§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 people listed in section 9001, and work with the appropriate Cabinet secretaries to do it. The Secretary of Defense can decide whether certain Department of Defense nonappropriated fund organizations are covered or can use a different long-term care plan. The program can only offer qualified long-term care contracts and those contracts must come from qualified insurers. If you apply because you are a qualified relative, you must give proof of the relationship. The program does not have to give coverage to someone who is already immediately eligible for benefits. For underwriting, a spouse should be treated as much like the covered person as possible. Coverage is not guaranteed. Contracts must be fully insured (reinsurance is allowed). Stronger underwriting can apply if you apply after your first enrollment chance ends. Benefits must be guaranteed renewable (see section 7A(2) of the model regulations in section 7702B(g)(2) of the Internal Revenue Code of 1986), and premiums may only be changed by class 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