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February 26, 2006 at 02:00 PM
Shopping the medical history can be a great advantage to your clients in the long term care insurance market. Many agents have found that shopping this history results in the best policy features to meet their clients’ needs and budgets.
Shopping also can help reduce unrealistic client expectations that might hurt the relationship with the agent, resulting in lost business or putting off clients from sending referrals to the agent.
Underwriting
Most carriers offer standard or preferred classifications, while some simply accept or reject applications or offer other ratings. Classifying the medical history can vary significantly from carrier to carrier as they take into consideration morbidity tables and studies of existing claims histories and patterns.
Underwriting for LTC insurance differs greatly from that of life or disability insurance. For example, some are surprised to be offered coverage after a cancer diagnosis or when taking medications for some forms of anxiety or depression. Others with a sports injury and undergoing physical therapy are shocked to learn most carriers cannot offer coverage until the physical therapy ends.
The need for long term care services usually occurs at the end of the disability spectrum, when people are sickest or in fragile health. Some of the health issues the underwriters evaluate when deciding whether to decline a policy, postpone it, issue a policy or issue it with a rating are as follows:
–Cognitive impairment: senility, Alzheimer’s, depression, brain tumors;
–Ability to perform the instrumental activities of daily living: meal preparation, shopping, phone use, laundry, taking medications, housework, managing finances;
–Ability to perform the activities of daily living: dressing, bathing, transferring, incontinence, eating, toileting, mobility;
–Musculoskeletal or balance issues: falls, fractures, osteoporosis, vertigo, alcohol, drugs, osteoarthritis;
–Combination medical histories: Diabetes with obesity or smoking;
–Multiple medications that may have adverse effects;
–Current or recent physical therapy;
–Any recent LTC services: home, nursing, assisted living or adult day care;
–Activities of independence: working, driving, volunteer work, gardening, travel, sports;
–Chronological and physiological age;
–Use of assistive devices: quad cane, walker, oxygen, wheelchair; and
–Planned or recommended surgery or medical-diagnostic tests or procedures.
