5 C.F.R. § 875.408 What is the significance of incontestability?
Title 5 - Administrative Personnel
(a) Incontestability means coverage issued based on an erroneous application may remain in effect. Such coverage will not remain in effect, and your claim may be denied, 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 or deny a claim upon a showing that information on your signed application that was material to your approval for coverage is different than 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 or deny a claim upon a showing that information on your signed application that was material to your approval for coverage is different than 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. (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.
Title 5: Administrative Personnel
PART 875—FEDERAL LONG TERM CARE INSURANCE PROGRAM
Subpart D—Coverage
§ 875.408 What is the significance of incontestability?
