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Welcome to the Gen
Re SOURCE for Long Term Care
Underwriting!
S
tandard
O
f
U nderwriting
and
R
isk
C
lassification
E
xpertise
Dynamic
Manual: This
manual has been developed for Long Term Care clients of Gen Re
LifeHealth.
We
have specifically designed this manual to help manage risk in
a maturing product line. In the past, most LTC manuals were
based on either the mortality model or the clinical model. In
the mortality model, one essentially adapted the tools of life
insurance underwriting to manage the risk. This meant that the
contract was usually issued in its most generous form,
declined, or in some cases issued with an additional
rating.
In
the clinical model, significant emphasis was placed on
impairment underwriting. This often meant focusing on the
individual diagnosis, but frequently at the expense of
ignoring other comorbid issues or lifestyle factors.
This
manual builds on past successes by offering numerous
underwriting factors and risk management criteria in an effort
to help determine the most appropriate offer for any given
applicant for long term care insurance. As with all Gen Re
LifeHealth manuals, the impairments listed will be
evaluated and updated on a regular basis based on research and
emerging experience. This is made possible by leveraging the
latest in internet delivery technology.
Whereas Gen Re LifeHealth strives to make
our manuals as informative and comprehensive as possible, it
would be impossible to develop guidelines for every
conceivable medical condition. Absence of guidelines for an
impairment, except for minor, self-limited conditions with
full recovery (e.g., colds, sprains), is in no way intended to
imply insurability. These conditions should be thoroughly
evaluated using sound underwriting and medical judgement and
referred to our underwriters for facultative
consultation.
Assumptions: There are a number
of items that should be emphasized prior to utilizing this
manual. The most important is that this manual was developed
to be used as a GUIDELINE, not a set of rules. By no means
does this manual replace sound underwriting judgement and
experience.
When
developing this manual, it was important to determine which
triggers we should assume in establishing guidelines. It was
determined that the standard guidelines established for
tax-qualified products, 2 of 6 ADLs or Cognitive Impairment,
would be the most appropriate. Should your product use other
triggers such as medical necessity, 1 of 6 ADLs, or IADLs, we
counsel you to keep that in mind when utilizing the published
guidelines. (A more conservative approach may be appropriate.)
Contract terms such as cash indemnity payments vs.
reimbursements may also affect the risk
considerably.
It
should also be noted that, in writing this manual, decisions
were made assuming the traditional (ages 65-75) long term care
consumer. Some of the guidelines have included age-specific
decisions. For those that do not, the underwriter will need to
apply their risk management judgement in determining if the
youth or advanced age of the applicant is a favorable or
unfavorable factor for the given
impairment.
The
format of this manual was designed to both guide the less
experienced underwriter towards the important factors and
considerations needed to arrive at an appropriate decision,
and to aid the experienced underwriter by offering factors
that will help with the most difficult of decisions.
Most
impairments are broken down into a number of categories. These
are intended to help broaden the scope of thought, while
narrowing the qualifying criteria categories.
Using
this manual: There are two ways in which
impairments may be searched for. The most common manner is to
click on the button to the left and to type in the word or
phrase that you wish to evaluate. This will search the entire
text of this manual and provide the underwriter with a list of
pages containing that entry to choose from. The second option
is to click on the Index button to the left. This will
link to a list of chapters, which will in turn link to a list
of impairments in each chapter. It is important to note that
since the function scans the entire text, it will be far more
comprehensive than the index function.
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