The LTC Product and Underwriting Guides, along with supporting underwriting forms or processes, has been updated to provide you with information and guidelines that are consistent with the way we will be processing and underwriting our MutualCare Solutions Long-Term Care Product Portfolios.
Click here for the updated Product and Underwriting Guide.
These updates are effective 8/14/17. This updated information is provided in order to equip you with the tools needed to better support field underwriting.
UNDERWRITING PROCESS CHANGES: After an extensive study of cases conducted earlier this year, we have implemented a new underwriting process. Rather than wait until all underwriting evidence is in, Underwriting will now review each piece of underwriting evidence as it is received, then determine if and what additional underwriting requirements are needed. Any additional requirements needed would be determined by the underwriter. This means Medical records may not be immediately requested. If they are needed, they may be ordered during the review of the application, prescription history, MIB, and telephone interview. This should reduce the number of medical records ordered and improve overall turnaround time.
IMPORTANT NOTE: Full disclosure of health history on the application by the applicant should also facilitate the ordering of appropriate underwriting evidence.
In addition to the above:
- Cognitive assessments will be conducted for ages 60 and older
- Cognitive assessments will be conducted for applicants with Family History of Dementia or Cognitive disorder
- We will no longer be accepting applications for individuals declined by another carrier. Any exception request must be approved by the Underwriting Manager
- California incomplete rules have changed we will no longer incomplete CA applications at day 60, but instead we will keep open the full 90 days if needed
- Policy limit clarification – “The total benefits for nursing home/assisted living or home health care, including all long term care coverage (includes coverage from other companies), cannot exceed a Maximum Monthly Benefit of $10,000 and/or a Policy Limit of $500,000.”
- Reminder added to Administrative Handling section for producers to deliver the policy timely
Preparing for the Health Interview: To help you in preparing your clients for the Personal Health Interview, a step-by-step guide is available in the application packet. Please use this tool to prevent any additional delays during the underwriting process.
PRODUCT and UNDERWRITING GUIDE UPDATES: These include newly added medical conditions, clarifying of medical conditions, and updating the medical condition criteria.
- Build Chart- new parameters of acceptability
- Removed medical conditions associated with medications
- Added additional medications
NEWLY ADDED Conditions:
- Atrial septal defect
- Claudication
- Hematuria
- Hypogammaglobinemia
- Interstitial Cystitis
- DISH
- Marijuana
- MFTHR
- Microalbuminuria
- Periodic Limb Movement Disorder
- Timed Get up and Go
- Tic Douloureux
- Watchman’s Device
UPDATED Conditions:
- Abdominal Aortic Aneurysm (AAA)
- ADD/ADHD- Possible Preferred
- Addison’s Disease- shorter waiting periods
- Alcohol
- ALS
- Amaurosis Fugax/Amnesia- new criteria
- Anemia Arthritis- updated injections- degree of arthritis
- Rheumatoid Arthritis- new criteria- Select possible
- Asthma- new criteria
- Ataxia- – not an auto decline
- Avascular Necrosis- updated, select possible
- Bell’s Palsy Blindness – added receiving
- Disability Benefits
- Blood Clotting disorders updated
- Cancer-Bladder Cancer with tobacco added, Neuroendocrine tumors added
- Cardiomyopathy- new criteria, Select possible
- Cerebrovascular Disease
- Ulcerative Colitis- handles as Crohn’s disease
- COPD
- Crohn’s- DMARD’s Added
- Depression- >age 70 criteria added, possible Preferred
- Diabetes- A1C and Creatinine updated
- Drug Abuse Additional Blood Clotting Factors- added
- Family History of Dementia- updated/clarified
- Fractures- waiting periods changed
- Hashimoto’s- possible
- Preferred Heart Valve Disorder- clarified
- Hepatitis
- Hepatitis C
- Herniated Disc- shorter waiting periods, Pt, injections
- Impaired glucose Intolerance- changed glucose limits
- Joint Injections- clarified
- Kidney Disorder- multiple changes, possible Preferred
- Left Atrial Enlargement- new criteria
- Lymphoma- added Stage 0 criteria
- Meningioma- new criteria
- Monoclonal Gammopathy – new criteria
- Migraines- new criteria
- Osteoporosis- tobacco added
- Oxygen use- new criteria use for sleep apnea
- Pancreatitis- updated new criteria
- Physical therapy- updated, shorter wait periods, possible
- Preferred Pregnancy- new criteria
- Psoriasis-new DMARD criteria
- Pulmonary Hypertension- new criteria
- Sleep Apnea- new criteria, possible Preferred
- Spinal Stenosis- updated/ clarified injections, shorter wait periods
- Stroke- added Chronic A-Fib/PAF Syncope- new criteria- possible Preferred
- TIA- added Chronic A-Fib/PAF
A PDF of the MutualCare Solutions agent and underwriting guide is currently available on SPA and forms and materials. You will be notified when it is ready to order. All changes go into effect on 8/14/17.