense for me at this time?
Also, does this help with our recruiting, particularly of younger workers that are so desperately needed? I can't help but think that like our great retirement benefits, this is something that won't interest the average recent college grad much. It's too far in the future!
Laura Lawrence: We just answered a question from a 30-something year old. Take a look. 30s is not too young to buy.
Washington, D.C.: Laura, you folks are doing a great job fielding questions. Obviously, OPM and the two insurance companies want everyone to understand that this will be a stable product for the long haul. But I've noticed that the contract with the insurance companies is good for seven years. When the contract comes up, does that suggest we'll face a premium increase?
Roger Gagne: We do not expect premiums to go up after seven years. In fact, with this ability to "go out to bid" after seven years, we expect that premiums will remain as low as the experience of the plan will allow due to competition.
During the seven year contract period, premiums may be raised only if OPM approves of the change.
Potomac Falls, Va.: Thanks for taking your time today to answer our questions. What factors would indicate that a person might be better off pursuing individual coverage outside the plan to take advantage of various additional discounts (for health, being married, part of another group, etc) that don't appear to be included in the group plan offered by the OPM?
Thanks for answering my question.
Laura Lawrence: There are no magic answers here. We think our policy will be hard to beat. But we welcome you to compare it with other policies. Just be sure that you understand the details of both policies. See my very first answer on the three things to keep in mind (the informal care example).
Washington, D.C.: Do you expect that the long-term insurance benefit will be opened up to allow same-sex domestic partners to be eligible for this coverage?
Laura Lawrence: First we have to get through this year (early enrollment and open season) and see where we are.
McLean, Va.: I am confused about who is insuring me: OPM, Hancock, MetLife or the partnership?
Laura Lawrence: OPM is not the insurer. And it isn't LTC Partners. The legal insurer is either Hancock or MetLife.
Washington, D.C.: Regarding July and the lifetime option: I assume that means you pay higher premiums for a certain period of time and have lifetime coverage. Is that a correct assumption? Also, is there any limit of time that participants pay for the current plans that are available or do you pay for life, similar to health insurance?
Laura Lawrence: Lifetime will have a higher premium than three or five year benefit periods. You pay premiums for life or until you cancel coverage or you begin receiving benefits.
Alexandria, Va.: Will the LTC coverage pay for a stay in a Christian Science nursing facility, or only in a medically oriented facility?
Irene Juthnas: We look at each Christian Scientist facility on a case by case basis to see if it meets the intent of the definition of a nursing facility in the contract.
Silver Spring, Md.: Hi, Can a spouse apply during early enrollment even if the employee doesn't qualify? Do the early enrollment policies cover home health aides?
Laura Lawrence: Yes, a spouse can apply even if the other spouse does not apply, or applies and is not approved for coverage. Everyone applies as an individual.
Yes, home health care is a covered service.
Washington, D.C.: I am a federal retiree and plan to get some form of this insurance. My question has to do with step-children. You said that step-parents would be covered, but will this also apply to step-children. And am I correct in assuming that siblings are excluded? Thank you for your answers.
Laura Lawrence: Yes, stepchildren are eligible as adult children (assuming age 18 or older). Siblings are not in the list of groups covered under the law.
Bethesda, Md.: I am worried about the catastrophic coverage provision. Does that mean that a war, terrorist attack or natural disaster could cause my benefits to be reduced?
Roger Gagne: Yes, that is a possibility. However, we feel it is an extremely remote one.
The purpose of this provision is to protect the program from becoming "bankrupt" in a worst case scenario. Most LTC policies provide this type of protection by using a "war exclusion" to allow the plan to not pay a massive amount of claims that could result from war. We believe that the Federal program is actually more liberal than other policies that contain a war exclusion, since the possibility of a catastrophic event is so small.
Stephen Barr: Once again, we've run out of time. I want to thank OPM and LTC Partners for taking questions today. I'm sure that many employees and retirees have a better grasp of this new federal benefit and how it works. Please join us at noon next Wednesday for another edition of Federal Diary Live.
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