Attachment 6E - Benefit Booklet.doc

BENEFIT BOOKLET

FEDERAL LONG TERM CARE INSURANCE PROGRAM

100 Arboretum Drive, Suite 100

Portsmouth, New Hampshire 03801-7833

1-800-LTC-FEDS (1-800-582-3337)

TDD 1-800-843-3557

Group Policyholder: United States Office of Personnel Management (OPM) Insurer: John Hancock Life Insurance Company or Metropolitan Life Insurance Company

Federal Program Administrator: Long Term Care Partners, LLC

Group Policy Numbers:

900-001

900-002

NOTICES: PLEASE READ CAREFULLY!

Important: Our decision to issue coverage was based upon your responses to the questions on your application. We have sent or will send a copy of your application to you. We may deny benefits or rescind your insurance coverage if your answers are incorrect or untrue for any reason. Please review the copy of your application. If any information you provided to us about your health or eligibility status has changed, you must notify us immediately. The best time to clear up any questions is now, before a claim arises! If for any reason, any of your answers is incorrect, please contact: Federal Long Term Care Insurance Program, 100 Arboretum Drive, Suite 100, Portsmouth, New Hampshire 03801-7833. You may also call 1-800-LTC-FEDS (1-800-582-3337), TDD 1-800-843-3557.

The Group Policy, including this Benefit Booklet, is designed to be a qualified long term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986, as amended. Subject to specified dollar limits that vary depending on your age, you may be able to include your premium in your itemized deductions on your Federal income tax return, if your total medical expenses, including the allowable portion of your premium, exceed 7½% of adjusted gross income. The allowable dollar limits are reviewed each year by the U.S. Treasury and adjusted accordingly. We have designed the Group Policy so that benefits you receive under the Federal Program should be tax-free. Please remember that tax laws can change and to consult your tax advisor if you have any questions or need further details.

The Federal Program may not cover all of your long term care costs. Please review all coverage limitations and exclusions described in this Benefit Booklet and your Schedule of Benefits.

Within 30 days after you receive this Benefit Booklet, you may cancel your coverage if you are not satisfied with it and receive a refund of any premium you paid. If you wish to do this, you must notify us within 30 days of receiving this Benefit Booklet. Then we will refund all of your premium within 30 days. It will be as if the coverage was never issued. You may cancel your coverage at any other time; however, we will only refund premium that covers a period after the effective date of your cancellation.

YOUR COVERAGE IS GUARANTEED RENEWABLE. This means we will not cancel your coverage as long as you pay your premium on time. Please see the Premiums section for information on when we may change your premium. Please see the Statements Made by You Relating to Insurability subsection of the General Provisions section for information on when we may Contest the Validity of your coverage. We and OPM will determine whether to renew the Group Policy. Your consent or the consent of any other person who may have a beneficial interest under the Group Policy is not required. You will be notified in the event the Group Policy is ended. You may continue your coverage, even if the Group Policy ends, subject to the terms and conditions of the Continuation of Coverage section.

This Benefit Booklet together with your Schedule of Benefits is your evidence of coverage. If you did not receive your Schedule of Benefits with this Benefit Booklet, please call 1-800-LTC-FEDS (1-800-582-3337), TDD 1-800-843-3557.

TABLE OF CONTENTS

SECTION PAGE

iNOTICES: PLEASE READ CAREFULLY!

TABLE OF CONTENTS

ii

INTRODUCTION

Defined Terms

EFFECTIVE DATE OF COVERAGE

If You Lost Your Eligibility Status Before Your Original Effective Date If Your Eligibility Status Changed Before Your Original Effective Date Actively at Work Requirement for Employees and Members of the Uniformed Services

CONDITIONS FOR PAYMENT OF BENEFITS

ELIGIBILITY FOR BENEFITS

How to Ask Us to Determine Whether You Are Eligible for Benefits Continuing Assessment of Your Eligibility for Benefits Notice and Review of Benefit Eligibility Decision

WAITING PERIOD

COVERED SERVICES

Facilities-Only Option Nursing Home and Assisted Living Facility Hospice Facility Comprehensive Option Services Provided by a Formal Caregiver at Home Services Provided by an Informal Caregiver Hospice Care at Home Services Provided at an Adult Day Care Center Additional Covered Services and Benefits Bed Reservations Caregiver Training Respite Services Alternate Plan of Care International Benefits

MAXIMUM BENEFIT WE WILL PAY

For the Facilities-Only Option For the Comprehensive Option Exception for Caregiver Training

CARE COORDINATION SERVICES

EXCLUSIONS

CATASTROPHIC COVERAGE LIMITATION

Your Coverage Does Not Have a War Exclusion Catastrophic Event

COORDINATION OF BENEFITS

Government Programs TABLE OF CONTENTS (Continued)

SECTION PAGE

CLAIMS

Notice and Review of Claim Determination

APPEALS

Appeals Committee Independent Third Party Exhaustion of the Appeals Process

PAYMENT OF BENEFITS

BENEFIT CHANGES

Automatic Compound Inflation Option Future Purchase Option Other Benefit Changes (Upgrades and Downgrades)

PREMIUMS

How Benefit Changes Affect Your Premium

GRACE PERIOD

WAIVER OF PREMIUM

WHEN YOUR COVERAGE WILL END

PORTABILITY

CONTINUATION OF COVERAGE

EXTENSION OF BENEFITS

REINSTATEMENT OF COVERAGE

GENERAL PROVISIONS

Statements Made by You Relating to Insurability Age No Cash Surrender Value Insurers Right to Change Contract Provisions Interpretation of Terms, Conditions and Provisions Limits on Legal Actions Refund of Premiums Payments on Your Death

DEFINITIONS

Act Actively at Work or Active Work Activities of Daily Living Adult Day Care Center Annuitant Assisted Living Facility Bed Reservations Benefit Amount Benefit Booklet TABLE OF CONTENTS (Continued)

SECTION PAGE

Benefit Period Caregiver Training Catastrophic Event Comprehensive Option Contest the Validity Covered Services Daily Benefit Amount Employee Facilities-Only Option Family Member Federal Program Formal Caregiver Group Policy Home Care Agency Home Health Aide Homemaker Hospice Hospice Care Hospital Informal Caregiver Licensed Health Care Practitioner Maintenance or Personal Care Material To Your Insurability Maximum Lifetime Benefit Medicare Member of the Uniformed Services Misrepresentation Nurse Nursing Care Nursing Home

OPM

Original Effective Date Physician Plan of Care Qualified Long Term Care Services Qualified Relative Respite Services Retired Member of the Uniformed Services Schedule of Benefits Severe Cognitive Impairment Signed Social Worker Substantial Assistance Substantial Supervision Terminal Illness or Terminally Ill Therapist Therapy Services United States Week Weekly Benefit Amount Workforce Written or Writing

INTRODUCTION

Thank you for selecting the Federal Long Term Care Insurance Program (Federal Program) to help meet your long term care insurance needs.

When you applied for coverage under the Federal Program, you selected one of two coverage options – the Facilities-Only Option or the Comprehensive Option. The Facilities-Only Option includes as Covered Services those you receive while in a Nursing Home, Assisted Living Facility, or Hospice facility. The Comprehensive Option includes all of the Covered Services under the Facilities-Only Option plus Covered Services you receive at home or an Adult Day Care Center. This Benefit Booklet describes both options. Your Schedule of Benefits provided with this Benefit Booklet shows your coverage option and the amounts of coverage that you have.

Long Term Care Partners, LLC, is the Federal Program administrator. You may contact Long Term Care Partners at 1-800-LTC-FEDS (1-800-582-3337), TDD 1-800-843-3557. In consultation with OPM, we may change the Federal Program administrator at any time without notice.

Defined Terms

Throughout this Benefit Booklet, “you” and “your” mean the person that is named as the enrollee in the Schedule of Benefits and “we”, “us” and “our” mean either John Hancock Life Insurance Company or Metropolitan Life Insurance Company. All other words that have special definitions in this Benefit Booklet begin with capital letters and are defined in the Definitions section.

EFFECTIVE DATE OF COVERAGE

If you do not pay your first premium when due, your coverage will not take effect.

Your coverage is scheduled to take effect on the Original Effective Date shown on your Schedule of Benefits. However, your coverage will not go into effect, or your Original Effective Date changes, in the situations described below.

If You Lost Your Eligibility Status Before Your Original Effective Date

Except as described below, if you lost your status as a Workforce member or a Qualified Relative before your Original Effective Date, coverage does not go into effect for you under the Federal Program.

Your coverage goes into effect on your Original Effective Date if you are an Employee or Member of the Uniformed Services who was involuntarily separated, for reasons other than your misconduct, after your application date but before your Original Effective Date. If you were involuntarily separated because of your misconduct, coverage for you and your Qualified Relatives does not go into effect.

Your coverage goes into effect on your Original Effective Date if you lost your status as a Qualified Relative after your application date but before your Original Effective Date due to:

the death of the Workforce member who was the basis of your status as a Qualified Relative; or the involuntary separation (for reasons other than misconduct) of the Employee or Member of the Uniformed Services who was the basis of your status as a Qualified Relative.

Note: If you were planning to pay your premium through the Workforce member’s payroll deduction, you will have to make other arrangements for payment of your premium.

If Your Eligibility Status Changed Before Your Original Effective Date

If your eligibility status changed between your application date and your Original Effective Date, coverage does not go into effect for you under the Federal Program, unless you have already passed the same or additional underwriting requirements that apply to your new status. If your status change requires additional underwriting, you must submit a new application that we must approve in order for you to receive coverage under the Federal Program. If your status change does not require additional underwriting, no action by you is required. Two examples follow. If you were an Employee or a Member of the Uniformed Services who submitted an abbreviated underwriting application, and retire before your Original Effective Date, you must submit a new application with the additional underwriting required for a retiree. If you apply as an Annuitant, and become an Employee before your Original Effective Date, your coverage will go into effect as scheduled.

Actively at Work Requirement for Employees and Members of the Uniformed Services

If you are an Employee or a Member of the Uniformed Services who submitted an abbreviated underwriting application, you must be Actively at Work on the Original Effective Date shown on your Schedule of Benefits. If your Original Effective Date falls on a weekend or holiday, you must be Actively at Work on the last work-day before your Original Effective Date. For employees working an alternative work schedule, an “AWS” day counts as a day you are Actively at Work.

You must notify us if you are not Actively at Work as required above. In this case, your coverage does not go into effect until the first day of the month on or after the date you return to being Actively at Work. That date will then be your new Original Effective Date provided that you are Actively at Work on that date. If your new Original Effective Date falls on a weekend or holiday, you must be Actively at Work on the last work-day before your new Original Effective Date. You must notify us of the date you return to Active Work and we will send you a new Schedule of Benefits. You must notify us if you are not Actively at Work on your new Original Effective Date. In this case, your coverage will not go into effect until you are Actively at Work as required above.

Your Original Effective Date does not change under this Actively at Work requirement if you were involuntarily separated (for reasons other than your misconduct) after your application date but before your Original Effective Date.

CONDITIONS FOR PAYMENT OF BENEFITS

We will pay benefits for long term care services if:

you receive them after your coverage becomes effective (please see the Original Effective Date shown on your Schedule of Benefits and the Effective Date of Coverage section); and you are eligible for benefits (please see the Eligibility for Benefits section); and you receive them after satisfying any required waiting period (please see the Waiting Period section); and they are Covered Services (please see the Covered Services section); and you have not exhausted your Maximum Lifetime Benefit (please see the When Your Coverage Will End section).

Payment of benefits is also subject to the maximums and limitations shown on your Schedule of Benefits and the exclusions and limitations contained in the following sections: Maximum Benefit We Will Pay, Exclusions, Catastrophic Coverage Limitation, Coordination of Benefits and When Your Coverage Will End.

ELIGIBILITY FOR BENEFITS

You are eligible for benefits if, after your coverage becomes effective:

a Licensed Health Care Practitioner has certified within the last 12 months that:

you are unable to perform, without Substantial Assistance from another person, at least 2 Activities of Daily Living for an expected period of at least 90 days due to a loss of functional capacity; or you require Substantial Supervision due to your Severe Cognitive Impairment; and we agree with that certification; and we approve a Written Plan of Care established for you by a Licensed Health Care Practitioner or our care coordinator.

How to Ask Us to Determine Whether You Are Eligible for Benefits

If you believe you may be eligible for benefits, you or your representative must call 1-800-LTC-FEDS (1-800-582-3337), TDD 1-800-843-3557.

If we need more information to make our determination:

we may contact you, your Physician or other persons familiar with your condition; and/or we may access your medical records to get information about your condition (we cannot determine that you are eligible for benefits if we are not given access to your medical records); and/or we may request, at our expense, to have you examined by a licensed health care professional and/or to conduct an on-site assessment.

Continuing Assessment of Your Eligibility for Benefits

We will reassess whether you continue to be eligible for benefits at least once every 12 months, but no more frequently than every 30 days.

Notice and Review of Benefit Eligibility Decision

We will send you Written notice of our decision on whether you are eligible for benefits no later than 10 business days after we have received all the information we need. If we determine that you are eligible for benefits, the notice will state the date as of which you are eligible for benefits and will include claim forms.

If we determine that you are not eligible for benefits, the notice will provide the reason(s) for the denial. You or your representative may request a review of a denial by sending a Written request to us no later than 60 days after the date of the denial. No later than 60 days after the date we receive your request, we will send you Written notice of our decision. If, on review, we determine that you are eligible for benefits, the notice will state the date as of which you are eligible for benefits and will include claim forms. If, on review, we uphold the initial denial, you may request an appeal. Please see the Appeals section.

WAITING PERIOD

The waiting period is the number of days during which you must be eligible for benefits and receiving Covered Services before we will pay benefits. The waiting period applies to payment of benefits for all Covered Services unless otherwise stated. You only have to satisfy the waiting period once in your lifetime. Days applied toward satisfying the waiting period need not be consecutive, nor associated with the same episode of care. The days will be added together until the waiting period is satisfied. The length of your waiting period is shown on your Schedule of Benefits. We do not pay benefits for services you receive during your waiting period, unless otherwise stated.

The waiting period does not apply to Hospice Care, Respite Services and Caregiver Training. Because we do not apply the waiting period to Hospice Care, Respite Services and Caregiver Training, these Covered Services do not count toward meeting your waiting period.

COVERED SERVICES

Your Schedule of Benefits shows whether you selected the Facilities-Only Option or the Comprehensive Option. If your Schedule of Benefits shows that you selected the Facilities-Only Option, the provisions of the Comprehensive Option do not apply to you.

The Federal Program provides reimbursement for actual charges you incur up to the Benefit Amount shown in your Schedule of Benefits for the following Covered Services if they are part of the Written Plan of Care approved by us and you have satisfied the applicable waiting period. Please see the Exclusions section for information on those services and supplies that are not covered under the Federal Program.

Facilities-Only Option

The following are Covered Services under the Facilities-Only Option.

Nursing Home and Assisted Living Facility

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, Maintenance or Personal Care, and Therapy Services provided to you by a Formal Caregiver; and drugs, incontinence supplies, dietary supplements, personal medical equipment and laundry services.

Hospice Facility

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.

Please see the Additional Covered Services and Benefits subsection for information on additional Covered Services and benefits that apply to the Facilities-Only Option.

Comprehensive Option

The Comprehensive Option includes all Covered Services under the Facilities-Only Option and also includes the following as Covered Services.

Services Provided by a Formal Caregiver at Home

We will pay for the following services provided to you by a Formal Caregiver at home: Nursing Care, Maintenance or Personal Care and Therapy Services.

Services Provided by an Informal Caregiver

We 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.

Hospice Care at Home

We will 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.

Services Provided at an Adult Day Care Center We will pay for services provided to you under an adult day care program at an Adult Day Care Center.

Please see the Additional Covered Services and Benefits subsection for information on additional Covered Services and benefits that apply to the Comprehensive Option.

Additional Covered Services and Benefits

(Applies to both the Facilities-Only Option and the Comprehensive Option)

Bed Reservations

We will pay for actual charges you incur for Bed Reservations. We will not pay more than the benefit that we would pay if you had been in the Nursing Home, Assisted Living Facility or Hospice facility on those days. Benefits for Bed Reservations are limited to 30 days per calendar year.

Caregiver Training

We will pay for Caregiver Training. Benefits for Caregiver Training are limited to an amount equal to 7 times your Daily Benefit Amount in your lifetime.

The waiting period does not apply to Caregiver Training. Caregiver Training does not count toward meeting your waiting period.

Respite Services

For the Facilities-Only Option, if you are eligible for benefits but are being cared for at home (rather than in a facility), we will pay for Respite Services provided in a Nursing Home, Assisted Living Facility or Hospice facility.

For the Comprehensive Option, we will pay for Respite Services:

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

Benefits for Respite Services 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.

Alternate Plan of Care

Under the circumstances described below, our care coordinator can authorize benefits for services for your care that are not specifically defined as Covered Services. For example, under an alternate plan of care, we will consider a facility that is not otherwise covered under the Federal Program (such as a residential care facility licensed in California). If you selected the Comprehensive Option, our care coordinator can also authorize benefits for supplemental items that enable you to remain at home, such as modification to your home to make it wheelchair-accessible, durable medical equipment, and emergency response systems.

Services for your care and supplemental items for which benefits are authorized by us under this section are called an alternate plan of care and, as such, will be considered Covered Services. Benefits under an alternate plan of care will only be authorized if we determine, in our sole discretion, that the alternate plan of care meets the following criteria:

it is part of your Written Plan of Care approved by us; and it effectively meets your long term care service needs; and it does not include services provided by a person who normally lived in your home at the time you became eligible for benefits; and it is cost-effective for the Federal Program; and for the Facilities-Only Option, it does not include services that are provided outside a facility.

Your receipt of services for your care under an alternate plan of care will be subject to the Waiting Period section. The benefits we will pay for such services will be subject to the Maximum Benefit We Will Pay section.

Supplemental items you pay for under an alternate plan of care will not count toward satisfying your waiting period. However, after you satisfy your waiting period and if you remain eligible for benefits, we will reimburse you retroactively for any expenses you incurred for approved supplemental items you received during your waiting period. Our care coordinator will determine whether reimbursement for supplemental items is subject to the Maximum Benefit We Will Pay section.

International Benefits We will pay benefits for Covered Services you receive outside the United States (see the Definitions section for the definition of United States). When you receive such services, we will pay benefits up to 80% of the Benefit Amounts shown on your Schedule of Benefits.

If your Schedule of Benefits shows that you have a 3 or 5 year Benefit Period, 80% of your Maximum Lifetime Benefit can be used for Covered Services you receive outside the United States; the remaining 20% will be available for Covered Services you receive in the United States.

If your Schedule of Benefits shows that you have an unlimited Benefit Period, your Benefit Period will be limited to 10 years for Covered Services you receive outside the United States. For such services, your Maximum Lifetime Benefit will be equal to 3,650 days (10 years) x 80% of your Daily Benefit Amount. Your Maximum Lifetime Benefit for Covered Services you receive in the United States will remain unlimited.

Example 1: Let’s assume that you selected the Comprehensive Option with a Daily Benefit Amount of $150 and that you have a 5 year Benefit Period. For purposes of determining international benefits, your Daily Benefit Amount is $120 ($150 x 80%) instead of $150. We would pay up to $120 per day for services provided to you in a Nursing Home. We would pay up to $90 ($120 x 75%) per day for services provided to you by a Formal or Informal Caregiver at home. Out of your Maximum Lifetime Benefit of $273,750, you could use up to 80% ($219,000) for all Covered Services you receive outside the United States. If you return to the United States and receive Covered Services, the remaining 20% ($54,750) of your Maximum Lifetime Benefit will be available for those services.

Example 2: Let’s assume that you selected the Comprehensive Option with a Daily Benefit Amount of $150 and that you have an unlimited Benefit Period. Let’s also assume that you chose to have that amount reimbursed as a Weekly Benefit Amount equal to $1,050 ($150 x 7). For purposes of determining international benefits, your Daily Benefit Amount is $120 ($150 x 80%) and your Weekly Benefit Amount is $840 ($120 x 7). We would pay up to $840 per Week for services provided to you in a Nursing Home. We would pay up to $630 per Week ($840 x 75%) for services provided to you by a Formal or Informal Caregiver at home. Your Maximum Lifetime Benefit for Covered Services you receive outside the United States would be limited to $438,000 (3,650 x $120). If you return to the United States and receive Covered Services, your Maximum Lifetime Benefit would remain unlimited for those services.

The Coordination of Benefits section does not apply to international benefits.

MAXIMUM BENEFIT WE WILL PAY

All benefit payments are limited by your Maximum Lifetime Benefit, unless your Schedule of Benefits shows that it is unlimited, and the following provisions.

For the Facilities-Only Option

If you receive more than one Covered Service on the same day, the most we will pay for all of those services is the Daily Benefit Amount shown on your Schedule of Benefits.

For the Comprehensive Option

If you receive more than one Covered Service on the same day, the most we will pay for all of those services is the highest Benefit Amount shown on your Schedule of Benefits for one of those services.

If you selected the Weekly Benefit Amount and receive more than one Covered Service during the same Week, the most we will pay for all of those services is the highest Benefit Amount shown on your Schedule of Benefits for one of those services.

Example 1: Let’s assume that you selected a Daily Benefit Amount of $100 and you incur charges of $75 for Hospice Care at home and charges of $50 for Informal Caregiver services on the same day. The Benefit Amount for Hospice Care is $100 (100% of your Daily Benefit Amount) and the Benefit Amount for Informal Caregiver services is $75 (75% of your Daily Benefit Amount). The most we would pay for the services received on that day is the Benefit Amount for Hospice Care ($100) since Hospice Care has a higher Benefit Amount than Informal Caregiver services. The total amount of benefits we would pay for that day would be $100.

Example 2: Let’s assume that you selected a Daily Benefit Amount of $100 and the Weekly Benefit Amount. Your Weekly Benefit Amount is $700 ($100 x 7). Let’s also assume that you incur charges of $300 for Hospice Care at home and $300 for Informal Caregiver services during the same Week. The Benefit Amount for Hospice Care is $700 (100% of your Weekly Benefit Amount) and the Benefit Amount for Informal Caregiver Services is $525 (75% of your Weekly Benefit Amount). The most we would pay for the services received during that Week is the Benefit Amount for the Hospice Care ($700) since Hospice Care has a higher Benefit Amount than Informal Caregiver services. The total amount of benefits we would pay for that Week would be $600.

Exception for Caregiver Training

We will pay up to the Benefit Amount shown on your Schedule of Benefits for Caregiver Training without considering benefits we pay for other Covered Services you receive on the same day, or if applicable, during the same Week. In addition, we will not consider Caregiver Training when determining the maximum we will pay for other Covered Services you receive on the same day, or if applicable, during the same Week.

Example 1: If you incur charges for Nursing Home services and Caregiver Training on the same day, we will pay up to 100% of your Daily Benefit Amount for each service.

Example 2: If you selected the Comprehensive Option with the Weekly Benefit Amount and you incur charges for services provided by an Informal Caregiver and Caregiver Training during the same Week, we will pay up to 75% of your Weekly Benefit Amount for the Informal Caregiver services and up to 100% of your Weekly Benefit Amount for Caregiver Training.

CARE COORDINATION SERVICES

Our care coordinators are Licensed Health Care Practitioners who provide the following services at no additional charge to you:

1. provide general information about long term care services; and

2.

assess and approve your need for long term care services; and

3.

develop a plan for long term care services; and

4. monitor and reassess from time to time the long term care services that you receive; and

5.

provide access to discounts for services, when available.

Our care coordinators will provide the services described above for your Qualified Relatives. These services will be provided regardless of whether your Qualified Relatives are enrolled in the Federal Program, as long as you are enrolled. The services listed under items 2, 3 and 4 will be available for your Qualified Relatives at an additional charge. For Qualified Relatives who are not enrolled in the Federal Program, we would only assess, not approve, their need for long term care services under item 2 above. Our care coordinators can provide you or your Qualified Relatives with information on the applicable charges for care coordination services for your Qualified Relatives.

You do not have to be eligible for benefits or satisfy the waiting period in order to receive care coordination services.

EXCLUSIONS

This section describes those services and supplies that are not covered under the Federal Program.

The Federal Program does not pay benefits for any of the following:

1.

illness, treatment or medical condition arising out of:

your participation in a felony, riot or insurrection; or your attempted suicide, while sane or insane; or injuries you intentionally inflict on yourself; or

2. care or treatment for alcoholism or drug addiction; or

3.

care or treatment provided in a government facility, including a Department of Defense or Department of Veterans Affairs facility, unless otherwise required by law; or 4.

care you receive while in a Hospital, except in a unit specifically designated as a Nursing Home or Hospice facility; or

5. any service or supply to the extent the expense for it is reimbursable under Medicare, or would be so reimbursable except for the application of a deductible, coinsurance or copayment amount. (This exclusion will not apply in those instances where Medicare is determined to be the secondary payor under applicable law); or

6. services or supplies for which you are not obligated to pay in the absence of insurance; or

7.

services provided by any person who normally lived in your home at the time you became eligible for benefits.

CATASTROPHIC COVERAGE LIMITATION

Your Coverage Does Not Have a War Exclusion

Unlike most long term care insurance policies available today, your coverage does not have a war exclusion. As a result, whether you are a civilian or Member of the Uniformed Services, benefits may be payable under the Federal Program for conditions due to war or acts of war, declared or undeclared, or service in the armed forces or auxiliary units. Your coverage may be reduced, however, if a war or act of war (declared or undeclared) is determined to be a Catastrophic Event as described below.

Catastrophic Event

Benefits described in this Benefit Booklet are subject to this Catastrophic Coverage Limitation. A Catastrophic Event is an event or series of events affecting such a significant number of enrollees that it threatens to undermine the financial stability of the Federal Program. Although it is unlikely, it is possible that such an event could occur. This is less likely as Federal Program reserves grow. This provision would apply to any claims related to a Catastrophic Event. If you are affected by a Catastrophic Event, your Daily Benefit Amount would remain the same but your Benefit Period (as shown in your Schedule of Benefits) would be shortened. For example, if you chose a Daily Benefit Amount of $100 and have a 5 year Benefit Period, you would still be entitled to receive up to $100 per day, but your Benefit Period would be reduced to fewer than 5 years.

The following types of events, among others, could be considered a Catastrophic Event:

natural disaster (e.g., flood or earthquake); or

· epidemic, or other widespread health crisis; or

· act of terrorism; or

· war (declared or undeclared) or any act of war.

We will determine if a Catastrophic Event has occurred by consulting with OPM when estimating the number of claims expected to arise from the event or series of events. We will also assess whether the expected claims attributable to the event(s) could undermine the financial stability of the Federal Program.

It is also important to note that this provision will apply only if we determine that a Catastrophic Event has occurred; it will apply only to enrollees affected by the Catastrophic Event and to claims related to that Catastrophic Event. For example, if a war triggers this provision, the Benefit Period for those whose claims are unrelated to that war would not be affected.

If we establish that a Catastrophic Event has occurred, we will consult with OPM to determine the new, shorter Benefit Period for affected enrollees. The amount of the Benefit Period reduction will depend on the number of claims attributable to the Catastrophic Event. Once the reduction is determined, there will be no further reductions related to that Catastrophic Event. If we find that claims are less severe than was estimated at the time we determined the reduction, then we will partially or fully restore your Benefit Period.

COORDINATION OF BENEFITS

Some enrollees may be eligible for benefits for long term care services under another plan or through other programs that are not listed in the Exclusions section. For this reason, the Federal Program includes this Coordination of Benefits (COB) provision. This COB provision follows the guidelines set by the National Association of Insurance Commissioners (NAIC).

In determining the amount of benefits we will pay, this COB provision allows us to look at other plans that might pay benefits for long term care services that you receive. The other plans we look at include government programs (other than Medicaid), group medical benefits, and other employer-sponsored long term care insurance. We do not look at Medicaid, individual insurance policies or association group insurance policies. This COB provision does not apply to international benefits.

If the Federal Program is primary (this means it pays first), we will pay benefits without coordinating with other plans. That means that we will pay benefits to the maximum extent permitted by your coverage.

If another plan or program is primary, then it will pay first. In this case, we will require you to submit the explanation of benefits you received from that other plan or program showing that you submitted a claim to it and how that claim was decided. We may also request a copy of the other plan or program booklet or terms of coverage. We will pay no more than the difference between the amount payable by your other coverage(s) and your actual expenses.

In those instances where this COB provision applies, the rules for determining which plan or program is primary (pays first) are as follows. These rules are subject to the special rules for government programs explained below.

1.

The plan or program that covers you as a member, an employee, or a Workforce member is considered primary over that covering you as a dependent or a Qualified Relative.

2. The plan or program covering you as a member, an employee, or a Member of the Uniformed Services is considered primary over that covering you as a laid-off or retired employee, an Annuitant, or a Retired Member of the Uniformed Services.

3.

The plan or program covering you as a dependent or a Qualified Relative of: a member, an employee, or a Member of the Uniformed Services, is considered primary over that covering you as a dependent or a Qualified Relative of: a laid-off or retired employee, an Annuitant or a Retired Member of the Uniformed Services.

If none of these rules determine the order, then the plan or program that has covered you for the longest period of time will be primary.

Government Programs

Unless otherwise required by law, any benefits for long term care services that you receive under other plans or programs established by the Federal or a state government are primary (pay first) to the Federal Program. Please see the Exclusions section, which excludes payment of benefits for care provided in a government facility.

CLAIMS

You or your representative must submit Written proof of your claim to us no later than 12 months from the date you incurred charges for Covered Services. If you or your representative do not submit proof of claim within this time limit, we may deny benefits unless you can show that it was not reasonably possible for you to submit proof of claim within the time limit, and you or your representative submitted proof of claim as soon as reasonably possible.

We must receive adequate Written proof (such as bills for services) that you have incurred charges for Covered Services. To assist us in determining whether you have incurred charges for Covered Services:

we may contact you, your Physician or other persons familiar with the services provided to you; and/or we may access your medical records to get information about your condition or the services provided to you (we cannot approve a claim if we are not given access to your medical records); and/or we may request to have you examined, at our expense, by a health care provider and to conduct an on-site assessment; and/or we may require you to submit Medicare explanations of benefits or documentation from any other source from whom you may have received or are eligible to receive reimbursement for the Covered Service for which you have submitted a claim.

Notice and Review of Claim Determination

We will send you Written notice of our claim determination no later than 10 business days after we receive all the information we need.

If we deny your claim, in whole or in part, the notice will provide the reason(s) for the denial. You or your representative may request a review of a denial by sending a Written request to us no later than 60 days after the date of the denial. No later than 60 days after the date we receive your request, we will send you Written notice of our decision. If the initial denial is upheld on review, you may request an appeal. Please see the Appeals section.

APPEALS

As stated in the Notice and Review of Benefit Eligibility Decision subsection of the Eligibility for Benefits section, and the Notice and Review of Claim Determination subsection of the Claims section, the Federal Program includes an appeals process. This section explains your right to appeal in the event we initially deny your eligibility for benefits or your claim and then, on review, we uphold our denial.

Appeals Committee

If you choose to appeal our eligibility for benefits or claim decision, you must send a Written request to us, with any additional information that you wish to have us consider, no later than 60 days after the date of our review decision. Your appeal will be reviewed by an appeals committee composed of: one or more representatives of John Hancock Life Insurance Company, one or more representatives of Metropolitan Life Insurance Company, and other person(s) if mutually agreed upon by OPM and us.

The appeals committee will provide you with Written notice of its final decision no later than 60 days after the date we receive your Written request for appeal. If the appeals committee upholds the denial and that denial is eligible for appeal to an independent third party (as explained below), our Written notice will let you know how to request such an appeal.

Independent Third Party

If the appeals committee upholds a denial of your eligibility for benefits or your claim due to its evaluation of your medical condition/functional capacity, (such as your ability to perform Activities of Daily Living or your cognitive status), you may request to appeal that decision to an independent third party mutually agreed to by OPM and us. You must make this request in Writing no later than 60 days after the date of our notice informing you of the appeals committee’s decision.

The independent third party will provide you with Written notice of its final decision no later than 60 days after we receive your request for appeal to the independent third party. The decision of the independent third party is final and binding on us.

The following is an example of when a denial by the appeals committee will be eligible for appeal to an independent third party: the appeals committee upholds a denial of your eligibility for benefits because its review indicates that you can perform 5 out of 6 Activities of Daily Living.

The following is an example of when a denial by the appeals committee will not be eligible for appeal to an independent third party: the appeals committee upholds a denial of your claim for benefits for Nursing Home services because you exhausted your Maximum Lifetime Benefit.

Exhaustion of the Appeals Process

Once you have exhausted this appeals process, you may seek judicial review of a final denial of eligibility for benefits or a claim. Please see the Limits on Legal Actions subsection of the General Provisions section for more information.

PAYMENT OF BENEFITS

All benefits will be paid in United States currency. All benefits will be paid directly to you unless you have completed an assignment of benefits. You may not assign benefits to any provider of Covered Services outside the United States. For the Comprehensive Option, we will determine, in our sole discretion, whether to honor assignments to Informal Caregivers. You may not assign benefits prior to a claim.

BENEFIT CHANGES

Anytime your Daily Benefit Amount changes under this section, all those benefit amounts that are determined based on your Daily Benefit Amount will change accordingly.

Automatic Compound Inflation Option

(Applies only if your Schedule of Benefits indicates “Yes” for this option)

On each anniversary of your Original Effective Date (or of the date you switch to this option), your Daily Benefit Amount and the remaining portion of your Maximum Lifetime Benefit will automatically increase at a rate of 5% compounded annually. In addition, the remaining portions of: (1) your lifetime maximum for Caregiver Training; and (2) your calendar year maximum for Respite Services, will increase at the same rate as your Daily Benefit Amount. Increases under this option are made even if you are eligible for benefits, without regard to your age, claim status, claim history or the length of time your coverage has been in effect, and will not cause your premium to increase.

If we determine in the future that the cumulative actual rate of inflation in the cost of long term care services since the last increase under this provision is significantly higher than 5% compounded annually, OPM and we will agree upon a method to allow you, at your option, to adjust your Daily Benefit Amount. This method will account for the higher rate of inflation for an additional premium if you are not then eligible for benefits.

Future Purchase Option

(Applies only if your Schedule of Benefits indicates “Yes” for this option)

Every two years we will increase your Daily Benefit Amount and the remaining portion of your Maximum Lifetime Benefit, except as described below. We will send notice of the first increase in the fall of 2003 for the increase that will apply on January 1, 2004. Increases will occur every two years on January 1st thereafter. Your coverage must be in effect for at least 12 months in order for you to receive your first increase under this provision. The increase will be based on the change in the Department of Labor’s Consumer Price Index for Medical Care or another index mutually agreed upon by OPM and us. We will include the amount of the increase in the notice. Please see the Premiums section, How Benefit Changes Affect Your Premium subsection, for information on how increases under this option affect your premium.

An increase under this provision will also increase the remaining portions of: (1) your lifetime maximum for Caregiver Training; and (2) your calendar year maximum for Respite Services, at the same rate as your Daily Benefit Amount.

If you do not want the increase, you must send us a Written rejection before the date the increase will take effect. If you want the increase, you do not have to take any action other than paying the additional premium. The increase will automatically take effect. Increases under this option will be made regardless of your age, but we will not increase your benefits under this option if you are eligible for benefits or if you declined a total of 3 prior increases.

Increases under this option do not require you to provide evidence of your good health, except as noted below. Each time we send you notice of an increase under this option, we will also offer you the opportunity to receive future benefit increases under the automatic compound inflation option instead of this option. If you elect to switch to the automatic compound inflation option, you will not receive the current increase under the future purchase option.

If you declined a total of 3 increases under this option and you later wish to resume receiving increases, you must provide, at your expense, evidence of your good health that is satisfactory to us.

Other Benefit Changes (Upgrades and Downgrades)

At any time, you may request an increase (upgrade) or decrease (downgrade) in your coverage by Writing to us or calling us at 1-800-LTC-FEDS (1-800-582-3337), TDD 1-800-843-3557. In order to receive approval of a request for an increase, you must provide, at your expense, evidence of your good health that is satisfactory to us. You do not have to provide evidence of your good health for a decrease. The amount of an increase or decrease is subject to Federal Program options available at the time of your request.

PREMIUMS

Your premium payment is due and payable on the first day of the month in which it is due. It must be paid in United States currency.

The amount of your premium when coverage first goes into effect is based upon your Original Issue Age as shown on your Schedule of Benefits. Your premium will not change because you get older or your health changes or for any other reason related solely to you. We may only increase your premium if you are among a group of enrollees whose premium is determined to be inadequate. While the Group Policy is in effect, OPM must approve the change.

How Benefit Changes Affect Your Premium

If you selected the automatic compound inflation option, your premium is designed to include all future inflation increases you will receive each year while you are insured. Your premium will not increase due to inflation increases under this option.

If you selected the future purchase option, your premium will increase for each inflation increase under this option; the additional premium for each increase will be based on your age and the premium rates in effect at the time the increase takes effect. If you accept an offer to switch from the future purchase option to the automatic compound inflation option, your premium will increase based on your age and the premium rates in effect at the time that switch goes into effect. This increase in premium pays for future increases under the automatic compound inflation option. Once you have switched, your premium will not increase for any subsequent inflation increase.

If you request and we approve a Daily Benefit Amount increase other than an inflation increase, your additional premium will also be based on your age and the premium rates in effect at the time the increase takes effect. Other coverage increases you request and we approve will cause your entire premium to be based on your age and the premium rates in effect at the time the increase takes effect. If you request a decrease in coverage consistent with available Federal Program options, your premium will decrease.

Please see the Benefit Changes section for information on these benefit change provisions.

GRACE PERIOD

There is a 30-day grace period for payment of your…