Cpssac.com2
The Prudential Insurance
Company of America
Long-Term Care Insurance
FIELD UNDERWRITING
POCKET GUIDE
The Prudential Insurance Company of America, Newark, NJ
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC
Prudential offers three underwriting rating/classification categories:Preferred, Standard I and Standard II. A. Review the Uninsurable Medical Conditions and the Stability
Indicators to determine if a given medical condition is insurable. If the Applicant meets the Stability Indicator* for their condition, they can qualify for a Standard I rate.
Examples:
1. If an Applicant admits to having had an angioplasty three or more
months ago and is otherwise in good health, they could qualify for aStandard I rate.
2. If an Applicant admits to having had surgery for Stage 1 breast cancer
6 or more months ago, has had no recurrence, and is otherwise ingood health, they could qualify for a Standard I rate.
The Following Conditions Are Exceptions Which Should Result In AStandard II rate:
1. Congestive Heart Failure (CHF) requiring daily prescription medication
5. Diabetes requiring daily, oral, or injectable prescription medication
would result in a Standard II rate, and Diabetes controlled by diet and exercise only would be a Standard I rate.
6. Chronic Obstructive Pulmonary Disease (COPD) requiring daily
7. Emphysema requiring daily prescription medication
* The minimum length of time that is required from completion of any/all treatment for a
condition, or to get it successfully controlled if chronic, to the time an Application canbe submitted.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
B. Review the Weight and Height Guidelines.
The Applicant’s weight and height must be within the acceptableranges to qualify for a Standard I rate. The acceptable ranges areshown in the Weight and Height Guidelines chart in this manual.
If an Applicant smokes, be sure to indicate so on the Application. AnApplicant can qualify for a Standard I rate even if they admit tosmoking provided they smoke less than one package of cigarettes (ora similar equivalent of other tobacco products) daily and have no car-diac, respiratory, or vascular/circulatory conditions.
ISSUE AGE/RATING AGEIssue ages are 18–79. The Applicant’s age as of the date the Applicationis signed is what is utilized for rating and issue purposes.
Do not back date the Application, under any circumstances. We will automatically save age up to 30 days prior to the Application date. We will not be able to save age 79 if the Applicant has turned 80 by the date of the Application.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Good habits and good lifestyles should be rewarded. Prudential wantsyour client to receive that reward in the form of a special 15% PreferredRating Class Discount available to those whose physical and health profiles are better than average.
While all decisions regarding the applicability of the discount must bemade by underwriting after a full review of the Applicant’s medicalrecords, we have provided these guidelines to help producers estimatewhether their client might be qualified. Simply ask the questions below.
If the answers are as indicated, your clients could be eligible for the premium they deserve.
Client Must Answer
“Yes” To All Of The Following Questions:
1. Is the Applicant within the weight and height guidelines?
2. Does the Applicant maintain a high level of activity outside the home?
This may include, but is not limited to: full- or part-time employment,regular exercise, regular social activities, or volunteer activities?
3. Is the Applicant’s blood pressure controlled to 140/90 or better as an
4. Has the Applicant refrained from smoking or using tobacco products
Client Must Answer
“No” To All Of The Following:
Any cardiac condition requiring medication
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Cancer (except skin cancer other than melanoma)
Chronic Pulmonary Disease (any respiratory condition thatrequires regular medication)
The use of multiple medications.
This includes, but is not limited
to, multiple medications used to control hypertension, multipleanxiety or depression medications and cholesterol lowering drugsor other circulatory medications
Circulatory Disease (Cartoid Artery Disease, Coronary ArteryDisease or Peripheral Vascular Disease)
Any chronic condition that is progressing in severity with age
Comorbids or combination of conditions will be individually considered
All answers to the above must be as noted for discount consideration.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Preferred Rating Class Weight And Height Guidelines
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Benign tumor of the auditory nerve• Post-surgical or radiation
treatment, now resolved . . . . . . . . . 6 months
• Surgery anticipated . . . . . . . . . . . . . Postpone
Acquired ImmuneDeficiency Syndrome(AIDS)
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
A chronic metabolic disorder that results in gradual enlargement of bones of face, jaw, hands, feet, and skull . . . . . . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . . 12 months
Anyone who requires the help of another person, for either physical or cognitive reasons, to perform any one of the following Activities of Daily Living (ADLs):Bathing, Dressing, Control of Bowel/Bladder (Continence)Using the Toilet
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
EatingAmbulation/Mobility (inside and outside) . . . . . . . . . . . . Uninsurable
AIDS Related Complex (ARC) . . . . . . . . . . . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
- Independent in ADLs, IADLs . . . 6 months
diabetes or PVD) . . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
A blood disorder in which there is a decreased ability of the red blood cells to provide adequate oxygen supplies to body tissues.
• The average Hematocrit
reading must be > 33, orHemoglobin > 10
for anemia . . . . . . . . . . . . . . . . . . 12 months
• Epogen or Procrit . . . . . . . . . . . . . 12 months• Cause Unknown . . . . . . . . . . . . . Uninsurable• Hemolytic
but recovered/stable . . . . . . . . . . 12 months
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
• Iron deficiency, corrected. . . . . . . . 6 months• Pernicious, with B12 injections
- No neurological impairment . . . . 6 months
• Splenectomy . . . . . . . . . . . . . . . . . 60 months
Abnormal dilation of a blood vessel • Abdominal, Thoracic, Aortic
- Unoperated . . . . . . . . . . . . . . . . . . 6 months- Operated, complete recovery . . . 3 months
or rupture . . . . . . . . . . . . . . . . . Uninsurable
- Unoperated . . . . . . . . . . . . . . . Uninsurable- Operated, complete recovery . . 12 months
Chest pain that results when not enough oxygen reaches the heart muscle• Asymptomatic,
controlled with meds . . . . . . . . . . . 6 months
Attack or Diabetes . . . . . . . . . . . . 12 months
• Intestinal. . . . . . . . . . . . . . . . . . . Uninsurable• In combination with CHF . . . . . Uninsurable• Work-up in progress. . . . . . . . . . Uninsurable
with a balloon or surgical procedure • Any history of Diabetes
> 75% major vessel . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Angioplasty, Cardiac • No Heart Attack . . . . . . . . . . . . . . 3 months
(cont’d)
- Asymptomatic . . . . . . . . . . . . . . . 6 months- Symptoms continue . . . . . . . . . Uninsurable- Treatment for Congestive
Heart Failure . . . . . . . . . . . . . . Uninsurable
affecting the spine and large joints;joints fuse together• Any history of falls . . . . . . . . . . . . 12 months• Narcotics used for pain. . . . . . . . Uninsurable• Functional limitations . . . . . . . . Uninsurable• Physical Therapy
in past 6 months. . . . . . . . . . . . . Uninsurable
• No pulmonary compromise . . . . . . 6 months• Major joint replacement . . . . . . . . 12 months
- No interference with activities. . . 6 months
- No ADL or IADL limitations- No cognitive impairment . . . . . . 12 months
disorder . . . . . . . . . . . . . . . . . . . Uninsurable
Variation in the normal rhythmof the heartbeat• Hospitalized in the past
6 months for arrhythmia . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
past 3 months . . . . . . . . . . . . . . . Uninsurable
in the past 12 months. . . . . . . . . Uninsurable
breath, swelling in feet/anklesin the past 12 months. . . . . . . . . Uninsurable
- Controlled with meds. . . . . . . . . . 3 months
- Single episode- Controlled with meds- No Transient Ischemic Attack (TIA)- No Cerebrovascular
Accident (Stroke) . . . . . . . . . . . . . 6 months
(Thromboangitis Obliterans, Buerger’s Disease, Temporal, Giant Cell)• No ADL or IADL limitations
- No active disease . . . . . . . . . . . . 12 months
Inflammation of joints withdegeneration of joint cartilage• Remicade, Humira, Arava, Enbrel
. . . 12 months with Individual Consideration
pain management . . . . . . . . . . . . Uninsurable
- No ADL or IADL limitations- No joint deformities
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
- No joint replacement . . . . . . . . . . 0 months
Mild-Moderate Rheumatoid Arthritis- No ADL or IADL limitations- No joint deformities- History of Joint Replacement- History of cortisone injections. . . 6 months
- Requires Durable Medical Equipment- ADL or IADL limitations- Continual steroidal use-Surgery recommended . . . . . . . Uninsurable
Reversible obstructive lung disease withnarrowing of airways when in spasm• Use of > 3 pulmonary mediations
per day . . . . . . . . . . Individual Consideration
- Controlled with meds- No ADL or IADL limitations- Stable weight- No home oxygen- No hospitalization within six months- No evidence of Congestive
Heart Failure. . . . . . . . . . . . . . . . 12 months
less than 5 mg/day . . . . . . . . . . Uninsurable
• Severe. . . . . . . . . . . . . . . . . . . . . Uninsurable• Currently smoking . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
- Pacemaker inserted . . . . . . . . . . . 3 months- History Transient Ischemic
Attack . . . . . . . . . . . . . . . . . . . . . 60 months
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Temporary or permanent loss of blood supply to the bones• No ADL or IADL limitations
- No pending surgery- No chronic pain . . . . . . . . . . . . . 12 months
for pain management . . . . . . . . . Uninsurable
functionality . . . . . . . . . . . . . . . . Uninsurable
completely recovered . . . . . . . . . . . 6 months
Unilateral paralysis of the muscles of the face• Any routine use of steroids
or immunosuppressivemedications . . . . . . . . . . . . . . . . Uninsurable
• No ADL or IADL limitations. . . . . 3 months
> 4–10 . . . . . . . . . . Individual Consideration
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
• If work-up in progress . . . . . . . . Uninsurable
- Asymptomatic . . . . . . . . . . . . . . . 0 months
- No urinary catheter . . . . . . . . . . . 6 months
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
or with ADL loss . . . . . . . . . . . . Uninsurable
to visual loss . . . . . . . . . . . . . . . . . 12 months
(exception for breast cancer) . . . Uninsurable
(spread from original site) . . . . . Uninsurable
(same organ or site) . . . . . . . . . . Uninsurable
brain, esophagus, liver, lung, ovary, pancreas, stomach, or testes . . . . . . . . . . . . . 48 months
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
stages 0 & I . . . . . . . . . . . . . . . . . 6 monthsstage II . . . . . . . . . . . . . . . . . . . . 12 monthsstages III & IV. . . . . . . . . . . . . Uninsurable
stage A . . . . . . . . . . . . . . . . . . . . . 6 monthsstage B . . . . . . . . . . . . . . . . . . . . 12 monthsstage C . . . . . . . . . . . . . . . . . . . . 60 Monthsstage D . . . . . . . . . . . . . . . . . . . Uninsurable
stage I & II . . . . . . . . . . . . . . . . . 48 monthsstages III & IV. . . . . . . . . . . . . Uninsurable
stages I & II . . . . . . . . . . . . . . . . 12 monthsstages III & IV. . . . . . . . . . . . . Uninsurable
stages I & II . . . . . . . . . . . . . . . . 48 monthsstages III & IV. . . . . . . . . . . . . Uninsurable
stages I, II, A & B . . . . . . . . . . . . 6 monthsstages III, C . . . . . . . . . . . . . . . . 24 monthsstage D . . . . . . . . . . . . . . . . . . . Uninsurable
stage 0 . . . . . . . . . . . . . . . . . . . . 12 monthsstages A & B . . . . . . . . . . . . . . . 24 monthsstages B2 & greater . . . . . . . . . Uninsurable
- Thyroid . . . . . . . . . . . . . . . . . . . . 24 months- Skin Basal Cell . . . . . . . . . . . . . . 0 months- Squamous Cell . . . . . . . . . . . . . . . 0 months- Melanoma in Situ, superficial
In situ-early stage . . . . . . . . . . . . . 6 monthsClark’s level I, II. . . . . . . . . . . . . 12 monthsClark’s level III. . . . . . . . . . . . . . 24 monthsClark’s level IV. . . . . . . . . . . . . . 48 months
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
or Breslow > 3.5 . . . . . . . . . . . Uninsurable
Cancer . . . . . . . . . Individual Consideration
Cancers . . . . . . . . Individual Consideration
stage 0 . . . . . . . . . . . . . . . . . . . . . 6 monthsstage I . . . . . . . . . . . . . . . . . . . . . 12 monthsstage II . . . . . . . . . . . . . . . . . . . . 36 monthsstages III, IV . . . . . . . . . . . . . . Uninsurable
Disease of heart muscle• Hospitalized in
past 12 months . . . . . . . . . . . . . . Uninsurable
• History of CHF. . . . . . . . . . . . . . . 12 months• Symptomatic
or progressive. . . . . . . . . . . . . . . Uninsurable
(from most recentstress test) ≤ 40% . . . . . . . . . . . Uninsurable
- No Congestive Heart Failure . . . 12 months
• Symptomatic or Progressive . . . Uninsurable
by narrowing or stenosis of the carotid artery in the neck• Operated, endarterectomy in combo
with Diabetes Mellitus . . . . . . . . . . 3 months
with Diabetes Mellitus . . . . . . . . . 12 months
- 75% Stenosis or greater . . . . . Uninsurable- History of TIA . . . . . . . . . . . . . . 60 months
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
• No ADL or IADL limitations . . . . . 3 months
Paralysis from developmental braindefects or trauma at birth• Any decrease in muscle strength
or functioning. . . . . . . . . . . . . . . Uninsurable
• Any increased fatigue . . . . . . . . Uninsurable
* Any history of Cerebral Palsy requires face-to-face interview
XXXX, Trisomy 21) . . . . . . . . . . . Uninsurable
Chronic ObstructiveLung Disease (COLD) (See Emphysema)
Chronic ObstructivePulmonary Disease (COPD) (See Emphysema)
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
- Any abnormal weight loss . . . . . 12 months- IBS, diverticulitis . . . . . . . . . . . . 12 months- Any use of Remicade . . . . . . . . . 12 months- Any use of
enzyme supplement . . . . . . . . . Uninsurable
enema) in past 12 months . . . . Uninsurable
past 12 months. . . . . . . . . . . . . Uninsurable
• Ischemic Colitis . . . . . . . . . . . . . Uninsurable• Crohn’s Disease
- Unoperated . . . . . . . . . . . . . . . . . 12 months- Independent with ostomy. . . . . . . 6 months
management . . . . . . . . . . . Underwrite Cause
- No cognitive impairment . . . . . . . 6 months
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
causing increased fluid retention in lungs andlower parts of body• If ejection fraction ≤ 40% . . . . . Uninsurable• If using Furosemide (Lasix)
> 80 mg a day . . . . . . . . . . . . . . Uninsurable
studies BUN > 30and Creatinine > 2.5 . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
• No ADL or IADL limitations• Controlled with meds . . . . . . . . . . 12 months• Multiple episodes . . . . . . . . . . . Uninsurable• In combination with:
Angina or Heart Attack;Angioplasty or HeartSurgery; Asthma or ChronicBronchitis; Diabetes;Emphysema or ChronicObstructive PulmonaryDisease; or Tuberculosis . . . . . . Uninsurable
an area of obstruction• Any history of TIA . . . . . . . . . . Uninsurable• If ejection faction ≥ 40% . . . . . . Uninsurable• If coronary stenosis > 75% . . . . Uninsurable• Asymptomatic . . . . . . . . . . . . . . . . 6 months• With history of Heart Attack,
during or after surgery or with diabetes. . . . . . . . . . . . . . . . . 12 months
post-operative. . . . . . . . . . . . . . . Uninsurable
anticipated . . . . . . . . . . . . . . . . . Uninsurable
- No ADL or IADL limitations . . . 6 months
Failure . . . . . . . . . . . . . . . . . . . . Uninsurable
• With Unstable Angina . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
An inherited disease of the endocrine glands affecting the gastrointestinal and respiratory systems. . . . . . . . . Uninsurable
Pressure sore . . . . . . . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Demyelinating Disease An inflammation process
of nerves that destroys normalhealthy myelin seen inneurological diseases. . . . . . . . . . . Uninsurable
drugs . . . . . . . . . . . Individual Consideration
• History of ECT. . . . . . . . . . . . . . . 36 months• Situational
- No ADL or IADL limitations- No cognitive impairment . . . . . . . 6 months
- Stable medication dose- No ADL or IADL limitations . . 12 months- Any hospitalization . . . . . . . . . . 36 months
Chronic disease of high blood sugarcaused by too little insulin
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
adjustments. . . . . . . . . . . . . . . . . 12 months
- Average A1c > 8%. . . . . . . . . . Uninsurable- Average fasting blood
sugar > 200 . . . . . . . . . . . . . . . Uninsurable
neurological complications . . . Uninsurable
complications . . . Individual Consideration
hemochromotosis. . . . . . . . . . . Uninsurable
with skin breakdown . . . . . . . . Uninsurable
for other diseases . . . . . . . . . . . Uninsurable
cardiomyopathy . . . . . . . . . . . . Uninsurable
or less daily. . . . . . . . . . . . . . . . . . 12 months
or Peritoneal . . . . . . . . . . . . . . . . Uninsurable
• Acute viral labyrinthitis . . . . . . . . . 3 months• Meniere’s Disease
- Controlled with meds. . . . . . . . . . 6 months
- No neurological impairment . . . 12 months
• Ongoing problem . . . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Drug/Chemical Dependency(including DrugsAlcohol and Other
• Treated with current abstinence . . 36 months
Chemical Dependency) • Current Use . . . . . . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . Underwrite Cause
Chronic irreversible obstruction to airflow• Mild
- Controlled with meds- No ADL or IADL limitations- Stable weight- No home oxygen- No hospitalization
within six months . . . . . . . . . . . . . 6 months
• Severe. . . . . . . . . . . . . . . . . . . . . Uninsurable• Actively Smoking . . . . . . . . . . . Uninsurable• Asthma or Chronic
Bronchitis . . . . . . . Individual Consideration
Heart Failure . . . . . . . . . . . . . . . Uninsurable
Acute inflammatory disease of the brain due to a virus• No cognitive impairment . . . . . . . 12 months
obstruction of artery . . . . . . . . . . . . . 3 months• History of Diabetes . . . . . . . . . . . 12 months
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
lining of the heart• Any history of hospitalization
for CHF . . . . . . . . . . . . . . . . . . . . 12 months
• No seizure activity . . . . . . . . . . . . 12 months
- No ADL or IADL limitations- No cognitive impairment . . . . . . 12 months
unknown reason . . . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 months
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . Underwrite Cause
Disorder characterized by chronic pain,tenderness, and stiffness of muscles• With pulmonary compromise . . Uninsurable• Fatigue that limits
daily function . . . . . . . . . . . . . . . Uninsurable
• Disease in remission. . . . . . . . . . . 12 months
- No ADL or IADL limitations . . . 3 months
• Compression . . . . . . . . . (See Osteoporosis)• Legs
- No ADL or IADL limitations . . . 6 months
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
- No ADL or IADL limitations- No cognitive impairment . . . . . . 12 months
- Due to Osteoporosis or Paget’s Disease
No ADL or IADL limitationsNo respiratory compromise . . . . 24 months
No ADL or IADL limitations . . . 6 months
• Pelvic Fracture . . . . . . . . . . . . . . . 12 months• Daily use of narcotics . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . . 12 months
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Giant Cell Arteritis (Active) . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Progressive loss of peripheral vision• No visual loss in last two years
to visual loss. . . . . . . . . . . . . . . . . 0 months
to visual loss. . . . . . . . . . . . . . . . 12 months
Painful inflammation of first great toe or elsewhere in the foot from uric acid deposits• Gouty Arthritis
- No ADL or IADL limitations- No joint deformities. . . . . . . . . . . 3 months
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Rapidly progressive disorder involving muscle weakness or paralysis• No residual neurological
impairment . . . . . . . . . . . . . . . . . . . 6 months
(i.e., fracture) . . . . . . . . . . . . . . . 12 months
• With residual impairment . . . . . Uninsurable
to hearing loss . . . . . . . . . . . . . . . . 3 months
- No Angina . . . . . . . . . . . . . . . . . . 3 months
- Controlled with meds. . . . . . . . . . 6 months
• In combination with CHF . . . . . Uninsurable
insufficiency, unoperated- No Congestive Heart Failure- Stable . . . . . . . . . . . . . . . . . . . . . . 6 months
Mitral stenosis/insufficiency, unoperated- No Congestive Heart Failure- Stable . . . . . . . . . . . . . . . . . . . . . . 6 months
• Single valve replacement . . . . . . . . 6 months
replacement . . . . . . Individual Consideration
. . . . . . . . . . . . . . . . Individual Consideration
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Inflammation of the liver• Resolved . . . . . . . . . . . . . . . . . . . . . 6 months• Hepatitis A & B with
normal liver function tests . . . . . . . 6 months
normal liver function tests . . . . . . 12 months
• Chronic, active . . . . . . . . . . . . . . Uninsurable• Liver function Tests
> 2.5 the normal. . . . . . . . . . . . . Uninsurable
• HCV-RNA > 600 . . . . . . . . . . . . Uninsurable
• Daily narcotic use . . . . . . . . . . . . Uninsurable
- No ADL or IADL limitations . . . 3 months
- No chronic pain . . . . . . . . . . . . . . 6 months
Acute infection characterized by vesicles and associated neuralgic pain• Post-acute episode
no pain or neuralgia . . . . . . . . . . . 3 months
• Neurological work-up. . . . . . . . . . 12 months
• Stable post-repair . . . . . . . . . . . . . . 3 months
High Blood Pressure • Controlled with meds . . . . . . . . . . . 3 months(Hypertension)
> 175/100 . . . . . . . . . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Malignancy found in the lymph nodes,spleen, liver, and bone marrow• Disease free, treatment free . . . . . 36 months
recovered . . . . . . . . . . . . . Underwrite Cause
anticipated admission. . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Anyone who requires the help ofanother person, for either physicalor cognitive reasons, to perform twoor more of the following InstrumentalActivities of Daily Living (IADLs):
Using the Telephone, Managing Finances,Taking Transportation, Shopping, Laundry, Housework, Taking all Medications,Preparing Meals/Cooking . . . . . . Uninsurable
Idiopathic Pulmonary • Localized . . . . . . . . . . . . . . . . . . . . 6 monthsFibrosis, Active
• Widespread . . . . . . . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Ileitis, Regional, end-stage . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Immune System Disorders . . . . . . . . . . . . . . Individual Consideration
(Hip, Knee, Shoulder) • No ADL or IADL limitations. . . . . 3 months
Malignant increase in cellsinvolving the skin associatedwith AIDS . . . . . . . . . . . . . . . . . . . Uninsurable
• No ADL or IADL limitations• No surgery recommended . . . . . . . . 3 months
• Acute, any type . . . . . . . . . . . . . . Uninsurable• Chronic, non-lymphocytic
(CML) . . . . . . . . . . . . . . . . . . . . Uninsurable
- stages 0-I . . . . . . . . . . . . . . . . . . 12 months- stage II . . . . . . . . . . . . . . . . . . . . 36 months- stages III and IV . . . . . . . . . . . Uninsurable
• Hairy Cell . . . . . . . . . . . . . . . . . . Uninsurable
Lues (Stage IV Syphilis) . . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Chronic inflammatory diseaseof the connective tissues• Systemic Lupus
fractures . . . . . . . . . . . . . . . . . . Uninsurable
Cyclosporin, narcotics . . . . . . Uninsurable
• Discoid, inactive . . . . . . . . . . . . . . . 6 months
An inflammatory disease transmitted by deer ticks• Residual symptoms,
decreased muscular strength,or limiting joint pain . . . . . . . . . Uninsurable
steroid use . . . . . . . . . . . . . . . . . Uninsurable
• Resolved . . . . . . . . . . . . . . . . . . . . . 6 months• Hospitalization for
complications . . . . . . . . . . . . . . . . 12 months
• Disease and treatment free . . . . . . 60 months
Macular Degeneration • No ADL or IADL limitations
visual loss. . . . . . . . . . . . Underwrite Cause
• No psychiatric hospitalization in five years
- Controlled with medication . . . . 24 months- History of electroconvulsive
therapy . . . . . . . . . . . . . . . . . . . . 36 months
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
. . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Mitral Valve ProlapseStenosis, Insufficiency
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
IADL Limitations . . . . . . . . . . . Uninsurable
Malignant disease of plasma cellsgenerally found in the pelvis,spine, ribs, and skull . . . . . . . . . . . Uninsurable
Demyelinating illness, causeunknown, affecting the centralnervous system with eventualcognitive impairment . . . . . . . . . . Uninsurable
Atrophy of the muscle spasms,inability to control and coordinatevoluntary muscles . . . . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Myasthenia . . . . . . . Individual consideration
> 20 mg per day . . . . . . . . . . . . . Uninsurable
or Mestinon . . . . . . Individual Consideration
unresponsive to treatment . . . . . Uninsurable
• Asymptomatic . . . . . . . . . . . . . . . . 6 months• Abnormal Bone
Marrow Exam. . . . . . . . . . . . . . . . 24 months
• Splenectomy . . . . . . . . . . . . . . . . . 60 months
Recurrent and unpredictable attacks of sleep• Asymptomatic . . . . . . . . . . . . . . . 12 months• Recent onset or hospitalization . . 24 months
• Stable renal function. . . . . . . . . . . 18 months
Nephritis, Glomerulonephritis . . . . . . . . . . . . . . . . . . . . . . . . 12 months
Post-Lithotripsy . . . . . . . . . . . . . . . . . 3 months
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
past 36 months- No antipsychotic medications . . 24 months
Inherited disorder characterizedby pigmented skin lesions andtumors affecting multiple organsystems, “café-au-lait” spots. . . . . Uninsurable
• Ability to self catheterize . . . . . . . 18 months• Normal and stable renal function . . 6 months
Compression or entrapment of a nervewith varying amounts of pain, weakness,and paresthesia• Narcotic-containing
pain management . . . . . . . . . . . . Uninsurable
• Multiple changes in meds . . . . . Uninsurable• Non-progressive, mild . . . . . . . . . . 6 months• Autonomic Neuropathy . . . . . . . Uninsurable
(See Transplant, Organ)Organic Brain Syndrome . . . . . . . Uninsurable
Osler-Weber-RenduDisease (Telangiectasis)
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
• Resolved . . . . . . . . . . . . . . . . . . . . 12 months
• Chronic, active . . . . . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Generalized, progressive loss ofbone density and thinning of bone tissue• If T score exceeds -3.5. . . . . . . . Uninsurable• Daily use of narcotics . . . . . . . . Uninsurable• Three or more
compression fractures . . . . . . . . Uninsurable
compromise . . . . . . . . . . . . . . . . Uninsurable
• Oxygen Use . . . . . . . . . . . . . . . Uninsurable
- No ADL or IADL limitations . . 24 months- stages 0, 1. . . . . . . . . . . . . . . . . . . 6 months- stage II . . . . . . . . . . . . . . . . . . . . 12 months- stages III, IV . . . . . . . . . . . . . . Uninsurable
Acute inflammation of the pancreas• Acute episode, now resolved . . . . 12 months• Alcohol use in
the past 36 months . . . . . . . . . . . Uninsurable
supplements Vionase,Cotazym, or Pancrease . . . . . . . Uninsurable
• Chronic. . . . . . . . . . . . . . . . . . . . Uninsurable
IADL limitations . . . . . . . Underwrite Cause
• Hemiplegia. . . . . . . . . . . . . . . . . Uninsurable• Paraplegia. . . . . . . . . . . . . . . . . . Uninsurable• Quadriplegia. . . . . . . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Slowly progressivedegenerative neurologicaldisorder characterizedby resting tremor, muscularrigidity, gait impairment,and postural instability . . . . . . . . . Uninsurable
• Asymptomatic . . . . . . . . . . . . . . . . 0 months• History of
gastrointestinal bleed . . . . . . . . . . . 6 months
• History of perforation. . . . . . . . . . 12 months
Inflammation of the liningthat covers the heart muscle . . . . . . . 6 months
to the extremities• No leg pain • Nonsmoker• No ADL or IADL limitations. . . . . 6 months• Hospitalization . . . . . . . . . . . . . . . 12 months• History of leg pain at rest
or walking few blocks . . . . . . . . Uninsurable
• Continued smoking . . . . . . . . . . Uninsurable
medication . . . . . . . . . . . . . . . . . Uninsurable
Inflammation and necrosisof small and medium-sizedmuscular arteries . . . . . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
and enlarges the kidneys, thus interferingwith their function• Any history of or recommendation
for kidney dialysis . . . . . . . . . . . Uninsurable
• Asymptomatic . . . . . . . . . . . . . . . . 6 months• Hospitalizations for renal failure
or surgery . . . . . . . . . . . . . . . . . . . 24 months
• Transplant . . . . . . . . . . . . . . . . . . . 60 months
Severe pain and stiffness of the proximal
muscle groups without weakness or atrophy• Asymptomatic . . . . . . . . . . . . . . . 12 months• History of 3 or more
compression fractures . . . . . . . . Uninsurable
narcotics for pain . . . . . . . . . . . . Uninsurable
Prednisone per day. . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 months
. . . . . . . . . . . . . . . . . . . . . Underwrite Cause
of leg muscles occurring years afteronset of disease• Any change in muscle
strength or evidence ofincreased fatigue . . . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
in the past 24 months. . . . . . . . . Uninsurable
• No history of paralysis . . . . . . . . . . 0 months• Any equipment usage
or ADL/IADL limitations . . . . . Uninsurable
*
A face-to-face interview will be obtained for any
history of polio regardless of age.
Progressive Muscular Atrophy . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Sudden blockage of pulmonary arteryby a blood clot with resultingobstruction of blood to lung tissue• Resolved . . . . . . . . . . . . . . . . . . . . . 6 months• Recurrent PE . . . . . . . . . . . . . . . . 12 months• CHF . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Scarring and thickening ofdeep lung tissue . . . . . . . . . . . . . . Uninsurable
Decline in the ability of the kidneysto function properly• Hospitalization
for complications . . . . . . . . . . . . . 24 months
for dialysis . . . . . . . . . . . . . . . . . Uninsurable
• Mild renal insufficiency . . . . . . . . 12 months• BUN > 30, Creatinine > 2.5 . . . Uninsurable• Moderate to severe. . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
level of sight loss, independent . . . . . . . . . . . . . . 3 months
• With diabetes . . . . . . . . . . . . . . . Uninsurable• Evidence of progressive
sight-loss, unarrested . . . . . . . . . Uninsurable
A disease of unknown case in whichinflammation occurs in the lymph nodes, lungs, liver, eyes, skin, or other tissues• Stage 1 . . . . . . . . . . . . . . . . . . . . . 12 months• Stage 2 . . . . . . . . . . . . . . . . . . . . . 36 months• Stage 3 . . . . . . . . . . . . . . . . . . . . Uninsurable• Asymptomatic . . . . . . . . . . . . . . . 36 months
Psychotic disorder characterized bydisturbances in thought, perception,affect, behavior . . . . . . . . . . . . . . . Uninsurable
Pain radiating along the sciatic nerve; most often in the buttocks and posterioraspects of the leg caused by compression of the sciatic nerve from a protruding disk• Any history of surgery
within the past 6 months . . . . . . Uninsurable
• Any daily narcotic use . . . . . . . . Uninsurable• No ADL or IADL limitations
- Asymptomatic . . . . . . . . . . . . . . . 6 months
A diffuse corrective tissue diseasecharacterized by changes in the skin,blood vessels, skeletal muscles, andinternal organs
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
crest syndrome . . . . Individual consideration
• In remission, no limitations . . . . . 12 months• Chronic continuous
steroid use . . . . . . . . . . . . . . . . . Uninsurable
fractures . . . . . . . . . . . . . . . . . . . . . . Decline
• History of plasmapheresis . . . . . . 24 months
Abnormal spinal curvature• No ADL or IADL limitations. . . . . 0 months
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Sleep related breathing disorderwith pauses in respiration lasting10 seconds or longer• More than 100 pounds
over ideal weight . . . . . . . . . . . . Uninsurable
• Asymptomatic . . . . . . . . . . . . . . . . 3 months• CPAP machine
without bottled oxygen . . . . . . . . . 6 months
• Hospitalization . . . . . . . . . . . . . . . 12 months
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
- No chronic pain- No narcotic medications . . . . . . . 6 months
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
- Post surgery . . . . . . . . . . . . . . . . . 6 months- History of a
compression fracture . . . . . . . . . 12 months
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
If surgery is recommended,planned, or has been recentlyperformed, do not take theApplication until the surgerywith full recovery. Refer to thespecific medical condition andStability Indicator for time frames.
A decrease in the number of plateletsin the blood; can result in spontaneous bruising or bleeding• Platelets < 60K
not on NSAIDS . . . . . . . . . . . . . Uninsurable
• Any current steroid use . . . . . . . Uninsurable• Unoperated, asymptomatic . . . . . . 12 months• Post-Splenectomy,
asymptomatic, stable . . . . . . . . . . 24 months
Thrombocytopenia . . . . . . Underwrite Cause
anticoagulant use . . . . . . . . . . . . . . 6 months
• Superficial phlebitis . . . . . . . . . . . . 0 months
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Resolved . . . . . . . . . . . . . . . . . . . . . 6 months
• Recurrent, 2 or more . . . . . . . . . . 12 months
within minutes, usually clearing within 15 minutes, but always resolving without permanent neurological impairment within 24 hours• Single Episode
- No ADL or IADL limitations - Nonsmoker . . . . . . . . . . . . . . . . . 60 months
• More than one TIA . . . . . . . . . . Uninsurable• In combination with
diabetes or heart surgery . . . . . . Uninsurable
• Corneal . . . . . . . . . . . . . . . . . . . . . . 3 months• Kidney . . . . . . . . . . . . . . . . . . . . . 60 months• All others . . . . . . . . . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Involuntary movement disorder• Benign, essential, or familial
- No ADL or IADL limitations . . . 6 months
• Work-up in progress. . . . . . . . . . Uninsurable• Due to Parkinson’s Disease . . . . Uninsurable
• Resolved . . . . . . . . . . . . . . . . . . . . 12 months• Active . . . . . . . . . . . . . . . . . . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
- No paralysis- No ADL or IADL limitations- No seizure disorder . . . . . . . . . . 48 months
• Other sites . . . . . . . . . . . . . . . . . . . 6 months
• Asymptomatic . . . . . . . . . . . . . . . . 0 months• History of Gastrointestinal Bleed. . 6 months
• Resolved . . . . . . . . . . . . . . . . . . . . 24 months• Active or chronic . . . . . . . . . . . . Uninsurable• Resulting in Amputation . . . . . . Uninsurable
• Independent in care . . . . . . . . . . . . 0 months• Use of catheter if
independent in use . . . . . . . . . . . . 18 months
dependent in ADLs . . . . . . . . . . Uninsurable
• Hospitalization or surgery . . . . . . . 6 months
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
Varicose Veins (Legs) • No ADL or IADL limitations. . . . . 0 months
stripping surgery. . . . . . . . . . . . . . . 6 months
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Inflammation of aorta which mayresult in weakness of the aorta wall• Asymptomatic, well controlled
hypertension . . . . . . . . . . . . . . . . . . 6 months
in legs while walking) . . . . . . . . Uninsurable
• No chronic pain or narcotic medications
Otherwise Classified • No active ongoing
therapy or recommendations for therapy . . . . . . . . . . . . . . . . . Uninsurable
Von Recklinghausen’s Generic Disorder . . . . . . . . . . . . . . Uninsurable
Malignant disease of the B cellssimilar to Lymphoma . . . . . . . . . . Uninsurable
. . . . . . . . . . . . . . . . . . . . . . . . . . Uninsurable
A systemic form of vasculitis . . . . Uninsurable
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
These represent the most common uninsurable conditions you willencounter in taking an Application. There are additional, less commonuninsurable conditions that are included in the Medical ConditionsGuidelines.
Acquired Immune Deficiency Syndrome (AIDS) or AIDS
ADL/IADL Limitation—Needing Assistance or Supervision in
performing any of the following: Bathing, Bowel or BladderControl, Dressing, Eating, Transferring, Taking Medication,Toileting
Alzheimer’s Disease, Chronic Memory Loss, Frequent or
Persistent Forgetfulness, Senility, Dementia, or Organic BrainSyndrome
Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease)
Autonomic Insufficiency (Shy-Drager Syndrome)
Cancer with Metastasis (Cancer that spread from the original siteor location)
Chronic Obstructive Pulmonary Disease (COPD)
in combination with: current smoking; Congestive Heart Failure (CHF); Asthma;
or Chronic Bronchitis
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Congestive Heart Failure (CHF)
in combination with: Angina or
Heart Attack; Angioplasty or Heart Surgery; Asthma or Chronic
Bronchitis; Diabetes; Emphysema or Chronic Obstructive
Pulmonary Disease; or Tuberculosis (TB)
Congestive Heart Failure, diagnosed or symptomatic, within thepast 12 months
Current use of narcotics for any pain management
Diabetes Mellitus treated with Insulin over 50 units, or DiabetesMellitus with Peripheral Vascular Disease
Emphysema
in combination with: current smoking; Congestive
Heart Failure (CHF); Asthma; or Chronic Bronchitis
Hospitalization (currently or anticipated)
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Paralysis (Hemiplegia, Paraplegia, Quadriplegia)
Phobias, Psychoneurosis (Treated with antipsychotic medication)
Transient Ischemic Attack (TIA) within the past five years; TIA
in combination with Diabetes or any Heart Surgery; or multipleTIAs
Within the past 6 months: Open Heart Surgery; Back or Spine
Surgery
Within the past 12 months: used Home Health Care or Adult
Day Care; been medically advised to enter or has been confined
to a Nursing Home or other Long-Term Care Facility
Within the past 48 months: Cancer of the Bone, Brain,
Esophagus, Liver, Lung, Ovary, Pancreas, Stomach, or Testes
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
The following terms and definitions may be helpful in understandingunderwriting decisions:
1. Approved: Coverage is approved as applied for.
2. Approved With Modifications: Coverage is approved with reduced
benefits due to the significance of the risk. Modifications may includeone or more of the following:
If a policy is Approved With Modifications no additional BenefitIncreases should be requested for at least two years.
3. Declined: Coverage is denied. The risk is too great to approve, even
with modifications. If an Application is declined, a letter is sent to theApplicant with a copy to the producer. The reason for decline will bebriefly explained if the medical history is provided on the application.
If we are unable to give the reason for decline (because it was of asensitive nature or the medical history was not provided) and theApplicant desires additional information regarding the reason fordecline, they must write a letter to the underwriting departmentauthorizing disclosure of the information to themselves, a physician oftheir choice, or to another third party. The letter must include the nameand address of the person to whom this information should go, as wellas the Applicant’s signature and social security number.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
4. Reconsideration Offer: An offer to review another Application at some
specified later date/time. Reconsideration Offers will be made, whenappropriate, to Applicants age < 72. Applicants ages 72 – 79 will sel-dom be offered reconsideration because of greater possibility of rapidchanges and deterioration of health.
5. No Reconsideration: This message is communicated to the producer
only. There will not be an offer to review another Application at a laterdate because the risk is ongoing or cannot be predicted. “NoReconsideration” will be indicated for progressive medical conditions,medical conditions with an unfavorable prognosis and multiple med-ical conditions that combine poorly.
6. Approved As Applied For—No Increases Permitted: Coverage is
issued with the maximum benefits acceptable for this risk. If a policyis Approved As Applied For—No Increases Permitted, no requests foradditional Benefit Increases should be submitted for at least two years.
7. Appeals Process: There may be instances where the Applicant and/or
their physician have additional information that they believe mayaffect our decision. If so, the decision can be appealed by providingthe additional information accompanied with appropriate supportivedocumentation such as tests results and other clinical findings.
Underwriting will review and consider the information and respondaccordingly. Appeals should be mailed to the following address:
PrudentialAttn: LTC Underwriting—Appeals2101 Welsh RoadDresher, PA 19025
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
The Prudential Insurance Company of America, Newark, NJ
Source: http://www.cpssac.com/docs/PruUWGuide.pdf
SPORTS ROUND-UP This week’s games schedule: April 22 MS Baseball vs St. Maur at Honmoku Field Varsity Baseball vs Zama at St. Mary’s Varsity Baseball vs ASIJ at St. Mary’s HS Track – Kanto Plain Finals at Yokota Coach Molina St. Mary’s 0, Kinnick 3 Varsity Baseball split with Kinnick last Tuesday, losing the first game 0-3 but taking the second, 13-6. In the
Swine Influenza – H1N1 Virus If you are experiencing flu-like symptoms and have recently been in a known affected area, stay at home and limit contact with other people. What is swine flu? Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can
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