Long term care insurance underwriting is vastly different from life insurance underwriting or even health insurance underwriting. We receive many calls from individuals with a prior history of a heart attack, angioplasty or arrhythmia who firmly believe they are uninsurable for long term care insurance, when in fact they can qualify for LTC coverage, often at Standard health rates.
Statistics do show that heart disease accounts as the primary health factor for about 10% of long term care claims, so adverse coronary history is not an issue that an LTC underwriter takes lightly. The long term care insurance underwriter will, however, view your heart disease differently than the life insurance underwriter.
Whereas the life or health insurance underwriter will charge a significantly higher premium or decline your application once you have been diagnosed with heart disease, the long term care underwriter instead focuses on 2 primary issues: stability periods and co-morbid conditions.
Heart Disease and LTC Underwriting 101: Stability Periods and Co-Morbid Conditions
Stability period: length of time that you have completed treatment (including hospitalization and physical therapy). If the disease is chronic, stability period refers to the length of time the disease has been well controlled by medication such that it poses no threat to your general health or to your need for long term care services. Stability periods might be as little as 3 months or 6 months.
Co-morbid condition: a secondary condition that affects the primary diagnosis. For example diabetes and heart disease.
With long term care underwriting once you have satisfied a short stability period if you have an absence of co-morbid conditions there is a strong likelihood your long term care insurance application will be approved.
As an example I personally have chronic Atrial Fibrillation, a cardiac arrhythmia and I was approved for long term care insurance.
To give you a better sense of long term care underwriting let's examine guidelines for a few cardiac conditions.
CORONARY ARTERY BYPASS SURGERY /ANGIOPLASTY
[Angioplasty, Coronary Artery Bypass Graft (CABG), Percutaneous Transluminal Coronary Angioplasty (PTCA), Stent]
Coronary Artery Bypass Grafting (CABG) and Percutaneous Transluminal Coronary Angioplasty (PTCA) are the surgical treatments for ischemic heart disease.
Bypass surgery is accomplished through the use of a section of a vein or artery to bypass an area of obstruction in the coronary arteries.
Angioplasty is carried out by maneuvering a balloon-tipped catheter through the skin and into the arterial system to the coronary arteries. The balloon tip is expanded against the obstructing lesion to widen the narrowed artery.
Symptoms of coronary artery disease include fatigue, palpitations, angina, chest, pain, dizziness, shortness of breath, and limitations of activities.
A history of coronary artery bypass surgery/angioplasty is not acceptable if:
- The angioplasty surgery has been recommended or planned
- PTCA/stent was completed within 3 months, or CABG within 6 months
- There is a history of Cardiomyopathy or post-surgical Congestive Heart Failure (CHF)
A history of bypass surgery may not be acceptable for long term care insurance if there is a history of any of the following:
- Aortic Aneurysm
- Carotid Artery Disease
- Diabetes (most but not every underwriter)
- Peripheral Vascular Disease (PVD)
- Pulmonary Hypertension
- Transient Ischemic Attack (TIA)
- Ventricular Fibrillation or Ventricular Tachycardia
- There have been symptoms of angina within 6 months
HEART ATTACK [Myocardial Infarction (MI)]
A myocardial infarction (MI) occurs when the blood flow in a coronary artery is abruptly blocked or markedly reduced by a clot. The heart muscle supplied by the coronary artery dies. If the affected heart muscle is located in the left ventricle, the heart can no longer function efficiently as a pump and Congestive Heart Failure (CHF) may result. If the conduction system is damaged, irregular and sometimes fatal heart rhythms may result. Following an acute MI, treatment consists of measures aimed at dissolving the clot, as well as prevention of fatal heart rhythms.
A history of heart attack may be unacceptable for long term care insurance if:
- The heart attack occurred within the past 3 months
- There is a history of congestive heart failure within 5 years
- An angiogram, angioplasty or heart surgery is anticipated
- The applicant has been hospitalized or had ER visits for angina one time in the past 6 months or twice within 12 months
- There is any history of Peripheral Vascular Disease (PVD)
- There is a history of cardioversion within the past 12 months
- There is any history of an aortic aneurysm, cardiomyopathy, diabetes, pulmonary hypertension, or TIA/stroke
- Carotid surgery is anticipated or completed
- There is carotid artery blockage > 40%
Arrhythmias are a variation in the normal rhythm of the heartbeat. The heart contracts in response to electrical impulses originating in the sinus node (sino-atrial or SA node) located at the upper border of the atria. The impulses spread rapidly through the atrial myocardium and then throughout the ventricular myocardium. Cardioversion is the restoration of a normal rhythm with medication or an electrical shock (DC) to the heart.
3 common types of arrhythmias are:
Paroxysmal Atrial Tachycardia (PAT) is characterized by an abrupt onset and termination with a rate between 150-230 beats per minute.
Premature Ventricular Contractions (PVC'S) are beats that originate from the ventricle rather than the atrium.
Sick-Sinus Syndrome (SSS) encompasses a variety of rhythm disturbances reflecting dysfunction of the SA node. SSS is often associated with dysfunction elsewhere in the conduction system. It often results in bradycardia (slow heart rate).
These arrhythmias may result in a variety of symptoms including dizziness, palpitations, rapid or slow heartbeat, and fainting. Treatment may be with medication, pacemaker, or defibrillator insertion.
Arrhythmias may be unacceptable for long term care insurance if:
- There has been any symptomatic CHF within 12 months (e.g., shortness of breath; fluid retention or swelling in the feet, ankles or legs; difficulty breathing when lying down)
- There have been any ablation procedures within the past 3 months
- There is a history of arterial thromboembolism (blood clot in an artery) within the past 12 months, or arterial thromboembolism with cardioversion within the past 6 months
- A pacemaker placement or ablation procedure is recommended or planned
The above guidelines are not necessarily hard and fast rules for long term care insurance underwriting.
Please understand each company views health guidelines differently.
For example, most underwriters will decline applications if there exists both heart disease and diabetes; however a few companies will actually allow these 2 specific co-morbid conditions and approve your application should you have diabetes and heart disease.
Thus, it is in your best interest to work with a long term care insurance specialist that is experienced with each company's underwriting guidelines so that an acceptance of your application will be produced for you.
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Should you wish to review your health history to see if you can qualify for long term care insurance please call us toll-free at (800) 891-5824.
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Please call us at (800) 891-5824 or you may complete your quote request form. We look forward to hearing from you.