PRIA, Government Policy, Made Personal

Summary

The Office of Personnel Management must create and run a long-term care insurance program, working with the appropriate Secretaries, so people listed in paragraphs (1)–(5) of section 9001 can get coverage. The Secretary of Defense may decide that a Department of Defense nonappropriated fund instrumentality is covered by this program or by a different long-term care plan. Insurance under the program can only be sold as qualified long-term care contracts by qualified carriers. If you apply as a qualified relative, you must show proof of the relationship the Office requires. The program does not have to cover someone who would already be eligible for benefits right away, and insurers do not have to offer guaranteed issue. For underwriting, a spouse of a listed person should be treated as nearly the same as that person. Contracts must be fully insured, including by reinsurance if used. Stricter underwriting may apply if you apply after your first enrollment chance ended. Coverage must be guaranteed renewable as defined by section 7A(2) of the model regulations in section 7702B(g)(2) of the Internal Revenue Code of 1986, and premium changes may be made only on a class basis and only as allowed under section 9003(b).

Title 5, §9002

Government Organization and Employees, Source: USLM XML via OLRC

(a)In General.—

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)Discretionary Authority Regarding Nonappropriated Fund Instrumentalities.—

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)General Requirements.—

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)Documentation Requirement.—

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)Underwriting Standards.—

(1)Disqualifying condition.—

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)Spousal parity.—

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)Guaranteed issue.—

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

(4)Requirement that contract be fully insured.—

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)Higher standards allowable.—

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)Guaranteed Renewability.—

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