Long Term Care Underwriting

The basic purpose of underwriting is to identify the degree of risk represented by the applicant. Long term care insurance underwriters look carefully at the health background of applicants. Because long term care covers a wide range of losses, it is very possible to be insurable with a history of medical problems.

Long term care underwriters generally consider the following

The applicant’s ability to perform the ‘Activities of Daily Living’ and maintain a self-care environment.
The applicant’s height and weight.
The applicant’s medical history.

Generally acceptable medical conditions

The applicant’s health conditions must be well controlled and stabilized. The condition can not impede social activity or exercise.

The applicant’s ‘Activities of Daily Living’ such as bathing, dressing, toileting, must be able to be performed. Other activities such as reading, administration of medications, using the telephone, writing, and meal preparation abilities are also taken into consideration.

The applicant’s height and weight must be in range with the company’s build chart.

The applicant’s intellectual abilities such as orientation, attention, memory, judgment, and comprehension must be intact.

Medical Conditions that are Considered Uninsurable for Long Term Care Insurance

AIDS
Untreated Alcoholism
Alzheimer’s disease
ALS/Lou Gehrig’s disease
Unstable Angina-cardiac work up is underway
Severe Osteoarthritis or rheumatoid arthritis (with conditional steroid use, surgery recommended or multiple joint replacements)
Sever Chronic Pulmonary Disease (including asthma, chronic bronchitis and emphysema with use of oxygen; more than hospitalizations in last year; evidence of congestive heart failure; and functional limitations)
Ataxia (unstable gait)
Some types of cancer (depending on history)
Cardiomyopathy with symptoms or with congestive heart failure
Cerebral Palsy
Cirrhosis of the liver with appearance of jaundice
Congestive heart failure (chronic, uncontrollable or accompanied by diabetes)
Dementia
Demyelinating disease
Diabetes (with elevated blood pressure, neuropathy, retinopathy, nephropathy, skin ulcers, or morbid obesity)
Dialysis
Seizure Disorder/Epilepsy (uncontrolled and of unknown etiology)
Esophageal varices
Osteoporosis (with history of multiple falls or fractures)
Fibromyalgia (with limitations of daily functioning)
Hepatitis B, C, E, F, G
Incontinence (complete or with use of catheter)
Chronic kidney failure
Hairy cell leukemia
Systemic Lupus
Macular Degenerations (with vision loss in both eyes)
Multiple Myeloma
Multiple Sclerosis
Muscular Dystrophy
Myasthenia Gravis
Neuropathy (due to diabetes, alcoholism or polio)
Organ transplant (except corneal)
Organic Brain Syndrome
Osteomyelitis (chronic or active)
Pancreatitis (with liver inflammation)
Paralysis
Parkinson’s disease
Peripheral Vascular disease (with regular claudication, poor exercise tolerance, continued smoking or history of skin ulcers)
Polycystic kidney disease
Renal insufficiency or failure
Schizophrenia
Scleroderma
Syncope (multiple episodes with unknown cause)
Stroke (multiple episodes, with certain other conditions)
Transient Ischemic Attacks (TIA) (multiple episodes)
Tremors (with unknown cause or neurological workup in progress)
Tuberculosis (active)
Ulcers of skin (due to disease processes)