[Code of Federal Regulations]
[Title 5, Volume 2]
[Revised as of January 1, 2008]
From the U.S. Government Printing Office via GPO Access
[CITE: 5CFR875.408]

[Page 440-441]
 
                    TITLE 5--ADMINISTRATIVE PERSONNEL
 
          CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT (CONTINUED)
 
PART 875_FEDERAL LONG TERM CARE INSURANCE PROGRAM--Table of Contents
 
                           Subpart D_Coverage
 
Sec.  875.408  What is the significance of incontestability?

    (a) Incontestability means coverage issued based on an erroneous 
application may remain in effect. Such coverage will not remain in 
effect under any of the following conditions:
    (1) If your coverage has been in force for less than 6 months, the 
Carrier may void your coverage upon a showing that information on your 
signed application that was material to your approval for coverage is 
different from what is shown in your medical records.
    (2) If your coverage has been in force for at least 6 months but 
less than 2 years, the Carrier may void your coverage upon a showing 
that information on your signed application that was material to your 
approval for coverage is different from what is shown in your medical 
records and pertains to the condition for which benefits are sought.
    (3) After your coverage has been in effect for 2 years, the Carrier 
may void your coverage only upon a showing that you knowingly and 
intentionally made a false or misleading statement or omitted 
information in your signed application for coverage regarding your 
health status that was material to your approval for coverage.
    (4) If your coverage is voided, as described in paragraph (a)(1), 
(a)(2), or (a)(3) of this section, no claims will be paid. In addition, 
the provisions of Sec.  875.104 relating to the procedures for resolving 
a dispute involving benefits eligibility or claims denials do not apply 
to your situation. You may request a review by the Carrier if you 
believe that your coverage was voided in error. You must submit your 
request in writing to the Carrier within 30 days of the date of the 
rescission letter (letter voiding your coverage).

[[Page 441]]

    (b) Your coverage can be contested at any time when the Carrier 
finds that you were not an eligible individual at the time you applied 
and were approved for coverage.
    (c) If the Carrier voids coverage after it has paid benefits, it 
cannot recover the benefits already paid.
    (d) Incontestability does not apply when you have not paid your 
premiums on a timely basis.

[68 FR 5534, Feb. 4, 2003, as amended at 72 FR 12037, Mar. 15, 2007]