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Federal Benefits Matrix

Federal Long Term Care (LTC) Insurance Program

Eligibility
Types of Care
  Cost

Coverage for all employees who are in a position that conveys eligiblity for FEHB coverage, you are eligible for this program (whether enrolled in FEHB or not - the key is ELIGIBILITY).

LTC is the kind of care that you would need to help you perform daily activities if you had an ongoing illness or disability. It also includes the kind of care you would need if you had a severe cognitive problem like Alzheimer's disease. It is help with eating, bathing, dressing, transferring from a bed to a chair, toileting, continence, etc. This type of care isn't received in a hospital and is not intended to cure you. It is not acute care. It is chronic care that you might need for the rest of your life. You can receive it in your own home, at a nursing home or other long term care facility.

Facilities-Only Option
The following services are covered under the Facilities-Only Option.

Nursing Home and Assisted Living Facility Care
On any day you are in a Nursing Home or Assisted Living Facility, including those specializing in the care of persons with Alzheimer’s disease, we will pay for:

  • room and board accommodations; and
  • nursing care by a formal caregiver; and
  • drugs, incontinence supplies, dietary supplements, personal medical equipment and laundry services.

Hospice Facility Care
On any day you are in a Hospice facility, we will pay for:

  • room and board accommodations; and
  • hospice care; and
  • drugs, incontinence supplies, dietary supplements, personal medical equipment and laundry services.

The waiting period does not apply to care in a Hospice facility.  Care in a Hospice facility does not count toward meeting your waiting period.

Respite Services in a Facility
We will pay for Respite Services provided in a Nursing Home, Assisted Living Facility or Hospice facility. Respite Services are limited to 30 times your daily benefit amount per calendar year

Comprehensive Option
The Comprehensive Option includes all services covered under the Facilities-Only Option plus the following additional covered services:

Home Care
Includes care provided at home by a nurse, home health aide, homemaker, or therapist.  The Program also covers informal care provided by friends, family members and other non-licensed caregivers who did not normally live in your home at the time you became eligible for benefits.  Informal care provided by family members is covered up to 365 days in a lifetime.

Formal Care at Home
A Comprehensive plan will pay for services provided to you by a Formal Caregiver at home.

Informal Care
A Comprehensive plan will pay for services provided by an Informal Caregiver if the services are:

  • provided to you at home or at a location other than a Nursing Home, Hospice facility or Assisted Living Facility (such as the home of a friend or relative); and
  • approved by our care coordinator as part of your written Plan of Care; and
  • provided by a person who did not normally live in your home at the time you became eligible for benefits.  (Note: we will pay for Informal Caregiver services provided by a person who began living in your home after you became eligible for benefits).

Benefits for Informal Caregivers who are Family Members are limited to 365 days in your lifetime.

Adult Day Care Center
A Comprehensive plan will also pay for services provided to you under an adult day care program at an Adult Day Care Center.

Hospice Care at Home
In addition to hospice care in a facility, a Comprehensive plan will also pay for Hospice Care provided to you at home.

The waiting period does not apply to Hospice Care at home.  Hospice Care at home does not count toward meeting your waiting period.

Respite Services at Home;

Includes care provided: 

  • in a Nursing Home, Assisted Living Facility or Hospice Facility; or
  • by a Formal or Informal Caregiver at home; or
  • at an Adult Day Care Center.

Benefits for Respite Services (in a facility or at home) are limited to an amount equal to 30 times your Daily Benefit Amount per calendar year.

The waiting period does not apply to Respite Services.  Respite Services do not count toward meeting your waiting period.

The amount of your premium is based on the coverage options you are approved for and your age.  Your premiums will not change because you get older or your health changes after your coverage becomes effective.

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