Title 5 — Government Organization and EmployeesRelease 119-73not60

§9004 Financing

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

Last updated Apr 3, 2026|Official source

Summary

Eligible people must pay 100 percent of their long-term care insurance premiums. The government can take the premium money out of a worker’s paycheck, an annuitant’s annuity, a service member’s pay, or a retiree’s retired or retainer pay. If someone wants coverage for a qualified relative, they can choose to have those premiums taken out the same way. Any money taken out goes straight to the insurance company. If a person does not choose withholding or does not get enough pay or annuity (or gets no government pay), they must pay the insurance company directly. Insurance companies must keep separate records for all money they get for this program, including any investment earnings. The Office of Personnel Management (OPM) may use the Employees’ Life Insurance Fund, with no fiscal year limit, to pay reasonable setup costs before a 7-year period starts. Carriers must repay those costs (including lost investment income) before the end of the first year of that 7-year period, paid pro rata under master contracts. A Long-Term Care Administrative Account is created in the same Fund for OPM’s costs after the 7-year period begins, and each master contract requires carriers to make yearly contributions to that account to cover expected administration costs (adjusted for past 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 3, 2026

Release point: 119-73not60