General Long-Term Care Underwriting Guidelines

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As we age, most people are in reasonably good health with an issue or two such as taking medication for cholesterol or hypertension and if well controlled, no reason why you should not qualify for long-term care insurance.  Even a more serious medical condition like cancer is insurable, depending on the type, how long it has been with no recurrence and regular follow-up visits.

However, certain pre-existing medical conditions, combinations of conditions, or medications raise potential red flags regarding your insurability and will create a postponement or an immediate decline.

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Postponed white stamp text on red backgroud

YOU NEED TO UNDERSTAND CERTAIN MEDICAL CONDITIONS ARE COMMON REASONS FOR POSTPONEMENT.  

Each company has its own set of guidelines that can result in a postponement for underwriting consideration.

Here are a few reasons requiring a 6-month wait after the following events.  They are heart angioplasty or bypass surgery, carotid artery surgery, heart attack, heart valve replacement, stroke, TIA and joint replacements.  Scheduled surgery in the next two to three months, or some serious medical conditions that are situational with a full recovery expected in a couple of months.  You will also have to be released from doctor’s care, no use of medical devices and back to a normal activity level.

Postponement does not mean DECLINE!

Certain pre-existing medical conditions, medications, having signs of needing long-term care or the beginning symptoms of cognitive impairment such as orientation, attention, memory, judgment, and comprehension will result in an immediate decline for any type of an insured long-term care solution.

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This is a partial list of reasons for an automatic decline: 

AIDs or HIV infection /  Alzheimer’s Disease / (ALS) Lou Gehrig’s Disease  / Certain Types of Cancer (Internal not cured or in remission) / Chronic Bronchitis and have used tobacco in the past year / (COPD) Chronic Obstructive Pulmonary Disease and have used tobacco in the past year / Cognitive Impairment / Congestive Heart Failure / Cystic Fibrosis / Dementia / Emphysema and have used tobacco in the past year / Hemophilia / Active Hepatitis C, Non-A, Non-B, or Autoimmune Disorders / Huntington’s Chorea / Hydrocephalus / Kidney Failure or receiving dialysis / Liver Cirrhosis / Memory Loss / Mental Retardation / (MS) Multiple Sclerosis / Muscular Dystrophy / Multiple Myeloma / Myasthenia Gravis / Previous Organ Transplants, Excluding Kidneys / Paralysis / Parkinson’s Disease / Psychosis / Post-Polio Syndrome / Schizophrenia / Sickle Cell Anemia / Systemic Lupus Erythematosus / Scleroderma, Schizophrenia /  (TIA) Transient Ischemic Attack or mini-stroke in the past 2 years / Stroke single episode in the past 2 years / Two or more strokes or TIA’s

Certain medications treating serious medical illnesses will also result in a decline.  

Other issues that will cause an automatic decline:

Have you previously been declined for LTC?

Are you disabled?  Do you use a disability placard?  Are you receiving any disability benefits including personal, state, workers’ compensation, social security?

Do you use a quad cane, crutches, walker, electric scooter, wheelchair, oxygen, respirator or dialysis?

Are you non-compliant with medications and / or treatment?

Are you under or over certain height / weight guidelines?

Have you not pursued additional medical testing recommended by your physician?

Do you have a medical conditional listed as a “decline” in the companies underwriting guidelines?

Have you been confined to a nursing home or assisted living facility in the last six months?

Have you received home health care services or adult daycare in the last six months?

Are you requiring assistance with ADL (activities of daily living – bathing, dressing, feeding, toileting, urinary or bowel continence, or transferring between your bed or a chair)?

Do you require assistance with grocery shopping, transportation, banking or the use of telephone?

Have you received occupational, physical or speech therapy in the last three months?

THESE RISK FACTORS AND GENERAL GUIDELINES ARE NOT MEANT TO BE ALL INCLUSIVE.  Due to the complexity of individual case medical histories, multiple co-morbid medical conditions could still result in a postponed decision or decline even if not listed here.  The underwriter will decide based on the application and disclosed information provided in the telephone or face-to-face interview.

The approach I always want to take is to determine everything
in advance so there are no underwriting surprises.

I have stated on my website.  Your insurability, which allows you to qualify for insurance, can also change at a moments notice.  One may not realize the importance of insurability until it changes.  This is why proper insurance planning ALWAYS has to occur in advance of a serious medical diagnosis or the need for actual care.  When it comes to long-term care insurance, there’s an old saying; “your health buys long-term care insurance, money only pays for it.”

Your health is your wealth - Comic book style word

Marc Maretsky Personal Insurance Services based in Beverly Hills, serves all of California and the United States.  I help my clients acquire life, disability, long-term care, and critical illness insured solutions, as well as enroll them into Medicare when eligible.

“No matter how fast technology changes our world and everything around us.  I believe the personal touch and a human voice are more important than ever.”

The purpose of MY WEBSITE is to provide insurance concepts and ideas of interest to my clients, favorable introductions, other professionals or anyone else who may be viewing this information.  The content is general in nature and subject to change.  It should not be considered complete advice on any company, product or ideas described.  Your appropriate attorney, CPA or tax advisor should be consulted for legal or tax reasons regarding your personal situation.

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