What Are Disqualifying Conditions for Federal Long-Term Insurance Coverage?

The Federal Long Term Care Insurance Program pays expenses for services you need from a caregiver when you can't perform routine daily activities, such as bathing, dressing and eating. A program beneficiary can qualify for reimbursement to cover the cost of caregiver services after an accident that renders you temporarily unable to care for yourself, if you need help due to declining physical health or upon being diagnosed with a cognitive disorder such as Alzheimer's disease. The program, open to federal employees, postal workers, active members of the military and their qualified relatives, covers care at your home, a nursing home, an assisted living or hospice facility and at an adult day care center. There are several expenses that the federal program excludes from reimbursement.

Care by Family Members

• The federal program doesn't pay for care or services provided by a family member or someone who normally lives with you upon your becoming eligible for benefits. However, it will pay if the family member works for an organization that provides long-term care services. The organization for which the family member works must receive the payment for the care, and his compensation must be equivalent to the salary of similar employees in his job category.

Medicare-Covered Expenses

• The federal program doesn't pay for services or supplies for which Medicare reimburses, unless the situation is one in which Medicare is determined to be the secondary insurance payor. Neither does the program pay for services or supplies for which there is no obligation to pay in the absence of insurance.

Inpatient Care

• The federal program doesn't pay for care that you receive while hospitalized, unless you are assigned to a unit in the hospital that specifically is designated as a nursing home or hospice facility. The federal program also excludes coverage for care or treatment provided in a government facility, such as a Department of Defense or Department of Veterans Affairs hospital.

Care Related to Vice

• The federal program doesn't pay for care related to illness, treatment or medical condition arising from alcoholism or drug addiction, participation in a felony, riot or insurrection. It doesn't pay for expenses related to attempted suicide, whether you are declared sane or insane. Neither does it pay for expenses related to intentionally self-inflicted injuries.