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Regulation and Compliance > Federal Regulation

Federal Program LTC Insurer Keeps Underwriting Authority

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The federal Office of Personnel Management has published a final version of the regulation that governs the Federal Long Term Care Insurance Program.[@@]

The program, created by Congress in 2000, now provides voluntary, employee-paid LTC insurance coverage for about 206,000 federal employees, retirees and dependents, according to the OPM.

The program has been operating under temporary regulations since 2003.

Long Term Care Partners L.L.C., Portsmouth, N.H., a joint venture formed by units of MetLife Inc., New York, and Manulife Financial Corp., Toronto, writes the program coverage.

Several members of the public asked the OPM to limit LTC Partners’ ability to reject LTC insurance applicants, according to a discussion of the final regulation that appears today in the Federal Register.

Today, new employees and spouses of new employees go through a light underwriting process when applying for coverage, and other people eligible to apply for coverage go through a more extensive underwriting process.

The OPM has decided to keep the rule that lets the LTC insurer determine applicants’ insurability, OPM officials write.

The objective of the federal employee LTC program is to “offer coverage to eligible individuals but also maintain competitive premiums,” officials write.

If applicants were allowed to participate regardless of health status, premiums might be higher, officials write.

Officials note that one change in the final regulation will state that appeals for reconsideration of underwriting decisions must be made to the insurer and not to the OPM.

An OPM-approved, independent company will step in when appeals move beyond the internal review process set up by Long Term Care Partners, according to the OPM officials.

The OPM also will be making changes in provisions that describe which employees qualify for simplified underwriting because they are “actively at work.”

One change will let working through telecommuting count as “reporting for work,” OPM officials write.

The final LTC program regulations are on the Web at //


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