§9002 — Title 5 Government Organization and Employees | U.S. Code

Summary

The Office of Personnel Management must create and run a long-term care insurance program for the five groups named in section 9001, and it must work with the appropriate Cabinet Secretaries to do so. The Secretary of Defense can decide whether a Department of Defense nonappropriated fund instrumentality is part of this program or is covered by a different long-term care plan. Coverage can only be offered through qualified long-term care insurance contracts sold by qualified carriers. People applying as a qualified relative must give the documents OPM requires to prove the relationship. The program does not have to offer coverage to someone who would get benefits right away, and it does not have to guarantee coverage to every eligible person. For underwriting, a spouse of someone in the first four groups of section 9001 should, as nearly as practicable, be treated like that person. A qualified contract must be fully insured (reinsurance is allowed). If someone applies after their first enrollment chance ends, stricter underwriting may be used. Benefits must be guaranteed renewable, and any premium changes may only be made on a class basis and as allowed under section 9003(b).

Title 5, §9002

Government Organization and Employees — Source: USLM XML via OLRC

(a)The Office of Personnel Management shall establish and, in consultation with the appropriate Secretaries, administer a program through which an individual described in paragraph (1), (2), (3), (4), or (5) of section 9001 may obtain long-term care insurance coverage under this chapter for such individual.

(b)The Secretary of Defense may determine that a nonappropriated fund instrumentality of the Department of Defense is covered under this chapter or is covered under an alternative long-term care insurance program.

(c)Long-term care insurance may not be offered under this chapter unless—

(1)the only coverage provided is under qualified long-term care insurance contracts; and

(2)each insurance contract under which any such coverage is provided is issued by a qualified carrier.

(d)As a condition for obtaining long-term care insurance coverage under this chapter based on one’s status as a qualified relative, an applicant shall provide documentation to demonstrate the relationship, as prescribed by the Office.

(e)(1)Nothing in this chapter shall be considered to require that long-term care insurance coverage be made available in the case of any individual who would be eligible for benefits immediately.

(2)For the purpose of underwriting standards, a spouse of an individual described in paragraph (1), (2), (3), or (4) of section 9001 shall, as nearly as practicable, be treated like that individual.

(3)Nothing in this chapter shall be considered to require that long-term care insurance coverage be guaranteed to an eligible individual.

(4)In addition to the requirements otherwise applicable under section 9001(9), in order to be considered a qualified long-term care insurance contract for purposes of this chapter, a contract must be fully insured, whether through reinsurance with other companies or otherwise.

(5)Nothing in this chapter shall, in the case of an individual applying for long-term care insurance coverage under this chapter after the expiration of such individual’s first opportunity to enroll, preclude the application of underwriting standards more stringent than those that would have applied if that opportunity had not yet expired.

(f)The benefits and coverage made available to eligible individuals under any insurance contract under this chapter shall be guaranteed renewable (as defined by section 7A(2) of the model regulations described in section 7702B(g)(2) of the Internal Revenue Code of 1986), including the right to have insurance remain in effect so long as premiums continue to be timely made. However, the authority to revise premiums under this chapter shall be available only on a class basis and only to the extent otherwise allowable under section 9003(b).

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 7702B(g)(2) of the Internal Revenue Code of 1986, referred to in subsec. (f), is classified to section 7702B(g)(2) of Title 26, Internal Revenue Code.

Amendments

2002—Subsecs. (b) to (f). Pub. L. 107–314 added subsec. (b) and redesignated former subsecs. (b) to (e) as (c) to (f), respectively.

§9002 Availability of insurance