Attachment_6A_-_FLTCIP_2.0_and_2.1_-_Book_One_-_Program_Details_and_Rates.pdf

The Federal Long Term Care Insurance Program book one Program Details and Rates www.LTCFEDS.com 1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-843-3557

Eligibility 2

The Federal Long Term Care Insurance Program—a smart choice 3

Key features 7

Prepackaged plans 9

Customized plans 10

Options for paying premiums 10

Premiums 11

Qualifying for benefits 15

What is not covered by the FLTCIP 15

FLTCIP 2.0 Outline of Coverage 16

The Federal Long Term Care Insurance Program Privacy Notice 35

Table of Contents

Have questions?

Visit us at www.LTCFEDS.com or call us at 1-800-LTC-FEDS

(1-800-582-3337) TTY 1-800-843-3557.

Note: Glossary terms appear in bold at first usage. To look up a term, see the Glossary section in Book Two: Additional Information.

The Federal Long Term Care Insurance Program is sponsored by the U.S. Office of Personnel Management, offered by John Hancock Life & Health Insurance Company, and administered by Long Term Care Partners, LLC.

Eligibility

Federal and U.S. Postal Service employees and annuitants, active and retired members of the uniformed services, and their qualified relatives are eligible to apply for coverage under the Federal Long Term Care Insurance Program (FLTCIP). Specifically, persons in the following groups are eligible to apply for coverage:

Employees Federal employees in positions that convey eligibility for the Federal Employees Health Benefits

(FEHB) Program (whether or not they are actually enrolled)

U.S. Postal Service (USPS) employees in positions that convey eligibility for the FEHB Program (whether or not they are actually enrolled)

Active members of the uniformed services who are on active duty or full-time National Guard duty for more than 30 days, including:

active members of the Selected Reserve (members of the Individual Ready Reserve are not eligible to apply)

Other eligible employees:

Tennessee Valley Authority employees (even though they may not be eligible for FEHB coverage)

D.C. Government employees who were first employed by the D.C. Government before October 1, 1987

D.C. Courts employees

Navy Personnel Command (BUPERS) employees

Nonappropriated Fund (NAF) employees

Annuitants Federal or USPS annuitants

Retired members of the uniformed services who are entitled to retired or retainer pay, including:

retired grey reservists, even if they are not yet receiving their retired pay

Other eligible annuitants:

deferred annuitants separated employees with title to a deferred annuity, even if they are not yet receiving that annuity

Tennessee Valley Authority annuitants compensationers receiving compensation from the U.S. Department of Labor

D.C. Government annuitants who were first employed by the D.C. Government before October 1, 1987

D.C. Courts annuitants

BUPERS annuitants

NAF annuitants

Survivors of deceased workforce members receiving an annuity (visit www.LTCFEDS.com/eligibility to determine if you are eligible as a survivor)

Qualified relatives If you are a qualified relative as described below, you can apply even if the person you’re related to does not apply, or even if the person you’re related to applies but is not approved for coverage.

Current spouses of eligible employees

Current spouses of eligible annuitants (but not former spouses, even if they are receiving an apportionment of annuity)

Parents, parents-in-law, and stepparents of living eligible employees (parents, parents-in-law, and stepparents of annuitants are not eligible)

Adult children (at least 18 years old, including adopted and stepchildren) of living eligible employees and annuitants

Eligibility

The Federal Long Term Care Insurance Program—a smart choice Long term care insurance is a smart way to protect your income and assets and remain financially independent should you need long term care services at home, in a nursing home or an assisted living facility, or in other settings. Most health insurance programs, including the FEHB Program, TRICARE, and TRICARE For Life, provide little or no coverage for long term care. And long term care services can be very expensive. These are the current national averages for long term care services:1

$19 an hour for a home health aide

$71 a day for care in an adult day care center

$3,427 a month for care in an assisted living facility

$227 a day for a semiprivate room in a nursing home

$258 a day for a private room in a nursing home

Home care—which most people prefer—is generally more affordable than nursing home care but still can be expensive. When averaged nationally, the cost of a six-hour visit by a home health aide is $114 per day.

That’s $29,640 per year for a home health aide visiting five days a week.

Is buying long term care insurance a smart financial move?

For many, it is, especially when you consider that approximately 70% of people over age 65 will require some long term care services at some point in their lives.2 This does not mean you should assume you’re too young to need the protection that long term care insurance provides if you’re under age 65. Unexpected injury or illness, which can occur at any age, can also cause the need for long term care. That’s why the U.S. Office of Personnel Management (OPM) sponsors the Federal Long Term Care Insurance Program (FLTCIP). It’s important to see what may make this federally sponsored program the right choice for you.

Sponsorship, strength, and stability Sponsored by the U.S. Office of Personnel Management The Long-Term Care Security Act (P.L. 106-265) authorizes OPM to sponsor a long term care insurance program designed exclusively for members of the Federal family. OPM serves as regulator of the FLTCIP and plays an important role in ensuring that the FLTCIP remains up-to-date and competitive.

Supported by the strength and stability of John Hancock Life & Health Insurance Company OPM selected John Hancock Life & Health Insurance Company to provide insurance for the FLTCIP’s second 7-year contract term, starting in 2009. John Hancock has experience offering long term care insurance for more than 20 years and provides the stability you need from an insurer. John Hancock consistently earns high ratings for financial strength and operating performance. Please visit www.LTCFEDS.com/JH for the most recent financial ratings. Long Term Care Partners, LLC, administers the program on behalf of and is owned by John Hancock.

1 John Hancock Life & Health Insurance Company, “John Hancock 2013 Cost of Care Survey,” conducted by LifePlans, Inc., April 2013.

2 U.S. Department of Health and Human Services, National Clearinghouse for Long-Term Care Information, www.longtermcare.gov/ the-basics (accessed September 30, 2013).

Qualified relatives (continued) Domestic partners* of eligible employees and annuitants (visit www.LTCFEDS.com/eligibility to determine if you are eligible as a domestic partner)

* A Declaration of Domestic Partnership form must be submitted to the employee’s agency or annuitant’s retirement system before you apply. Visit www.LTCFEDS.com/dp for details.

Benefits designed to meet your needs You can choose your care setting OPM has worked closely with John Hancock to ensure this insurance coverage offers the kind of benefits and features that are valuable to members of the Federal family today and in the future. You’ll find that with this program, you can choose to receive care at home, in an assisted living facility, in a nursing home, or in other settings.

Features and services Home, assisted living, and nursing home care The FLTCIP provides comprehensive coverage, regardless of whether you receive care at home, in an assisted living facility, in a nursing home, or in an inpatient hospice care environment. Additionally, the FLTCIP covers care provided in the home by friends, family members, and other unlicensed caregivers who did not normally live in your home at the time you became eligible for benefits. When informal care is provided by your family members, it’s covered for up to 500 days.

Up to 100% of your daily benefit amount is available for:

home care provided by a nurse, home health aide, therapist, or other authorized provider (including a friend or family member authorized to act as an informal caregiver) care provided in the community, such as adult day care care, room and board, and other services provided in a facility setting, including assisted living and nursing home facilities

Stay-at-home benefit The ability to receive long term care at home can be an important factor in maintaining quality of life.

So, the FLTCIP offers numerous options that support care in a home environment.

The stay-at-home benefit is a separate pool of money equal to 30 times your daily benefit amount.

The waiting period does not apply to the stay-at-home benefit.

Except for care planning visits, you must be living at home in order to be eligible for the stay-at-home benefit.

It can pay benefits for:

care planning visits—a professional assists you in developing a plan to meet your long term care needs, including identifying helpful community resources.

home safety checks—a professional evaluates your home environment in areas such as the need for safety bars in the bathroom, how furniture is arranged, doorway and hallway widths, and appliance and cabinet heights.

home modifications—improvements that can help you better manage long term care in a home setting, such as adding handgrips in a bathtub or installing wheelchair ramps.

emergency medical response system—a communication system can be installed in your home that can be used to call for assistance in a medical emergency (not a home security system).

durable medical equipment—provided to assist you to safely perform the normal activities of daily living— includes wheelchairs, walkers, crutches, and hospital-style beds.

caregiver training—pays training expenses for a family member or other informal caregiver to learn about how to care for you. The maximum amount payable in your lifetime for caregiver training is seven times your daily benefit amount.

Benefits paid under the stay-at-home benefit will not reduce your maximum lifetime benefit.

The Federal Long Term Care Insurance Program—a smart choice

Portability Once you have coverage, it’s portable. You can keep it as long as you continue to pay the required premiums and have not exhausted your maximum lifetime benefit, even if you are no longer a member of an eligible group (for example, if you leave government employment).

Guaranteed renewable Your insurance coverage is guaranteed renewable. It can never be canceled by the insurance carrier as long as you pay your premiums. It cannot be canceled due to your age or a change in your health.

Waiver of premium Once you have completed your waiting period, you do not pay premiums while you are receiving benefits.

Convenience of payroll and annuity/pension deductions The FLTCIP offers the convenience of payroll and annuity/pension deductions of premiums to employees and annuitants, for themselves and/or their qualified relatives. These automatic premium deductions can ensure that your premiums will be paid on time. (This service is available to most enrollees.)

Also available under the FLTCIP Alternate plan of care In certain circumstances, our care coordinators can authorize customized benefits for services that are not specifically covered under the FLTCIP. For example, under an alternate plan of care, we will consider a facility that is not normally covered under the program if it meets your needs. The flexibility of an alternate plan of care allows the program to provide you with benefits for cost-effective care and the services you want and need.

Generous informal caregiver provisions The FLTCIP covers approved care provided at home by informal caregivers such as friends, family members, and other nonlicensed caregivers. When informal care is provided by non-family members, it’s covered for the benefit period you’ve selected (two years, three years, five years, or unlimited). When informal care is provided by family members, it’s covered for up to 500 days of care in your lifetime. Informal caregivers cannot have lived with you at the time you became eligible for benefits, but they can live in your home after you become eligible for benefits.

International benefits Because this program was designed exclusively for the Federal family, it features international benefits that provide coverage for enrollees who live or may require care outside the United States. When you receive such services, the FLTCIP pays benefits up to 80% of the benefit amounts shown on your schedule of benefits. If your schedule of benefits shows that you have a two-, three-, or five-year benefit period, 80% of your maximum lifetime benefit (MLB) 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 MLB, benefits payable for any covered services you receive outside the United States will be limited to 10 years. For such services, your MLB will be equal to 3,650 days (10 years) x 80% of your daily benefit amount. Your MLB for covered services you receive in the United States will remain unlimited.

Bed reservations If you are in an assisted living facility, nursing home, or hospice facility and need to leave that facility for any reason (for example, you need to be hospitalized), the bed reservations feature in your coverage will pay up to 100% of the daily benefit amount for up to 60 days per calendar year to hold your space.

Respite care This benefit provides you with temporary care if your caregiver (such as a family member) needs to take some time off. Respite care is covered up to 30 times the daily benefit amount per calendar year, and there is no waiting period requirement. It includes:

respite care in a nursing home, assisted living facility, or hospice facility respite care by a formal or informal caregiver at home respite care at an adult day care center

No war exclusion Unlike coverage under some other long term care insurance plans, coverage under the FLTCIP does not have a war exclusion. As a result, benefits may be payable for conditions due to war or acts of war, declared or undeclared, or service in the armed forces or auxiliary units. There is also no catastrophic event limitation.

Third-party review of claims If we deny your appeal of benefits eligibility or of a claims decision due to our evaluation of your medical condition or functional capacity, you may request an independent third-party review. A third party, mutually agreed to by OPM and Long Term Care Partners, will review our evaluation of your medical condition or functional capacity and will provide a final and binding determination within 60 days after we receive your request for appeal.

Access to knowledgeable program representatives Program consultants can assist you at every step The FLTCIP has extremely knowledgeable program consultants who can help you every step of the way.

Whether you’re requesting information, reviewing benefits, or completing an application, these highly trained employees (who do not work on commission) can help you decide on a plan that will best meet your individual needs. One popular service requested of the program consultants is a personalized rate quote. Using the rate quote, program consultants can demonstrate the wide range of benefits you can apply for and the costs associated with each. Our program consultants take pride in providing the highest level of quality service to the Federal family and adhere to the strictest service levels set forth by OPM. Should you have any questions, we are available to assist you. You can visit us at www.LTCFEDS.com or call us at 1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-843-3557.

Care coordinators understand your individual care needs If you’re approved for coverage and enroll, you’ll have unlimited access to the FLTCIP’s care coordinators.

They are registered nurses who have worked extensively in the field of long term care. You can contact them to ask any questions you may have about long term care (even if you are not receiving benefits). If you initiate a claim and are approved for benefits, care coordinators will work with you and/or your family members to develop a plan of care to meet your individual care needs. They can also help you find high-quality care providers in your area and share the results of state survey reports about service availability, quality, costs, and licensing. Gaining access to this level of detailed information allows you to make a knowledgeable decision about which provider is best for you.

Care coordinators can also arrange for discounted services, monitor the care you’re receiving, and assist with changing your plan of care as your needs change. This service is personal because you can talk to the same care coordinator who knows your particular situation each time you call. Unlike most long term care insurance plans, the FLTCIP also provides certain care coordination services to qualified relatives of enrollees at no cost. This can be invaluable in helping reduce the stress that may develop when a relative needs long term care.

For more details, see the Benefits Provided by the FLTCIP section of the FLTCIP 2.0 Outline of Coverage, which begins on page 16.

Because there is no one-size-fits-all when it comes to long term care insurance, the FLTCIP gives you the opportunity to choose among options in three areas:

daily benefit amount benefit period inflation protection options

If you have any questions about your options, please visit us at www.LTCFEDS.com or call us at

1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-843-355.

Daily benefit amount This is the maximum amount your insurance will pay in any single day. The FLTCIP offers eight daily benefit amounts (DBAs) from $100 to $450 in $50 increments.

Which DBA is right for me?

If you want your DBA to approximately match the 2013 national average daily cost of nursing home care, you may want to choose a $200 DBA. If you are able to pay a portion of the cost of care out of your own pocket (for example, from your savings) or if you live in an area where the cost of care is lower than the national average, you may want to choose a lower DBA. On the other hand, you may want to choose a higher DBA if you live in an area where the cost of care is higher than the national average. It’s important to keep in mind that services can be more costly in metropolitan areas. To find the average daily cost of care in your area (for home care, assisted living facilities, and nursing home care), you can visit us at www.LTCFEDS.com/costofcare or call us at 1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-843-3557.

Benefit period This is the length of time benefits will be paid if you receive benefits each and every day equal to your DBA.

You can choose from a two-year, three-year, five-year, or unlimited benefit period.

If you receive services that cost less than your DBA or you don’t receive services every day, your benefits will last longer than your benefit period.

The benefit period is used together with the DBA to calculate the maximum lifetime benefit.

Which benefit period is right for me?

When deciding which benefit period is right for you, it’s important to think about your budget, as well as your potential needs. If you want to keep your premium costs low and are willing to pay out of pocket for some of your care, the two-year benefit period will provide you with a basic level of protection. If you’ve considered that future advances in medical care could mean longer life expectancy, and the possibility of needing care for many years, you may prefer a longer benefit period, if it’s something you can comfortably afford.

What is a maximum lifetime benefit?

The maximum lifetime benefit (MLB) is the maximum amount your coverage can pay. To calculate your MLB, multiply your DBA by your benefit period (in days).

FLTCIP benefit periods: two years (730 days), three years (1,095 days), five years (1,825 days), or the unlimited benefit period (no maximum lifetime benefit).

Example: The following is the MLB calculation for an enrollee with a DBA of $150 and a three-year benefit period:

$150 x 1,095 days = $164,250 MLB

Key features

Inflation protection options To help make sure that your benefits keep pace with inflation and the rising costs of care, the FLTCIP offers two types of inflation protection: the automatic compound inflation option and the future purchase option.

For complete information on inflation protection options, see the Relationship of Cost of Care and Benefit Selection sections in the FLTCIP 2.0 Outline of Coverage, which begins on page 16.

The automatic compound inflation option With this option, your DBA and remaining portion of your MLB will automatically increase by either 4% or 5% (depending on the percentage you choose when you apply) compounded every year. The 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. Your premium does not increase annually as a result of this annual increase in benefits. However, premiums are not guaranteed.*

With long term care costs continuing to rise almost every year, you may want to consider the automatic compound inflation option (ACIO). The initial premiums are higher than the future purchase option because you are prefunding automatic future benefit increases that are designed to help keep pace with inflation.

For additional information about changes in premiums, please see the FLTCIP 2.0 Outline of Coverage, When We May Increase Premiums subsection, page 17, and When Your Premium May Change section, page 32.

The future purchase option With this option, you are given the opportunity to increase your DBA and MLB every two years with a corresponding increase in your premium. Premiums are not guaranteed.* You may decline the increase an unlimited number of times. The increase in your benefits is based on the U.S. Department of Labor’s Consumer Price Index for All Urban Consumers (CPI-U).

The amount of the increase to your DBA and the corresponding increase in your premium will be sent in a notice to you every two years in the fall. The increase will automatically take effect unless you tell us at that time you do not want the increase. Your coverage must be in effect for at least 12 months in order for you to receive your first increase under this option.

As your benefits increase, your future purchase option (FPO) premium increases and may eventually become greater than the ACIO premium. You may want to consider if you can afford increased premiums for future increases to your benefits. If you do not plan to accept future increases, you may want to consider how you will pay for any long term care that exceeds the amount your insurance will cover.

You can change to the ACIO at any time if you provide evidence of insurability (meaning you will be required to provide, at your expense, evidence of good health that is satisfactory to us).

For additional information about changes in premiums, please see the FLTCIP 2.0 Outline of Coverage, When We May Increase Premiums subsection, page 17, and When Your Premium May Change section, page 32.

Key features

* Premiums are not guaranteed. Your premium will not change because you get older or your health changes or for any other reason related solely to you. However, your premiums may increase 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.

Plan A Consider this plan if you want protection but are looking for a lower-cost option, if you will be living in an area where long term care costs are low, or if you plan to pay out of pocket for some of the costs of long term care in the future, if needed.

Daily benefit amount: $150 Benefit period: 2 years Maximum lifetime benefit: $109,500 Waiting period: 90 calendar days Inflation protection options:

4% automatic compound inflation option 5% automatic compound inflation option future purchase option

Plan B Consider this plan if you want protection for at least three years, which corresponds to the current average length of stay in a nursing home, or if you will be living in an area where long term care costs are low.

Daily benefit amount: $150 Benefit period: 3 years Maximum lifetime benefit: $164,250 Waiting period: 90 calendar days Inflation protection options:

4% automatic compound inflation option 5% automatic compound inflation option future purchase option

Plan C Consider this plan if you want protection for at least three years, which corresponds to the current average length of stay in a nursing home, or if you will be living in an area where long term care costs are around the national average.

Daily benefit amount: $200 Benefit period: 3 years Maximum lifetime benefit: $219,000 Waiting period: 90 calendar days Inflation protection options:

4% automatic compound inflation option 5% automatic compound inflation option future purchase option

Plan D Consider this plan if you will be living in an area where long term care costs are around the national average but you want protection for a longer period of time.

Daily benefit amount: $200 Benefit period: 5 years Maximum lifetime benefit: $365,000 Waiting period: 90 calendar days Inflation protection options:

4% automatic compound inflation option 5% automatic compound inflation option future purchase option

The FLTCIP offers four prepackaged plans that you can choose from. For the plan you select, you will need to choose an inflation protection option. Premiums for the prepackaged plans are listed on pages 11 to 14.

If you prefer other plan designs, you can create a customized plan.

Prepackaged plans

1. Daily benefit amount:

$100 $150 $200 $250

$300 $350 $400 $450

2. Benefit period:

2 years 3 years 5 years Unlimited

3. Inflation protection option:

4% automatic compound inflation option

5% automatic compound inflation option future purchase option

If you choose to customize a plan, you can pick the options that best suit your needs. You must make a choice for each of the three key features, noted below. To find the premiums for your customized plan, visit www.LTCFEDS.com/rate to use the Premium Calculator or call us at 1-800-LTC-FEDS

(1-800-582-3337) TTY 1-800-843-3557.

Customized plans

Options for paying premiums

The FLTCIP offers three convenient options for paying your premiums:

1. Payroll or annuity/pension deduction If you choose this option, premiums will be deducted from your pay or annuity/pension (or the pay or annuity/pension of the person you specify on your application). This option is available to most enrollees.

If you are paid biweekly and choose this option, your premiums will be deducted biweekly. If you are paid monthly (or receive a monthly annuity), your premiums will be deducted each month.

2. Automatic bank withdrawal If you choose this option, premiums will be deducted automatically on the third business day of every month from the checking or savings account you specify.

3. Direct bill If you choose this option, you will receive a monthly bill at your designated mailing address the month before your premium is due.

Premiums

Monthly premiums

Plan A Plan B Plan C Plan D

Age 4% ACIO 5% ACIO FPO 4% ACIO 5% ACIO FPO 4% ACIO 5% ACIO FPO 4% ACIO 5% ACIO FPO

18–30 $57.87 $97.52 $12.85 $78.71 $133.76 $14.67 $104.94 $178.35 $19.56 $166.18 $284.49 $27.83

31 $58.80 $98.21 $13.38 $79.99 $134.70 $15.33 $106.65 $179.60 $20.45 $168.95 $286.55 $29.17

32 $59.75 $98.90 $13.93 $81.29 $135.64 $16.03 $108.38 $180.85 $21.37 $171.76 $288.62 $30.59

33 $60.72 $99.60 $14.50 $82.61 $136.59 $16.76 $110.15 $182.12 $22.34 $174.61 $290.71 $32.07

34 $61.70 $100.31 $15.09 $83.95 $137.55 $17.52 $111.94 $183.40 $23.36 $177.52 $292.81 $33.62

35 $62.70 $101.02 $15.71 $85.32 $138.51 $18.32 $113.76 $184.68 $24.42 $180.47 $294.93 $35.25

36 $63.71 $101.74 $16.28 $86.70 $139.48 $19.06 $115.61 $185.97 $25.42 $183.47 $297.06 $36.96

37 $64.74 $102.46 $16.86 $88.11 $140.46 $19.84 $117.48 $187.28 $26.46 $186.52 $299.21 $38.75

38 $65.79 $103.19 $17.47 $89.55 $141.44 $20.65 $119.39 $188.59 $27.54 $189.62 $301.37 $40.63

39 $66.86 $103.92 $18.11 $91.00 $142.43 $21.50 $121.34 $189.91 $28.66 $192.77 $303.55 $42.60

40 $67.94 $104.65 $18.76 $92.48 $143.43 $22.37 $123.31 $191.24 $29.83 $195.98 $305.75 $44.66

41 $68.97 $105.23 $19.74 $93.88 $144.18 $23.61 $125.17 $192.24 $31.48 $198.95 $307.35 $46.95

42 $70.02 $105.80 $20.77 $95.29 $144.94 $24.92 $127.06 $193.26 $33.22 $201.97 $308.96 $49.35

43 $71.08 $106.38 $21.85 $96.73 $145.70 $26.30 $128.97 $194.27 $35.06 $205.03 $310.57 $51.88

44 $72.16 $106.97 $22.99 $98.19 $146.47 $27.75 $130.92 $195.29 $37.00 $208.13 $312.20 $54.53

45 $73.26 $107.56 $24.19 $99.67 $147.24 $29.29 $132.90 $196.32 $39.05 $211.29 $313.83 $57.32

46 $74.57 $108.45 $25.47 $101.47 $148.45 $30.92 $135.29 $197.93 $41.22 $215.16 $316.47 $60.45

47 $75.91 $109.35 $26.83 $103.29 $149.67 $32.64 $137.72 $199.55 $43.52 $219.10 $319.13 $63.75

48 $77.27 $110.26 $28.25 $105.15 $150.89 $34.45 $140.20 $201.19 $45.94 $223.11 $321.81 $67.24

49 $78.66 $111.17 $29.75 $107.05 $152.13 $36.37 $142.73 $202.84 $48.50 $227.20 $324.52 $70.91

50 $80.07 $112.10 $31.33 $108.97 $153.38 $38.40 $145.30 $204.51 $51.19 $231.36 $327.24 $74.78

51 $83.98 $116.01 $33.40 $112.86 $157.44 $41.00 $150.48 $209.92 $54.66 $239.48 $335.68 $79.95

52 $88.08 $120.06 $35.61 $116.89 $161.61 $43.78 $155.85 $215.48 $58.37 $247.87 $344.32 $85.47

Premiums are based on your age and the premium rates in effect at the time we receive your application.

The following monthly and biweekly premium charts provide premiums for the FLTCIP’s prepackaged plans and are valid for 30 calendar days.

If you do not apply within 30 calendar days, are customizing a plan, or are older than age 80, visit www.LTCFEDS.com/rate or call us at 1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-843-3557 to calculate your premium.

Premiums are not guaranteed. Your premium will not change because you get older or your health changes or for any other reason related solely to you. However, your premiums may increase 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.

Premiums

Monthly premiums

Plan A Plan B Plan C Plan D

Age 4% ACIO 5% ACIO FPO 4% ACIO 5% ACIO FPO 4% ACIO 5% ACIO FPO 4% ACIO 5% ACIO FPO

53 $92.38 $124.26 $37.96 $121.06 $165.88 $46.74 $161.41 $221.18 $62.33 $256.57 $353.20 $91.36

54 $96.89 $128.60 $40.46 $125.38 $170.27 $49.91 $167.18 $227.03 $66.55 $265.56 $362.30 $97.67

55 $101.62 $133.09 $43.13 $129.86 $174.78 $53.30 $173.14 $233.04 $71.06 $274.88 $371.63 $104.41

56 $106.79 $138.70 $45.92 $136.04 $180.61 $56.80 $181.39 $240.81 $75.74 $286.30 $383.61 $112.34

57 $112.21 $144.54 $48.89 $142.52 $186.63 $60.54 $190.02 $248.84 $80.72 $298.20 $395.97 $120.86

58 $117.91 $150.63 $52.05 $149.30 $192.85 $64.52 $199.07 $257.13 $86.03 $310.59 $408.74 $130.04

59 $123.89 $156.98 $55.42 $156.41 $199.28 $68.77 $208.55 $265.70 $91.69 $323.50 $421.91 $139.91

60 $130.19 $163.60 $59.00 $163.86 $205.92 $73.29 $218.48 $274.56 $97.72 $336.94 $435.51 $150.52

61 $137.86 $171.78 $63.57 $173.35 $216.00 $79.12 $231.14 $288.00 $105.49 $355.62 $455.59 $164.00

62 $145.99 $180.36 $68.48 $183.39 $226.58 $85.41 $244.52 $302.10 $113.88 $375.33 $476.58 $178.68

63 $154.60 $189.38 $73.77 $194.01 $237.67 $92.20 $258.69 $316.89 $122.93 $396.14 $498.55 $194.67

64 $163.71 $198.85 $79.47 $205.25 $249.30 $99.53 $273.67 $332.40 $132.70 $418.09 $521.53 $212.10

65 $173.37 $208.79 $85.62 $217.14 $261.51 $107.44 $289.52 $348.68 $143.25 $441.27 $545.56 $231.09

66 $176.61 $211.70 $92.53 $224.73 $269.59 $116.00 $299.64 $359.46 $154.66 $460.48 $564.65 $249.06

67 $179.92 $214.65 $100.01 $232.59 $277.93 $125.24 $310.12 $370.57 $166.99 $480.54 $584.39 $268.42

68 $183.29 $217.65 $108.08 $240.73 $286.52 $135.22 $320.97 $382.03 $180.30 $501.46 $604.83 $289.29

69 $186.72 $220.68 $116.81 $249.15 $295.38 $146.00 $332.19 $393.84 $194.67 $523.30 $625.99 $311.78

70 $190.22 $223.76 $126.24 $257.86 $304.51 $157.64 $343.81 $406.01 $210.18 $546.09 $647.88 $336.02

71 $208.65 $243.57 $142.04 $280.36 $328.49 $176.40 $373.81 $437.99 $235.20 $584.73 $688.93 $368.87

72 $230.77 $265.12 $159.81 $304.83 $354.36 $198.44 $406.43 $472.48 $264.58 $626.09 $732.57 $404.94

73 $255.24 $288.59 $179.81 $331.43 $382.26 $223.22 $441.90 $509.68 $297.63 $670.39 $778.98 $444.53

74 $282.31 $316.16 $202.32 $360.35 $412.36 $251.10 $480.47 $549.82 $334.80 $717.82 $828.33 $487.99

75 $312.25 $346.75 $227.63 $391.80 $444.83 $282.46 $522.39 $593.11 $376.62 $768.60 $880.81 $535.70

76 $340.10 $376.38 $251.50 $425.99 $479.86 $312.01 $567.98 $639.82 $416.01 $822.97 $936.61 $588.08

77 $370.44 $408.56 $277.87 $463.16 $517.65 $344.64 $617.55 $690.20 $459.52 $881.20 $995.95 $645.58

78 $403.49 $443.47 $307.00 $503.58 $558.41 $380.69 $671.44 $744.55 $507.59 $943.54 $1,059.05 $708.69

79 $439.48 $481.38 $339.19 $547.52 $602.39 $420.51 $730.03 $803.18 $560.68 $1,010.29 $1,126.14 $777.98

80 $478.68 $522.52 $374.75 $595.30 $649.82 $464.49 $793.74 $866.43 $619.32 $1,081.77 $1,197.49 $854.05

Premiums

Biweekly premiums

Plan A Plan B Plan C Plan D

Age 4% ACIO 5% ACIO FPO 4% ACIO 5% ACIO FPO 4% ACIO 5% ACIO FPO 4% ACIO 5% ACIO FPO

18–30 $26.70 $45.00 $5.93 $36.32 $61.73 $6.77 $48.43 $82.31 $9.02 $76.69 $131.30 $12.84

31 $27.13 $45.32 $6.17 $36.91 $62.16 $7.07 $49.22 $82.89 $9.43 $77.97 $132.25 $13.46

32 $27.57 $45.64 $6.42 $37.51 $62.60 $7.39 $50.02 $83.46 $9.86 $79.27 $133.20 $14.11

33 $28.02 $45.96 $6.69 $38.12 $63.04 $7.73 $50.83 $84.05 $10.31 $80.58 $134.17 $14.80

34 $28.47 $46.29 $6.96 $38.74 $63.48 $8.08 $51.66 $84.64 $10.78 $81.93 $135.14 $15.51

35 $28.93 $46.62 $7.25 $39.37 $63.92 $8.45 $52.50 $85.23 $11.27 $83.29 $136.12 $16.26

36 $29.40 $46.95 $7.51 $40.01 $64.37 $8.79 $53.35 $85.83 $11.73 $84.67 $137.10 $17.05

37 $29.88 $47.28 $7.78 $40.66 $64.82 $9.15 $54.22 $86.43 $12.21 $86.08 $138.09 $17.88

38 $30.36 $47.62 $8.06 $41.33 $65.28 $9.53 $55.10 $87.04 $12.71 $87.51 $139.09 $18.75

39 $30.85 $47.96 $8.35 $42.00 $65.73 $9.92 $56.00 $87.65 $13.22 $88.97 $140.10 $19.66

40 $31.35 $48.30 $8.65 $42.68 $66.19 $10.32 $56.91 $88.26 $13.76 $90.45 $141.11 $20.61

41 $31.83 $48.56 $9.11 $43.32 $66.54 $10.89 $57.77 $88.72 $14.52 $91.82 $141.85 $21.66

42 $32.31 $48.83 $9.58 $43.98 $66.89 $11.50 $58.64 $89.19 $15.33 $93.21 $142.59 $22.77

43 $32.80 $49.09 $10.08 $44.64 $67.24 $12.13 $59.52 $89.66 $16.18 $94.62 $143.34 $23.94

44 $33.30 $49.37 $10.61 $45.31 $67.60 $12.80 $60.42 $90.13 $17.07 $96.06 $144.09 $25.16

45 $33.81 $49.64 $11.16 $46.00 $67.95 $13.51 $61.33 $90.60 $18.02 $97.51 $144.84 $26.45

46 $34.41 $50.05 $11.75 $46.83 $68.51 $14.27 $62.44 $91.35 $19.02 $99.30 $146.06 $27.90

47 $35.03 $50.46 $12.38 $47.67 $69.07 $15.06 $63.56 $92.10 $20.08 $101.12 $147.29 $29.42

48 $35.66 $50.88 $13.03 $48.53 $69.64 $15.90 $64.70 $92.85 $21.20 $102.97 $148.52 $31.03

49 $36.30 $51.30 $13.73 $49.40 $70.21 $16.78 $65.87 $93.61 $22.38 $104.86 $149.77 $32.72

50 $36.95 $51.73 $14.46 $50.29 $70.79 $17.72 $67.06 $94.38 $23.62 $106.78 $151.03 $34.51

51 $38.76 $53.54 $15.41 $52.08 $72.66 $18.92 $69.45 $96.88 $25.22 $110.52 $154.92 $36.90

52 $40.65 $55.41 $16.43 $53.94 $74.58 $20.20 $71.93 $99.45 $26.94 $114.40 $158.91 $39.44

53 $42.63 $57.35 $17.52 $55.87 $76.56 $21.57 $74.49 $102.08 $28.76 $118.41 $163.01 $42.16

54 $44.71 $59.35 $18.67 $57.86 $78.58 $23.03 $77.16 $104.78 $30.71 $122.56 $167.21 $45.07

55 $46.90 $61.42 $19.90 $59.93 $80.66 $24.60 $79.91 $107.55 $32.79 $126.86 $171.52 $48.18

56 $49.28 $64.01 $21.19 $62.78 $83.35 $26.21 $83.71 $111.14 $34.95 $132.13 $177.05 $51.84

57 $51.78 $66.71 $22.56 $65.77 $86.13 $27.94 $87.70 $114.84 $37.25 $137.63 $182.75 $55.78

58 $54.42 $69.52 $24.02 $68.90 $89.00 $29.77 $91.87 $118.67 $39.70 $143.34 $188.64 $60.01

59 $57.18 $72.45 $25.57 $72.18 $91.97 $31.74 $96.25 $122.63 $42.31 $149.30 $194.72 $64.57

60 $60.08 $75.50 $27.23 $75.62 $95.04 $33.82 $100.83 $126.72 $45.10 $155.51 $201.00 $69.47

61 $63.62 $79.28 $29.34 $80.00 $99.69 $36.51 $106.68 $132.92 $48.68 $164.13 $210.27 $75.69

Premiums

Biweekly premiums

Plan A Plan B Plan C Plan D

Age 4% ACIO 5% ACIO FPO 4% ACIO 5% ACIO FPO 4% ACIO 5% ACIO FPO 4% ACIO 5% ACIO FPO

62 $67.38 $83.24 $31.60 $84.64 $104.57 $39.42 $112.85 $139.43 $52.56 $173.22 $219.96 $82.46

63 $71.35 $87.40 $34.04 $89.54 $109.69 $42.55 $119.39 $146.25 $56.73 $182.83 $230.10 $89.84

64 $75.55 $91.77 $36.67 $94.73 $115.06 $45.93 $126.30 $153.41 $61.24 $192.96 $240.70 $97.89

65 $80.01 $96.36 $39.51 $100.21 $120.69 $49.58 $133.62 $160.92 $66.11 $203.66 $251.79 $106.65

66 $81.51 $97.70 $42.70 $103.72 $124.42 $53.53 $138.29 $165.90 $71.38 $212.52 $260.60 $114.95

67 $83.04 $99.06 $46.15 $107.34 $128.27 $57.80 $143.13 $171.03 $77.07 $221.78 $269.71 $123.88

68 $84.59 $100.45 $49.88 $111.10 $132.24 $62.40 $148.14 $176.32 $83.21 $231.44 $279.15 $133.51

69 $86.17 $101.85 $53.91 $114.99 $136.32 $67.38 $153.31 $181.77 $89.84 $241.52 $288.91 $143.89

70 $87.79 $103.27 $58.26 $119.01 $140.54 $72.75 $158.68 $187.38 $97.00 $252.04 $299.02 $155.08

71 $96.30 $112.41 $65.55 $129.39 $151.61 $81.41 $172.52 $202.14 $108.55 $269.87 $317.96 $170.24

72 $106.50 $122.36 $73.75 $140.69 $163.55 $91.58 $187.58 $218.06 $122.11 $288.96 $338.10 $186.89

73 $117.80 $133.19 $82.98 $152.96 $176.42 $103.02 $203.95 $235.23 $137.36 $309.41 $359.52 $205.16

74 $130.29 $145.92 $93.37 $166.31 $190.32 $115.89 $221.75 $253.76 $154.52 $331.30 $382.30 $225.22

75 $144.11 $160.03 $105.06 $180.83 $205.30 $130.36 $241.10 $273.74 $173.82 $354.73 $406.52 $247.24

76 $156.96 $173.71 $116.07 $196.61 $221.47 $144.00 $262.14 $295.30 $192.00 $379.83 $432.28 $271.42

77 $170.97 $188.56 $128.24 $213.76 $238.91 $159.06 $285.02 $318.55 $212.08 $406.70 $459.66 $297.96

78 $186.22 $204.67 $141.69 $232.42 $257.72 $175.70 $309.89 $343.63 $234.27 $435.48 $488.79 $327.08

79 $202.83 $222.17 $156.54 $252.70 $278.02 $194.08 $336.93 $370.69 $258.77 $466.28 $519.75 $359.06

80 $220.92 $241.16 $172.96 $274.75 $299.91 $214.38 $366.34 $399.89 $285.84 $499.27 $552.68 $394.17

Qualifying for benefits

What is not covered by the FLTCIP

If you apply for coverage and are approved, you will be eligible for benefits after your coverage becomes effective and when a licensed health care practitioner certifies, and we agree, that you are unable to perform at least two of six activities of daily living without substantial assistance for a period expected to last at least 90 days or you require substantial supervision to protect yourself due to a severe cognitive impairment, such as Alzheimer’s disease.

The six activities of daily living are:

bathing dressing toileting continence eating transferring (from bed to chair)

Definitions of the activities of daily living are included in the FLTCIP 2.0 Outline of Coverage, which begins on page 16.

Benefits can begin (after the waiting period as described on page 23) as long as the covered services are part of a plan of care developed by a licensed health care practitioner and approved by us. You can initiate a claim by calling us at 1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-843-3557.

Like most long term care insurance plans, the FLTCIP does not pay benefits for any of the following:

illness, treatment, or medical condition arising out of:

your participation in a felony, riot, or insurrection your attempted suicide, while sane or insane injuries you intentionally inflict on yourself care or treatment for alcoholism or drug addiction care or treatment provided in a government facility, including a Department of Defense or Department of Veterans Affairs facility, unless otherwise required by law care you receive while in a hospital, except in a unit specifically designated as a nursing home or hospice facility 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) services or supplies for which you are not obligated to pay in the absence of insurance services provided by any person who normally lived in your home at the time you became eligible for benefits

FLTCIP 2.0 Outline of Coverage

The Outline of Coverage provides a brief description of the most important features of coverage available under the FLTCIP. You should compare this Outline of Coverage to outlines of coverage for other policies available to you.

The Federal Long Term Care Insurance Program (FLTCIP)

P.O. Box 797 Greenland, New Hampshire 03840-0797

1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-843-3557

Group Policyholder: United States Office of Personnel Management (OPM) Insurer: John Hancock Life & Health Insurance Company Administrator: Long Term Care Partners, LLC

FLTCIP 2.0 Outline of Coverage

Group Policy Number: 900-003 Benefit Booklet—FLTCIP 2.0

1. Notices Important: We will make our decision whether to issue your insurance coverage based on your responses to the questions on your application. We will send you a copy of your application. We may deny benefits or rescind your insurance coverage if: your answers are incorrect or untrue for any reason or the answers changed between the date you completed your application and the date your coverage would become effective. The best time to clear up any questions is before a claim arises! If for any reason, any of your answers is or becomes incorrect before the date your coverage would become effective, please contact:

Federal Long Term Care Insurance Program, P.O. Box 797, Greenland, New Hampshire 03840-0797.

You may also call 1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-843-3557.

The Group Policy, including the 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 10% of your annual adjusted gross income or 7.5% if you are 65 or older.

Due to changes to the itemized deduction for 2013 medical expenses, the 7.5% limitation is a temporary exemption, from January 1, 2013, to December 31, 2016, for individuals who are 65 or older. 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 FLTCIP should be tax-free. Also, many states offer tax incentives for residents who purchase long term care insurance. Please remember that tax laws can change. It is important to consult your tax advisor if you have any questions or need further details. Visit www.LTCFEDS.com/tax for more information.

The FLTCIP may not cover all of your long term care costs. Please review all coverage limitations and exclusions when you receive your Benefit Booklet, including the Schedule of Benefits.

Coverage under the FLTCIP is guaranteed renewable. This means we will not cancel your coverage as long as you pay your premium on time. However, this does not mean that premiums are guaranteed to remain unchanged. See the next paragraph.

When we may increase premiums. We reserve the right to increase premiums in the future. However, it is important to note that we cannot single you out and raise your premium because of your advancing age, declining health, claim status or for any other reason related solely to you. We may only increase premiums 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 increase in premium. As a reminder, your premium may also increase if you voluntarily elect to increase your benefits. Please see the subsection When Your Premium May Change.

2. Purpose of Outline of Coverage This outline provides a brief description of the most important features of coverage available under the FLTCIP. Since all long term care insurers are required to issue outlines of coverage, you should compare this outline to outlines of coverage for other policies you may be considering. This outline is not an insurance contract, but only a summary of coverage. If you apply for coverage and are approved, the Benefit Booklet and the Schedule of Benefits will contain the governing contractual provisions that relate specifically to you. Other rights are contained in the Group Policy that OPM has with us. OPM has reviewed and approved this outline to assure its accuracy. If you apply for the coverage offered under the FLTCIP and your application is approved, you will automatically receive a copy of the Benefit Booklet. It is important that you read your Benefit Booklet carefully!

Throughout this outline “we,” “us,” and “our” means John Hancock Life & Health Insurance Company.

3. Long Term Care Insurance Coverage Long term care insurance coverage is designed to cover services you need when you are unable to perform certain activities of daily living or need care due to a severe cognitive impairment. The long term care insurance provided under the FLTCIP is designed to provide reimbursement for costs of necessary diagnostic, preventive, therapeutic, curative, rehabilitative, maintenance, or personal care services, provided in a setting such as an assisted living facility, a nursing home, an adult day care center, or your home, but not in an acute care unit of a hospital.

The FLTCIP provides reimbursement, based on the Daily Benefit Amount you select, for actual charges you incur for covered long term care expenses, subject to the limitations, exclusions, and waiting period described in this outline.

Medical insurance and Medicare are entirely different than long term care insurance. They are primarily designed to cover acute care, and not long term care services. If you are eligible for Medicare you need to know that the long term care insurance coverage under the Federal Long Term Care Insurance Program is not Medicare Supplement Coverage. If you want to learn about Medicare Supplement Coverage, ask us for the Guide To Health Insurance For People With Medicare.

4. Effective date of coverage and Actively at Work requirement Coverage under the FLTCIP becomes effective on the first day of the month after the month in which you are approved. For example, if you are approved for coverage on April 15, your coverage becomes effective May 1.

However, Employees and Members of the Uniformed Services who apply using the abbreviated underwriting application or the abbreviated underwriting section of the coverage change application must meet the actively at work requirement described below in order for their coverage to become effective.

FLTCIP 2.0 Outline of Coverage

If you are an Employee or a Member of the Uniformed Services who submitted an abbreviated underwriting application, you must be Actively at Work at least one day during the calendar week immediately prior to the week which contains the Original Effective Date shown on your Schedule of Benefits. From time to time, OPM may implement revised Actively at Work requirements for specified periods under the FLTCIP.

You must inform us if you do not meet this requirement. In the event you do not meet this requirement, we will issue you a revised Original Effective Date, which will be the 1st day of the next month. You also must meet the Actively at Work requirement for any revised Original Effective Date for coverage to become effective, or you will be issued another revised Original Effective Date in the same manner. 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 from Federal civilian service (for reasons other than your misconduct) or from the uniformed services (except for a dishonorable discharge) after your application date but before your Original Effective Date.

Actively at Work or Active Work means:

for an Employee, that you meet all of the following conditions:

you are reporting for work at an approved location and work at least ½ of your regularly scheduled hours for that day; and you are able to perform all the usual and customary duties of your employment on your regular work schedule;

for a Member of the Uniformed Services, that you are on active duty and are physically able to perform the duties of your position.

5. Benefits provided by the FLTCIP Covered Services Covered Services under the FLTCIP are those you receive while in a Nursing Home, Assisted Living Facility, or Hospice facility, plus Covered Services you receive at home or an Adult Day Care Center. Coverage also includes Informal Caregiver services, Hospice Care, Respite Care, Bed Reservations and a Stay-At-Home Benefit which covers expenses for care planning visits, home modifications, emergency medical response systems, durable medical equipment, caregiver training, and home safety checks.

We will only pay benefits for covered services if:

you are eligible for benefits and, where required, have satisfied the waiting period; and they are part of a written plan of care approved by us.

Benefit Amounts You may select a Daily Benefit Amount from $100-$450 in $50 increments. Your Daily Benefit Amount determines the most we will pay per day for covered services. It also determines your maximum lifetime benefit—see the maximum lifetime benefit subsection for more information.

The FLTCIP provides reimbursement for actual charges you incur for covered services up to the following percentages:

Covered services Daily reimbursement up to

Nursing home, assisted living facility, or hospice facility

100% of your Daily Benefit Amount

Bed reservations 100% of your Daily Benefit Amount benefits limited to 60 days per calendar year and will be reduced by any days…