Attachment_6C-_The_FLTCIP_Alternative_Insurance_Plan.pdf

www.LTCFEDS.com 1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-843-3557

Waiting period The waiting period is the number of service days during which you must be eligible for benefits and receiving and paying for care before we will pay for covered charges.

The length of your waiting period is 180 days.

Future purchase option If your WBA increases to $500, you will then qualify for an increase in your coverage every two years. These increases are called future purchase option (FPO) increases. FPO increases take effect only on January 1 of even-numbered years. After your WBA increases to $500, your first increase will take effect on January 1 of the next even-numbered year. After the first increase takes effect, you will continue to receive these increases every two years on January 1. However, if you have declined a total of three prior increases or if you are eligible for benefits at the time an increase takes effect, you will not receive the increase.

The additional premium for these increases will be based on your age and the rates in effect at the time the increases take effect. Future purchase option increases in your WBA and the remaining amount of your MLB are based on increases in the Consumer Price Index for Medical Care or another index mutually agreed upon by OPM and John Hancock.

Have questions?

Call us at 1-800-LTC-FEDS

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

The FLTCIP Alternative Insurance Plan Read this brochure for an overview of the Federal Long Term Care Insurance Program (FLTCIP) Alternative Insurance Plan (AIP).

Complete the enclosed Alternative Insurance Plan Supplemental Application and mail it in the enclosed postage-paid envelope.

Nursing home-only care

Weekly benefit amount: $200 (initially)

Benefit period: 2 years (104 weeks)

Maximum lifetime benefit: $20,800 (initially)

Waiting period: 180 service days

Inflation protection: Future purchase option

Weekly benefit amount The initial weekly benefit amount (WBA) is $200. Care in a nursing home will be covered up to 100% of your WBA.

If your coverage remains in effect and you do not become eligible for benefits, your WBA will increase as follows in the chart below. These increases will not cause your premium to increase.

Number of months your coverage is in effect

WBA

Up to 24 months $200

25 to 48 months $300

49 to 72 months $400

73 months $500

Key features

Benefit period This is the length of time your insurance coverage will last if you receive care every single week at a cost equal to or more than your WBA. If you receive services that cost less than your WBA, your benefits will last longer than your benefit period.

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

If your WBA increases over time, your MLB will increase as well.

Example:

$200 ~ 104 weeks = $20,800

St ep

St ep

The Federal Long Term Care Insurance Program Alternative Insurance Plan

Nursing home care All levels of care are covered, including skilled, intermediate, and custodial nursing care, up to 100% of your WBA.

Respite care in a nursing home This benefit provides you with temporary nursing home care if your caregiver needs to take some time off.

Respite care is covered up to four times your WBA per calendar year, and there is no waiting period.

International benefits The FLTCIP AIP provides coverage for enrollees who live or may require care outside the United States.

The following services are covered

Care coordination services As an enrollee you have unlimited access to our care coordinators, who are registered nurses experienced in long term care. The care coordinators can help you find high-quality care providers in your area; share the results of state survey reports about service availability, quality, costs, and licensing; arrange for discounted services;

monitor the care you are receiving; and assist with altering your plan of care as your needs change. Certain care coordination services are also available to your qualified relatives at no cost. This can be invaluable in helping reduce the stress that you may experience when a qualified relative needs long term care.

Caregiver training The FLTCIP AIP will pay training expenses up to your WBA (with no waiting period) for a family member or other informal caregiver to learn how to care for you.

Bed reservations If you are in a nursing home and need to leave the facility for any reason, this benefit will pay up to 30 days per calendar year to hold your space.

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.

Also available under the FLTCIP AIP

You may be eligible for benefits if a licensed health care practitioner certifies in the last 12 months that:

you are unable, without substantial assistance from another person, to perform at least two 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

The six activities of daily living are:

If your benefit eligibility is approved, you must work with a care coordinator to establish an approved plan of care and satisfy your waiting period. There is no waiting period for caregiver training or respite services.

Eligibility for benefits

Biweekly Premiums

Age Premium Age Premium

18–30 $9.06 56 $35.66

31 $9.45 57 $38.10

32 $9.86 58 $40.72

33 $10.28 59 $43.51

34 $10.72 60 $46.49

35 $11.18 61 $50.06

36 $11.71 62 $53.91

37 $12.26 63 $58.06

38 $12.84 64 $62.52

39 $13.44 65 $67.32

40 $14.08 66 $72.78

41 $14.84 67 $78.66

42 $15.64 68 $85.03

43 $16.49 69 $91.92

44 $17.39 70 $99.35

45 $18.32 71 $111.89

46 $19.36 72 $126.01

47 $20.45 73 $141.91

48 $21.60 74 $159.82

49 $22.82 75 $179.99

50 $24.11 76 $198.97

51 $25.73 77 $219.94

52 $27.46 78 $243.13

53 $29.30 79 $268.76

54 $31.27 80 $297.10

55 $33.37

Monthly Premiums

Age Premium Age Premium

18–30 $19.65 56 $77.28

31 $20.49 57 $82.57

32 $21.37 58 $88.23

33 $22.29 59 $94.28

34 $23.24 60 $100.74

35 $24.24 61 $108.48

36 $25.39 62 $116.82

37 $26.58 63 $125.80

38 $27.83 64 $135.47

39 $29.14 65 $145.88

40 $30.51 66 $157.69

41 $32.16 67 $170.45

42 $33.90 68 $184.24

43 $35.74 69 $199.16

44 $37.68 70 $215.27

45 $39.71 71 $242.44

46 $41.95 72 $273.03

47 $44.32 73 $307.48

48 $46.82 74 $346.29

49 $49.46 75 $389.99

50 $52.25 76 $431.11

51 $55.76 77 $476.55

52 $59.50 78 $526.79

53 $63.50 79 $582.33

54 $67.76 80 $643.72

55 $72.31

Premiums for individuals age 18 to 80

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

The following biweekly and monthly premium charts provide premiums for the FLTCIP AIP and are valid for 30 calendar days.

If you do not apply within 30 calendar days or are older than age 80, 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.

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

The Federal Long Term Care Insurance Program (FLTCIP) P.O. Box 797 Greenland, NH 03840-0797

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

Group policyholder: U.S. Office of Personnel Management (OPM) Insurer: John Hancock Life & Health Insurance Company Administrator: Long Term Care Partners, LLC

FLTCIP Alternative Insurance Plan (AIP) Outline of Coverage Group policy number: 900-003 Benefit booklet: FLTCIP AIP

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:

The Federal Long Term Care Insurance Program, P.O. Box 797, Greenland, NH 03840-0797. You may also call 1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-843-3557.

The group policy, including the FLTCIP AIP 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 AIP 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 AIP may not cover all of your long term care costs. Please review all coverage limitations and exclusions when you receive your FLTCIP AIP Benefit Booklet, including the schedule of benefits.

Coverage under the FLTCIP AIP 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.

FLTCIP Alternative Insurance Plan Outline of Coverage

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 the outline of coverage This outline provides a brief description of the most important features of coverage available under the FLTCIP AIP. 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 FLTCIP AIP 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 AIP and your application is approved, you will automatically receive a copy of the FLTCIP AIP Benefit Booklet. It is important that you read your FLTCIP AIP 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 coverage under the FLTCIP AIP is designed to reimburse for costs of necessary diagnostic, preventive, therapeutic, curative, rehabilitative, maintenance, or personal care services provided in a nursing home.

The FLTCIP AIP provides reimbursement, based on a weekly benefit amount 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 FLTCIP is not Medicare Supplement Coverage.

If you want to learn about Medicare Supplement Coverage, ask us for the Choosing a Medigap Policy: Guide to Health Insurance for People with Medicare.

4. Effective date of coverage and actively at work requirement Coverage under the FLTCIP AIP 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 must meet the actively at work requirement described below in order for their coverage to become effective.

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 that 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 AIP.

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 first 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 half 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 AIP Covered services Covered services under the FLTCIP AIP are those you receive while in a nursing home. Coverage also includes bed reservations, caregiver training, and respite care while in a nursing home.

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 Your initial weekly benefit amount (WBA) is $200. If your coverage remains in effect for 24 months, and you do not become eligible for benefits during this period, your WBA will increase to $300 on the first day of the next month. If your coverage remains in effect for 48 months, and you do not become eligible for benefits during this period, your WBA will increase to $400 on the first day of the next month. If your coverage remains in effect for 72 months, and you do not become eligible for benefits during this period, your WBA will increase to $500 on the first day of the next month. These increases will not cause your premium to increase.

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

Covered services Weekly reimbursement up to

Nursing home 100% of your weekly benefit amount

Bed reservations 100% of your weekly benefit amount

Benefits are limited to 30 days per calendar year and will be reduced by any days you received bed reservation benefits under any prior benefit booklet

Caregiving training 100% of your weekly benefit amount

Benefits are limited to your weekly benefit amount in your lifetime and will be reduced by any benefits you received for caregiving training under any prior benefit booklet

Respite care 100% of your weekly benefit amount

Benefits are limited to 4 times your weekly benefit amount per calendar year and will be reduced by any benefits you received for respite care under any prior benefit booklet

Maximum lifetime benefit The benefit period is the length of time your coverage will last if we pay your full WBA every week. Your benefit period is 2 years (104 weeks). Benefits will last longer than the benefit period if benefits paid for each week that you receive covered services are less than the WBA.

Your maximum lifetime benefit (MLB) is the total amount of money that we may pay for charges you incur for covered services. It is equal to your benefit period (in weeks) multiplied by your WBA. Your MLB will be reduced by the amount of benefits that we pay. In addition, your MLB will be reduced by any benefit payments made under any prior benefit booklet issued to you under the FLTCIP.

Schedule of benefits

The schedule of benefits that we send you will show, among other things, the covered services, the maximum we will pay for those services per week, the benefit period, the waiting period, and your MLB.

International benefits

The FLTCIP AIP provides benefits for covered services you receive outside the United States, its territories and possessions (collectively referred to as the “United States”). When you receive such services, we will pay benefits up to the amounts listed in the Benefit Amounts subsection in this outline.

The coordination of benefits provision described in the section Exclusions and Limitations (Coordination of Benefits subsection) in this outline does not apply to international benefits.

Payment of benefits

You must be eligible for benefits and satisfy the waiting period to be reimbursed for services that are part of your approved plan of care. We pay all benefits in U.S. currency.

Eligibility for benefits

You may be eligible to receive the benefits of your plan if you meet all of the following requirements:

a licensed health care practitioner has certified (provided a written statement describing the nature and degree of physical or cognitive loss, how long services may be needed, and the services that may be required) in the last 12 months that:

you are unable, without substantial assistance from another person, to perform at least two 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 we agree with that certification we approve a written plan of care established for you by a licensed health care practitioner or a care coordinator

Activities of daily living include:

bathing:

getting into and out of a tub or shower washing your body in a tub, a shower, or by sponge bath washing your hair in a tub, shower, or sink continence:

maintaining control of bowel and bladder function when unable to maintain control of bowel or bladder function, performing associated personal hygiene (including caring for a catheter or colostomy bag) dressing:

putting on and taking off all clothing items and any necessary braces, fasteners, or artificial limbs eating:

feeding yourself by getting food into your mouth from a container (such as a plate or cup), including the use of utensils when appropriate (such as a spoon or fork) when unable to feed yourself from a container, feeding yourself by a feeding tube or intravenously toileting:

getting on and off the toilet performing associated personal hygiene transferring:

getting into and out of a bed, chair, or wheelchair

A severe cognitive impairment is a deterioration or loss in intellectual capacity (such as Alzheimer’s disease) that:

places you in jeopardy of harming yourself or others, and therefore you require substantial supervision (continual monitoring by another person to protect you from threats to your health and safety, for instance, while wandering) by another person is measured by clinical evidence and standardized tests that reliably measure impairment in short or long term memory; orientation to people, places, or time; deductive or abstract reasoning

Waiting period

The waiting period is 180 days. The waiting period is the number of service days during which you must be eligible for benefits and receiving covered services before we will pay benefits. We do not pay benefits for services you receive during your waiting period, except for caregiver training and respite care. Because we do not apply the waiting period to caregiver training and respite care, these covered services do not count toward meeting your waiting period. 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.

Waiver of premium

You will not have to pay your premium if you are eligible for benefits and have satisfied the waiting period.

If you satisfy the requirements for waiver of premium on the first day of a month, the waiver will take effect on that date. Otherwise, the waiver will take effect on the first day of the following month. If, at a later date, you are no longer eligible for benefits (e.g., you recover) and wish to maintain your coverage, you may do so provided you have not exhausted your MLB. To maintain your coverage, you will have to resume paying your premium on the first day of the month following the month in which you are no longer eligible for benefits.

Care coordination services

Our care coordinators are registered nurses experienced in long term care. If your benefit eligibility is approved, we will assign a personal care coordinator to work with you and your family members to develop a plan of care that meets your individual needs. Your care coordinator can also:

help you find high-quality care providers in your area share the results of state survey reports about service availability, quality, costs, and licensing arrange for discounted services monitor the care you are receiving assist with changing your plan of care as your needs change

Our care coordinators will provide the services described above for your qualified relatives, if you are enrolled in the program. These services will be provided regardless of whether your qualified relatives are enrolled in the FLTCIP, as long as you are enrolled.

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

6. Exclusions and limitations Exclusions

The FLTCIP AIP 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 U.S. Department of Defense or U.S. 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 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

This coverage does not have a war exclusion

Coverage under the FLTCIP AIP does not have a war exclusion. As a result, benefits may be payable under the FLTCIP AIP for conditions due to war or acts of war, declared or undeclared, or service in the armed forces or auxiliary units.

Limitations

Benefits payable for covered services are subject to maximums and limitations. See the section Benefits Provided by the FLTCIP AIP (Benefit Amounts and Maximum Lifetime Benefit subsections).

Coordination of benefits

The FLTCIP AIP includes a coordination of benefits (COB) provision that follows the guidelines set by the National Association of Insurance Commissioners (NAIC). In determining the amount of benefits we will pay under the FLTCIP AIP, the COB provision allows us to look at other plans that might pay benefits for long term care services 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. The COB provision does not apply to international benefits.

If the FLTCIP AIP is primary (this means it pays first), we will pay benefits without coordinating with other plans. This 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 pay no more than the difference between the amount payable by your other coverage(s) and your actual expenses. In addition, we will not pay benefits that duplicate benefits paid under any prior benefit booklet issued to you under the FLTCIP.

7. Relationship of cost of care and benefits Because the costs of long term care services will likely increase over time, you should consider whether and how benefits under the FLTCIP AIP may be adjusted.

Future purchase option

If your WBA increases to $500, every two years we will further increase your WBA and the remaining portion of your MLB, as described below. We will send notice of the increase to enrollees with the next fall FPO offering for an increase that will apply the following January 1. Increases will occur every two years on January 1 thereafter. Your WBA must have increased to $500 in order for you to receive your first increase under this provision. The increase will be based on the change in the U.S. Department of Labor’s Consumer Price Index for Medical Care or another index mutually agreed upon by OPM and John Hancock. Please see the When We May Increase Premiums subsection and the When Your Premium May Change section for information on how increases under this section 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 care, at the same rate as your WBA.

If you do not want the increase, we must receive your rejection before the date specified in the increase notice. 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 three prior increases, including increases under any prior benefit booklet issued to you under the FLTCIP.

If you have declined a total of three 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.

Graphs for comparing inflation options

The following graphs compare the monthly premium and the WBA over time under the WBA increase and FPO under the FLTCIP AIP. You may be eligible for FPO increases when your WBA increases to $500.

For purposes of the graphs below, the FPO inflation index was assumed to increase at 5% per year. The graphs illustrate only the first 30 years of premiums and benefits. The second graph on each page shows how your WBA may increase over time, depending on whether you accept the FPO increases so they take effect or decline the FPO increases so they do not.

Please read the following important assumptions about the graphs:

Important assumptions Horizontal premium lines in these graphs indicate that premiums will not automatically increase every year when WBAs automatically increase. This does not mean that premiums will never increase. The underlying premium rates are not guaranteed.

The graphs reflect two different scenarios: all FPO increases accepted and all FPO increases declined.

We are assuming an annual rate of inflation increase of 5%. Actual FPO premiums and benefits will vary depending on actual future inflation rates.

The graphs do not imply that your coverage will end after 30 years.

Purchase at age 50 examples

Premium comparison for purchase at age 50

FLTCIP Alternative Insurance Plan Outline of Coverage

Weekly benefit amount comparison for purchase at age 50

Future purchase option—all increases accepted

Future purchase option—all increases declined

W ee kl y be ne fit a m ou nt

$1,800

$1,500

$1,200

$900

$600

$300

Age

50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80

M on th ly p re m iu m s

$700

$600

$500

$400

$300

$200

$100

50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80

Age

Future purchase option—all increases accepted

Future purchase option—all increases declined

Purchase age at 65 examples

Premium comparison for purchase at age 65

FLTCIP Alternative Insurance Plan Outline of Coverage

Weekly benefit amount comparison for purchase at age 65

Future purchase option—all increases accepted

Future purchase option—all increases declined

W ee kl y be ne fit a m ou nt

$1,800

$1,500

$1,200

$900

$600

$300

Age

65 67 69 71 73 75 77 79 81 83 85 87 89 91 93 95

M on th ly p re m iu m s

$2,700

$2,400

$2,100

$1,800

$1,500

$1,200

$900

$600

$300

65 67 69 71 73 75 77 79 81 83 85 87 89 91 93 95

Age

Future purchase option—all increases accepted

Future purchase option—all increases declined

8. When your premium may change Your premium will not increase due to automatic WBA increases that may occur. However, your premiums may still increase under the conditions described below.

Your premium will increase for each inflation increase under the FPO. 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.

See the section Relationship of Cost of Care and Benefits for a summary of these benefit change provisions.

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.

9. When you may receive a premium refund 30-day free look and cancellation of coverage

Within 30 days after you receive your FLTCIP AIP 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 the FLTCIP AIP Benefit Booklet. Then we will refund all of your premium paid for coverage under the FLTCIP AIP Benefit Booklet 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 premiums that cover a period after the effective date of your cancellation.

Other refunds of premium

We will refund any premium that you paid to cover any period after the date of your death or during which your premium is waived.

10. When coverage may be continued or ended When your coverage will end

Your coverage will end on the earliest of the following:

the date you specify to us that you wish your coverage to end the date of your death the end of the period covered by your last premium payment if you do not pay the required premium when due the date the group policy ends, subject to continuation of coverage as described below the date that you have exhausted your MLB (in this event, care coordination services will continue)

Grace period

There is a 30-day grace period for payment of your premium. This means that we must receive your premium payment by the 30th day after the date it is due. If we do not receive your premium by the end of this grace period, we will send you written notice of termination of your coverage by first-class U.S. mail.

You will have 35 days from the date of the termination letter to pay your premium; otherwise, your coverage will end.

Portability

Long term care insurance coverage under the FLTCIP AIP is portable. This means that once you have coverage under the FLTCIP AIP and later are no longer a member of an eligible group, you can keep your coverage if you continue to pay the required premium and have not exhausted your MLB.

Continuation of coverage

If the group policy ends, OPM has stated that it intends to continue your insurance coverage by replacing the group policy with another that will:

be effective on the day after the group policy ends provide coverage that is substantially the same as that provided by the group policy calculate your premium based on the same issue(s) as under the group policy

In the unlikely event that the group policy ends and there is no replacement policy as described above, we will continue your coverage.

11. Premium The premium required for coverage under the FLTCIP AIP may be available in the enclosed materials;

otherwise, premiums can be obtained by contacting Long Term Care Partners, the FLTCIP administrator.

Premiums may change. See the section When Your Premium May Change.

12. Applying for coverage under the FLTCIP AIP Anyone who is eligible to apply for coverage under the FLTCIP AIP and wishes to do so must complete the appropriate application. We must approve your application in order for your coverage to become effective.

FLTCIP Alternative Insurance Plan Outline of Coverage

Have questions?

Call us at 1-800-LTC-FEDS

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

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.

FLTCIP5880 v. 1 0815