Title 5 — Government Organization and EmployeesRelease 119-73

§9004 Financing

Title 5 › Part PART III— - EMPLOYEES › Subpart Subpart G— - Insurance and Annuities › Chapter CHAPTER 90— - LONG-TERM CARE INSURANCE › § 9004

Last updated Apr 6, 2026|Official source

Summary

People who get long-term care insurance here must pay the full premium themselves. The government can take that premium from an employee’s pay, an annuitant’s annuity, an active service member’s pay, or a retired member’s retired or retainer pay. If an eligible person chooses, the same kind of withholding can pay a qualified relative’s premium. Money taken out this way goes straight to the insurance company. If someone does not choose withholding, or does not get enough pay or any pay, they must pay the full premium directly to the insurance company. Each insurance company must keep separate records for all money it gets for this coverage, including any investment earnings. The Employees’ Life Insurance Fund may be used, with no yearly limit, to cover reasonable Office of Personnel Management (OPM) costs to set up and run the program before the start of the 7-year period described in section 9003(d)(2)(B). Before the end of the first year of that 7-year period, insurers must repay the Fund their share of those setup costs, including lost investment income, as set in the master contracts. The Fund also includes a Long-Term Care Administrative Account to pay OPM’s costs after that 7-year period starts. Each master contract must make insurers put in yearly contributions to that account so expected OPM expenses are covered, and those payments must be adjusted later to correct any over- or underestimates.

Full Legal Text

Title 5, §9004

Government Organization and Employees — Source: USLM XML via OLRC

(a)Each eligible individual obtaining long-term care insurance coverage under this chapter shall be responsible for 100 percent of the premiums for such coverage.

(b)(1)The amount necessary to pay the premiums for enrollment may—

(A)in the case of an employee, be withheld from the pay of such employee;

(B)in the case of an annuitant, be withheld from the annuity of such annuitant;

(C)in the case of a member of the uniformed services described in section 9001(3), be withheld from the pay of such member; and

(D)in the case of a retired member of the uniformed services described in section 9001(4), be withheld from the retired pay or retainer pay payable to such member.

(2)Withholdings to pay the premiums for enrollment of a qualified relative may, upon election of the appropriate eligible individual (described in section 9001(1)–(4)), be withheld under paragraph (1) to the same extent and in the same manner as if enrollment were for such individual.

(c)All amounts withheld under this section shall be paid directly to the carrier.

(d)Any enrollee who does not elect to have premiums withheld under subsection (b) or whose pay, annuity, or retired or retainer pay (as referred to in subsection (b)(1)) is insufficient to cover the withholding required for enrollment (or who is not receiving any regular amounts from the Government, as referred to in subsection (b)(1), from which any such withholdings may be made, and whose premiums are not otherwise being provided for under subsection (b)(2)) shall pay an amount equal to the full amount of those charges directly to the carrier.

(e)Each carrier participating under this chapter shall maintain records that permit it to account for all amounts received under this chapter (including investment earnings on those amounts) separate and apart from all other funds.

(f)(1)(A)The Employees’ Life Insurance Fund is available, without fiscal year limitation, for reasonable expenses incurred by the Office of Personnel Management in administering this chapter before the start of the 7-year period described in section 9003(d)(2)(B), including reasonable implementation costs.

(B)Such Fund shall be reimbursed, before the end of the first year of that 7-year period, for all amounts obligated or expended under subparagraph (A) (including lost investment income). Such reimbursement shall be made by carriers, on a pro rata basis, in accordance with appropriate provisions which shall be included in master contracts under this chapter.

(2)(A)There is hereby established in the Employees’ Life Insurance Fund a Long-Term Care Administrative Account, which shall be available to the Office, without fiscal year limitation, to defray reasonable expenses incurred by the Office in administering this chapter after the start of the 7-year period described in section 9003(d)(2)(B).

(B)Each master contract under this chapter shall include appropriate provisions under which the carrier involved shall, during each year, make such periodic contributions to the Long-Term Care Administrative Account as necessary to ensure that the reasonable anticipated expenses of the Office in administering this chapter during such year (adjusted to reconcile for any earlier overestimates or underestimates under this subparagraph) are defrayed.

Reference

Citations & Metadata

Citation

5 U.S.C. § 9004

Title 5 — Government Organization and Employees

Last Updated

Apr 6, 2026

Release point: 119-73