Proposed Rule2022-11720
Enhancing Stability and Flexibility for the Federal Long Term Care Insurance Program (FLTCIP)-Abbreviated Underwriting, Applications for FLTCIP Coverage, and Technical Corrections
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
June 3, 2022
Issuing agencies
Personnel Management Office
Abstract
The Office of Personnel Management (OPM) is proposing amendments to support FLTCIP program stability and flexibility by amending when abbreviated underwriting will be offered to prospective enrollees and proposing rules for the suspension of applications for coverage and the requirements around any such suspension periods. OPM is also proposing technical corrections for the sake of clarity and to remove redundancies. Finally, with the publication of this rule, OPM is also providing notice of an anticipated suspension period.
Full Text
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<title>Federal Register, Volume 87 Issue 107 (Friday, June 3, 2022)</title>
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[Federal Register Volume 87, Number 107 (Friday, June 3, 2022)]
[Proposed Rules]
[Pages 33653-33658]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-11720]
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Proposed Rules
Federal Register
________________________________________________________________________
This section of the FEDERAL REGISTER contains notices to the public of
the proposed issuance of rules and regulations. The purpose of these
notices is to give interested persons an opportunity to participate in
the rule making prior to the adoption of the final rules.
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Federal Register / Vol. 87, No. 107 / Friday, June 3, 2022 / Proposed
Rules
[[Page 33653]]
OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 875
RIN 3206-AO21
Enhancing Stability and Flexibility for the Federal Long Term
Care Insurance Program (FLTCIP)--Abbreviated Underwriting, Applications
for FLTCIP Coverage, and Technical Corrections
AGENCY: Office of Personnel Management.
ACTION: Notice of proposed rulemaking.
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SUMMARY: The Office of Personnel Management (OPM) is proposing
amendments to support FLTCIP program stability and flexibility by
amending when abbreviated underwriting will be offered to prospective
enrollees and proposing rules for the suspension of applications for
coverage and the requirements around any such suspension periods. OPM
is also proposing technical corrections for the sake of clarity and to
remove redundancies. Finally, with the publication of this rule, OPM is
also providing notice of an anticipated suspension period.
DATES: OPM must receive comments on or before July 5, 2022.
ADDRESSES: You may submit comments, identified by docket number and/or
Regulatory Information Number (RIN) and title, by the following method:
[ssquf] Federal Rulemaking Portal: <a href="http://www.regulations.gov">http://www.regulations.gov</a>.
Follow the instructions for submitting comments. All submissions
received must include the agency name and docket number or RIN for this
document. The general policy for comments and other submissions from
members of the public is to make these submissions available for public
viewing at <a href="http://www.regulations.gov">http://www.regulations.gov</a> as they are received without
change, including any personal identifiers or contact information.
FOR FURTHER INFORMATION CONTACT: Julia Elam, Supervisory Analyst,
<a href="/cdn-cgi/l/email-protection#b3d9c6dfdad29dd6dfd2def3dcc3de9dd4dcc5"><span class="__cf_email__" data-cfemail="b8d2cdd4d1d996ddd4d9d5f8d7c8d596dfd7ce">[email protected]</span></a>, (202) 606-1560.
SUPPLEMENTARY INFORMATION:
Background
The Federal Long Term Care Insurance Program (FLTCIP) was created
as a result of the enactment of the Long Term Care Security Act of
2000, Public Law 106-265 (``the FLTCIP statute''). This Act required
OPM to make long term care (LTC) benefits available to Federal
employees, annuitants, active and retired members of the uniformed
services, and the qualified relatives of these individuals. As of
September 2021, FLTCIP has approximately 267,000 enrollees.
FLTCIP is administered by OPM in accordance with 5 U.S.C. chapter
90 and implementing regulations (5 CFR part 875). FLTCIP is an
enrollee-pay-all program; there is no Government contribution toward
premiums. Pursuant to 5 U.S.C. 9008, OPM has authority to administer
the FLTCIP and is proposing changes, including to the use of
abbreviated underwriting and suspension of applications for coverage,
as a part of our administrative functions. More information on the
program can be found at <a href="http://LTCFEDS.com">LTCFEDS.com</a>.
Discussion of the Changes
Changes to the Use of Abbreviated Underwriting
Underwriting is the process of reviewing medical and health-related
information furnished in an insurance application process to determine
if an applicant presents what an insurance carrier considers an
acceptable level of risk. Under current regulations at 5 CFR 875.101
full underwriting is the more comprehensive type of underwriting under
FLTCIP which requires an applicant to answer many questions about their
health status to enable the Carrier to determine whether the
application will be approved. It may also include a review of the
applicant's medical records, a phone interview, or an in-home
interview. Under the regulations, abbreviated underwriting in FLTCIP
asks fewer questions about an applicant's health status than with full
underwriting to enable the Carrier to determine whether the application
for coverage will be approved. It may also include a review of the
applicant's medical records, a phone interview, or an in-home
interview.
While eligible individuals may apply for FLTCIP coverage at any
time with full underwriting, current rules also provide a 60-day
abbreviated underwriting period to newly eligible active workforce
members and their spouses. An individual becomes newly eligible as an
active workforce member when they enter a position that conveys
eligibility, enter a position that conveys eligibility from a position
that did not convey eligibility, or return to active service after a
break in service of at least 180 days to a position that conveys
eligibility. However, experience has shown that the 60-day abbreviated
underwriting period for newly eligible active workforce members and
spouses is not well-suited to FLTCIP. FLTCIP enrollment is much more
common later in one's career than when someone is newly hired.
According to a Treasury Report of the Federal Interagency Task Force on
Long-Term Care Insurance, people typically purchase long term care
insurance (LTCI) in their 50s or 60s, and then hold the insurance while
paying premiums for a lengthy period.\1\ Since the inception of FLTCIP,
only approximately 8% of FLTCIP applicants have applied during the 60-
day abbreviated underwriting period. The remaining 92% of FLTCIP
applicants have applied during an open season or with full
underwriting.
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\1\ U.S. Department of the Treasury, ``Long-Term Care Insurance:
Recommendations for Improvement of Regulation.'' Report of the
Federal Interagency Task Force on Long-Term Care Insurance, August
2020, <a href="https://home.treasury.gov/system/files/136/Report-Federal-Interagency-Task-Force-Long-Term-Care-Insurance.pdf">https://home.treasury.gov/system/files/136/Report-Federal-Interagency-Task-Force-Long-Term-Care-Insurance.pdf</a>.
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The proposed changes would eliminate the 60-day abbreviated
underwriting period, but not remove abbreviated underwriting entirely
from the FLTCIP application process. Instead, OPM would continue to
announce in the Federal Register any period during which active
workforce members and spouses may apply with abbreviated underwriting,
as OPM has done with open seasons in the past. To use more accurate
terminology that reflects the underwritten nature of the benefit, and
to reduce confusion between a FLTCIP abbreviated underwriting
opportunity and the annual Federal Benefits Open Season, OPM is
proposing to change the name of any such period to a ``special
application period'' rather than an
[[Page 33654]]
``open season.'' Each future special application period may offer its
own underwriting rules. Individual agencies will provide notice to
their Federal employees of any special application period.
Suspension of Applications for FLTCIP Coverage
Current rules permit eligible individuals to apply for FLTCIP
coverage at any time with full underwriting. As a result, the FLTCIP is
continuously open to new enrollment. However, it may be appropriate
from time to time for OPM to suspend applications for FLTCIP coverage.
For example, it may be appropriate to suspend applications to allow a
period of time for revisions to underwriting processes or for premium
repricing after a review of actuarial assumptions, in order to ensure
that premium rates reasonably and equitably reflect the cost of the
benefits provided as required by the statute, and to ensure that OPM
can provide eligible individuals with the information needed to enable
them to fully evaluate the advantages and disadvantages of obtaining
LTCI under FLTCIP. The proposed changes create a process for suspending
applications and communicating the start and end of such a suspension
period.
Technical Corrections
The current rules have some language that may be considered
duplicative or would benefit from greater clarity. The proposed changes
make such technical corrections, which do not make any substantive
changes to the FLTCIP rules.
Proposed Changes by Section
OPM proposes to make technical corrections to several sections. In
5 CFR 875.101, OPM makes such corrections to the definitions of
``Carrier'' and ``Eligible individual.'' Additional technical
corrections are proposed to 5 CFR 875.102, 875.203, 875.204, 875.213,
and 875.404.
In 5 CFR 875.101, OPM proposes to amend the definition of ``Free
look'' to clarify that the 30-day period is only ``after you are
approved for coverage and receive the Benefit Booklet,'' and not just
any time after receiving the Benefit Booklet. The free look applies to
any approved coverage, including coverage increases. OPM proposes to
add a definition of ``special application period'' to identify periods
of applications for coverage with abbreviated underwriting for active
workforce members and spouses. The term ``open season'' was not used
here because such periods require some form of underwriting for
enrollment and are held as determined by OPM and not on an annual
basis. Conforming amendments are proposed throughout 5 CFR part 875 to
use the term ``special application period'' instead of ``open season.''
In 5 CFR 875.107, OPM proposes to add holding special application
periods and suspending applications for FLTCIP coverage in its list of
responsibilities. OPM proposes the process for such a suspension period
in a new section at 5 CFR 875.110. Under this process, OPM may suspend
applications for FLTCIP coverage, including coverage increases, for up
to 24 months when it determines a suspension to be in the best
interests of the Program. A duration of up to 24 months may be
necessary to allow for revisions to underwriting processes or for the
development and review of pricing assumptions and rates in order to
ensure the premium rates reasonably and equitably reflect the cost of
the benefits provided, and to ensure that OPM can provide eligible
individuals with the information needed to enable them to fully
evaluate the advantages and disadvantages of obtaining LTCI under
FLTCIP. OPM will issue a Federal Register notice announcing the
beginning and end date of the suspension period, at least 30 days
before the start of the suspension period. The suspension period may be
extended with another notice in the Federal Register at least 30 days
before the end of the current suspension period. Additional conforming
amendments are proposed throughout 5 CFR part 875 to note that
applications for FLTCIP coverage are only permitted outside of a
suspension period.
OPM proposes to delete the language at 5 CFR 875.206. This section
provided for the 60-day abbreviated underwriting period for new, newly
eligible, or returning active workforce members and their spouses. This
proposed rule eliminates this 60-day abbreviated underwriting period,
thereby limiting abbreviated underwriting to special application
periods, for which a definition and conforming amendments are proposed
throughout 5 CFR part 875.
In 5 CFR 875.207, OPM previously addressed nonpay status during an
open season. OPM proposes to amend this section to use the term
``special application period'' instead of ``open season.'' To limit
program risk, OPM also proposes to allow only those individuals that
return to pay status within 180 days after the end of a special
application period to apply using the special application period's
rules. Anyone who returns to pay status after missing at least half of
the special application period and is eligible to apply using the rules
of the special application period will have at least 60 days to do so.
In 5 CFR 875.209, OPM proposes to amend paragraph (a) to require a
qualified relative to provide identifying information about the
workforce member that makes the qualified relative an eligible
individual. This amendment clarifies the regulation and makes it
consistent with the application required for the FLTCIP.
In 5 CFR 875.210, OPM proposes to amend paragraph (b)(1) to clarify
that the qualified relative of a workforce member that has been
involuntarily separated remains eligible for coverage if their
application has already been submitted even if coverage has not become
effective. This situation only applies where the involuntary separation
is not for misconduct in the Federal civilian service or a dishonorable
discharge from the uniformed services.
In 5 CFR 875.211, an individual that applies as an active workforce
member, but whose eligibility status changes to annuitant, retired
member of the uniformed services, or qualified relative, must reapply
based on the applicable underwriting requirements. Under the proposed
changes for abbreviated underwriting, the underwriting rules would be
the same for all applications outside of special application periods.
As such, OPM proposes to only require notification to the Carrier about
a change in eligibility status after submitting an application for
coverage as an active workforce member. No reapplication is necessary
if the application was originally submitted with full underwriting.
In 5 CFR 875.213, OPM proposes to delete paragraph (b). That
paragraph contains a definition of ``domestic partner.'' The applicable
definition of ``domestic partner'' is contained in 5 CFR 875.101 and
applies to all of 5 CFR part 875.
In 5 CFR 875.401, OPM proposes to remove paragraph (b). The
language is now contained in 5 CFR 875.403.
In 5 CFR 875.402, OPM confirms that there are no regularly
scheduled open seasons. OPM proposes to amend this section to state
that there may be special application periods as appropriate, that
those special application periods will be announced in the Federal
Register, and the special application periods would offer abbreviated
underwriting to active workforce members and their spouses. OPM
proposes to delete paragraph (c) since abbreviated underwriting would
not be tied to new eligibility under the proposed changes to 5 CFR
875.206.
[[Page 33655]]
In 5 CFR 875.403, OPM addresses the timing for applications for
FLTCIP coverage. OPM proposes to amend this section to confirm that
applications for coverage, including coverage increases, are permitted
outside of a suspension period. Applications outside of a special
application period would be subject to full underwriting. The language
from the removed paragraph (b) of 5 CFR 875.401 is now contained in
this section.
In 5 CFR 875.405, OPM proposes to remove all specific provisions
based on the nature of the relationship. With the proposed changes to
abbreviated underwriting, this language is unnecessary. All
applications for FLTCIP coverage outside of a special application
period would be subject to full underwriting.
In 5 CFR 875.406, OPM proposes to amend paragraph (a)(1) to make it
clear that, outside of a suspension period as described in 5 CFR
875.110, applications for coverage increases are permitted with full
underwriting.
In 5 CFR 875.410, OPM proposes to amend the language by deleting
the second sentence referencing abbreviated underwriting during any
future open season. OPM is proposing to use the term ``special
application period'' and addresses abbreviated underwriting rules for
such a period in the proposed changes to 5 CFR 875.402.
In 5 CFR 875.413, OPM proposes to clarify that the potential
reinstatement window will begin with the date of the written notice of
termination and not from the termination date itself. The written
notice comes after the actual termination date, so this allows more
time and does not adversely impact the individual if the Carrier is
delayed in sending the written notice. The provisions reinstating
coverage to the termination date remain unchanged.
Notice of Anticipated Suspension Period
Based on the facts available to OPM at the time of publication of
this NPRM, OPM anticipates a 24-month suspension period. Due to
emerging program experience, OPM has determined that there is a strong
likelihood that FLTCIP premium rates will need to be revised. OPM
anticipates a need for a 24-month suspension period in order to ensure
FLTCIP premium rates reasonably and equitably reflect the cost of
benefits provided, and to revise or adjust as necessary. Based on the
facts available to OPM at the time of publication of this NPRM, the
suspension period pursuant to 5 CFR 875.110 will begin at the time this
rule is finalized. OPM considers this NPRM to serve as the notice
required under the proposed paragraph (b) of 5 CFR 875.110(b). In the
final rule, OPM will confirm the specific dates and duration for the
suspension period based on the most up-to-date information about the
Program.
Expected Impact of Proposed Changes
The proposed changes, including underwriting changes and any future
suspensions of applications for FLTCIP coverage, would not affect
current FLTCIP enrollees. Individuals already enrolled in FLTCIP will
retain their coverage as long as they continue to pay premiums. The
proposed changes impact new enrollment and are expected to impose no
more than de minimus administrative costs to Federal agencies since
FLTCIP is an enrollee-pay-all program, and there is no Government
contribution toward enrollee premiums.
We expect that the rule will not result in a significant impact on
the eligible or newly eligible population. Approximately 6,000 eligible
individuals enroll in FLTCIP annually, which is less than 0.1% of 11
million eligible federal and military actives and annuitants (not
including spouses and other qualified relatives who are also eligible).
This low percentage mirrors the low uptake for purchasing LTCI in the
broader LTC market. The previously mentioned Treasury Report states
that sales of new LTCI policies have declined since the early 2000s, as
numerous insurers decided to exit the market due to the poor financial
performance of the product line; and, low take-up rates for LTCI appear
to stem in part from low demand for these products.\2\ The report
identifies factors influencing demand including: Substitutes for
private LTCI such as Medicaid; unpaid care or the ability to receive
informal care from family; a desire to leave assets to heirs can
suppress demand because people may be motivated to postpone consumption
and save money; lack of information and awareness about LTC costs and
the ways to finance those costs; lack of trust in insurers; and
premiums, costs, and loads.\3\
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\2\ See footnote 1.
\3\ See footnote 1.
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Since less than 0.1% of the eligible population annually enroll in
FLTCIP, based on this trend and market trends, it is unlikely that
newly eligible individuals would have a high demand for LTCI during a
suspension of applications. Further, there are other options for
eligible individuals to plan for LTC needs. Some other options to plan
for LTC needs during a suspension period include the following: Saving
for future needs by setting aside funds to invest in a 401(k), an IRA,
or a non-retirement investment account; investing in a long-term care
annuity; purchasing a ``combination'' or ``hybrid'' product that
combines a life insurance policy with a LTC rider; or purchasing a
short-term care insurance policy.
Indirect Effects on Other Parties
OPM does not believe this regulation will have a large impact on
the broader LTCI market. Approximately 6,000 eligible individuals
enroll in FLTCIP annually, which is less than 0.1% of the eligible
population. At an average premium of $125 per month or $1,500 per year,
the forgone annual premium for new enrollees would total less than $10
million per year during any FLTCIP enrollment suspension. The forgone
annual premium for new enrollees would total less than $10 million per
year during a FLTCIP enrollment suspension. As discussed above,
affected individuals would likely pursue substitute savings and
insurance products during a suspension period. OPM estimates that the
magnitude of the forgone $10 million on other parties, such as LTC
insurers in the LTCI market, would be quite small compared to the
larger LTCI market.
Benefits of the Proposed Changes
This proposed rule establishes provisions for OPM to suspend
applications to FLTCIP when it is in the best interest of the program.
For example, in order to allow for adjustment to underwriting processes
or to reprice premium rates after a review of actuarial assumptions.
The rule aims to protect eligible individuals from applying to enroll
when it has been determined that underwriting processes may need
revisions or when the current premium rates may not reflect the cost of
the benefits provided due to market volatility and changes to
projections about future costs. This allows OPM and the FLTCIP carrier
to agree on underwriting changes or new premium rates that reasonably
and equitably reflect the cost of the benefits provided as required by
the FLTCIP statute.
Executive Orders 12866 and 13563
Executive Orders 12866 and 13563 direct agencies to assess all
costs and benefits of available regulatory alternatives and, if
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public,
health, and safety effects, distributive impacts, and
[[Page 33656]]
equity). Executive Order 13563 emphasizes the importance of quantifying
both costs and benefits and of reducing costs, harmonizing rules, and
promoting flexibility. This rule has been designated as a significant,
but not economically significant, regulatory action under Executive
Order 12866.
Congressional Review Act
This rule is not a major rule under 5 U.S.C. 804(2). Subtitle E of
the Small Business Regulatory Enforcement Fairness Act of 1996
(codified at 5 U.S.C. 801-808), also known as the Congressional Review
Act or CRA, generally provides that before a rule may take effect, the
agency promulgating the rule must submit a rule report, which includes
a copy of the rule, to each House of the Congress and to the
Comptroller General of the United States. A major rule under the CRA
cannot take effect until 60 days after it is published in the Federal
Register.
Paperwork Reduction Act
Notwithstanding any other provision of law, no person is required
to respond to, nor shall any person be subject to a penalty for failure
to comply with a collection of information subject to the requirements
of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.) (PRA)
unless that collection of information displays a currently valid Office
of Management and Budget (OMB) Control Number.
Regulatory Flexibility Act
I certify that this regulation will not have a significant economic
impact on a substantial number of small entities.
Federalism
We have examined this rule in accordance with Executive Order
13132, Federalism, and have determined that this rule will not have any
negative impact on the rights, roles, and responsibilities of State,
local, or tribal governments.
List of Subjects in 5 CFR Part 875
Administration and general provisions, Eligibility, Cost, and
Coverage.
Office of Personnel Management.
Stephen Hickman,
Federal Register Liaison.
Accordingly, OPM proposes to amend title 5, Code of Federal
Regulations part 875, as follows:
PART 875--FEDERAL LONG TERM CARE INSURANCE PROGRAM
0
1. The authority citation for 5 CFR part 875 continues to read as
follows:
Authority: 5 U.S.C. 9008; Pub. L. 116-92, 133 Stat. 1198 (5
U.S.C. 8956 note).
Subpart A--Administration and General Provisions
0
2. Amend Sec. 875.101 by revising the definitions of Carrier, Eligible
individual, and Free look; and adding, in alphabetical order, the
definition of special application period.
The revisions and addition read as follows:
Sec. 875.101 Definitions
* * * * *
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 one or more administrators to perform some of its
obligations.
* * * * *
Eligible individual means an employee, annuitant, 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.
* * * * *
Free look means that within 30 days after you are approved for
coverage and receive the Benefit Booklet, you may cancel that coverage
if you are not satisfied with it and receive a refund of any premium
you paid for that coverage. It will be as if the coverage was never
issued.
* * * * *
Special application period is a period in which active workforce
members and their spouses may apply based on abbreviated underwriting.
Such application periods will be provided for pursuant to OPM's
authority in section 9008 of title 5, United States Code.
0
3. Revise Sec. 875.102 to read as follows:
Sec. 875.102 Where do I send benefit claims?
You must submit your benefit claims to the FLTCIP Carrier.
0
4. Amend Sec. 875.107 by replacing ``and'' with ``;'' at the end of
paragraph (b); replacing ``.'' with ``;'' at the end of paragraph (c);
and adding paragraphs (d) and (e).
The revisions and additions read as follows:
Sec. 875.107 What are OPM's responsibilities as regulator under this
Program?
* * * * *
(d) Suspending applications for FLTCIP coverage, including coverage
increases as specified in Sec. 875.110; and
(e) Holding special application periods as specified in Sec.
875.402.
0
5. Add Sec. 875.110 to read as follows:
Sec. 875.110 May OPM suspend applications for FLTCIP coverage?
(a) OPM may suspend applications for FLTCIP coverage, including
coverage increases, when OPM determines that a suspension is in the
best interest of the Program.
(b) OPM will issue a notice in the Federal Register with the
effective date of the suspension period, during which no applications
for FLTCIP coverage will be accepted. The effective date will be
determined at the discretion of the Director and will be at least 30
days after the date of the notice.
(c) The duration of the suspension period, as determined at the
discretion of the Director and not to exceed 24 months, will be
announced in the Federal Register notice.
(d) At least 30 days before the end of the suspension period, OPM
may issue a notice in the Federal Register announcing an extension to
the suspension period when OPM determines that such extension is in the
best interest of the Program. Any extension will conform to the
requirements of this subsection.
Subpart B--Eligibility
0
6. Revise Sec. 875.203 to read as follows:
Sec. 875.203 Am I eligible if I separated under the FERS MRA+10
provision?
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 as an annuitant under this part.
0
7. Amend Sec. 875.204 by revising paragraph (c) to read as follows:
Sec. 875.204 Am I eligible as a member of the uniformed services?
* * * * *
(c) You are not eligible to apply for coverage solely because you
belong to the Individual Ready Reserve. The Individual Ready Reserves
includes Reservists who are assigned to a Voluntary Training Unit in
the Naval Reserve and Category E in the Air Force Reserve.
Sec. 875.206 [Reserved]
0
8. Remove and reserve Sec. 875.206.
0
9. Revise Sec. 875.207 to read as follows:
[[Page 33657]]
Sec. 875.207 What happens if I am in nonpay status during a special
application period?
(a) If you return to pay status from nonpay status during a special
application period, you have 60 days from the date of your return, or
until the end of the special application period, whichever gives you
more time, to apply for coverage pursuant to the rules of that special
application period.
(b) If you return to pay status from nonpay status within 180 days
after the end of the special application period, you have 60 days from
the date of your return to apply for coverage pursuant to the rules of
that special application period.
(c) Paragraphs (a) and (b) of this section apply only when you have
been in nonpay status for more than one-half of a special application
period, unless you went into nonpay status for a reason beyond your
control.
0
10. Amend Sec. 875.209 by revising paragraph (a) to read as follows:
Sec. 875.209 How do I demonstrate that I am eligible to apply for
coverage?
(a) When you submit your application for coverage, you must make
known your status as a member of an eligible group. If you are a
qualified relative, you need to provide identifying information about
the workforce member who makes you an eligible individual.
* * * * *
0
11. Amend Sec. 875.210 by revising paragraph (b)(1) to read as
follows:
Sec. 875.210 What happens if I become ineligible after I submit an
application?
* * * * *
(b) * * *
(1) When you are involuntarily separated from Federal civilian
service (except for misconduct) or from the uniformed services (except
for a dishonorable discharge); or, when you are the qualified relative
of a workforce member who has been involuntarily separated from Federal
civilian service (except for misconduct) or from the uniformed services
(except for a dishonorable discharge).
* * * * *
0
12. Revise Sec. 875.211 to read as follows:
Sec. 875.211 What happens if my eligibility status changes after I
submit my application?
(a) If you applied as an active workforce member, and you retire or
separate from service after you submit an application for coverage, but
before your coverage becomes effective, you must notify the Carrier of
this change.
(b) If you applied with abbreviated underwriting during a special
application period as an active workforce member or the spouse of an
active workforce member, and the active workforce member retires or
separates from service before your coverage becomes effective, you must
reapply based on your new eligibility status.
0
13. Revise Sec. 875.213 to read as follows:
Sec. 875.213 May I apply as a qualified relative if I am the
domestic partner of an employee or annuitant?
You may apply for coverage as a qualified relative if you are a
domestic partner, as described in Sec. 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 Sec. 875.210
of this chapter, if you lose your status as a domestic partner, and
therefore status as a qualified relative, before your coverage goes
into effect, you are no longer eligible for FLTCIP coverage.
Subpart D--Coverage
0
14. Revise Sec. 875.401 to read as follows:
Sec. 875.401 How do I apply for coverage?
To apply for coverage, you must complete the application in a form
appropriate for your eligibility status as prescribed by the Carrier
and approved by OPM.
0
15. Revise Sec. 875.402 to read as follows:
Sec. 875.402 When will open seasons be held?
(a) There are no regularly scheduled open seasons for long term
care insurance. OPM may have special application periods in which
active workforce members and their spouses may apply based on
abbreviated underwriting.
(b) In situations where OPM determines that it is appropriate to
have a special application period, OPM will announce any such period
via a Federal Register Notice. The Notice will include the requirements
for eligible applicants during the special application period.
0
16. Revise Sec. 875.403 to read as follows:
Sec. 875.403 When may I apply for coverage?
If you are an eligible individual, you may apply at any time
outside of a suspension period described in Sec. 875.110. You will be
subject to full underwriting requirements. The only exceptions to the
full underwriting requirements are described in Sec. 875.402. You may
apply as a qualified relative of a workforce member even if the
workforce member does not apply for coverage.
0
17. Revise Sec. 875.404 to read as follows:
Sec. 875.404 What is the effective date of coverage?
(a)(1) The effective dates of coverage under special application
period enrollments will be announced in a Federal Register Notice that
announces special application period dates.
(2) If you are an active workforce member or the spouse of an
active workforce member and you are applying for coverage during a
special application period, the workforce member must be actively at
work at least 1 day during the calendar week immediately before the
week which contains your coverage effective date for your coverage to
become effective. You must inform the Carrier if you do not meet this
requirement. In the event you do not meet this requirement, the Carrier
will issue you a revised effective date, which will be the 1st day of
the next month. The workforce member also must meet the actively at
work requirement for any revised effective date for coverage to become
effective, or you will be issued another revised effective date in the
same manner.
(b) If you enroll at any time outside of a special application
period, your coverage effective date is the 1st day of the month after
the date your application is approved.
0
18. Revise Sec. 875.405 to read as follows:
Sec. 875.405 May a spouse, domestic partner, or other qualified
relative of a workforce member apply for coverage?
A spouse, domestic partner, or other qualified relative of a
workforce member may apply for coverage with full underwriting at any
time following the marriage or commencing date of the domestic
partnership, outside of a suspension period as described in Sec.
875.110.
0
19. Amend Sec. 875.406 by revising paragraph (a)(1) to read as
follows:
Sec. 875.406 May I change my coverage?
* * * * *
(a) * * *
(1) At any time outside of a suspension period described in Sec.
875.110, you may apply to increase your coverage with full
underwriting.
* * * * *
0
20. Revise Sec. 875.410 to read as follows:
[[Page 33658]]
Sec. 875.410 May I continue my coverage when I leave Federal or
military service?
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.
0
21. Revise Sec. 875.413 to read as follows:
Sec. 875.413 Is it possible to have coverage reinstated?
(a) Under certain circumstances, your coverage can be reinstated.
The Carrier will reinstate your coverage if it receives proof
satisfactory to it, within 6 months from the date of the written notice
of termination, that you suffered from a cognitive impairment or loss
of functional capacity, before the grace period ended, that caused you
to miss making premium payments. In that event, you will not be
required to submit to underwriting. Your coverage will be reinstated
retroactively to the termination date but you must pay back premiums
for that period. The premium will be the same as it was prior to
termination.
(b) If your coverage has terminated because you did not pay
premiums or because you requested cancellation, the Carrier may
reinstate your coverage within 12 months from the date of the written
notice of termination at your request. You will be required to reapply
based on full underwriting, and the Carrier will determine whether you
are still insurable. If you are insurable, your coverage will be
reinstated retroactively to the termination date and you must pay back
premiums for that period. The premium will be the same as it was prior
to termination.
[FR Doc. 2022-11720 Filed 6-2-22; 8:45 am]
BILLING CODE P
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</html>Indexed from Federal Register on June 3, 2022.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.