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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