How a Left Or Right Bundle Branch Block is Seen by Life Insurance Underwriters When Applying

The human heart has an electrical conduction system that controls when each part of the heart contracts. When part of the system has slow or blocked conduction it is called a heart block. The electrical impulse that for a heart beat is initiated at the SA node causing the atrium to contract and follows pathways to the AV node. From the AV node the impulse travels through the left and right bundles that stimulate the ventricles to contract pumping blood out of the heart. In less than 1% of the population there is a conduction problem in the left or right bundle that shows up on an EKG. What physically happens is that the left and right ventricles are a little out of sync instead of contracting at the same time.

50% of bundle branch blocks (BBB) are caused by coronary artery disease. They can also be caused by trauma, hypertension, fibrosis, congenital lesions, tumors and cardiomyopathy. And, sometimes they occur in a heart with no known abnormalities.

If the cause of the BBB will affect the mortality of the patient, the underwriter will need to address the cause to determine a fair price for the insurance. For example if the BBB was caused by a heart attack, the question should be how will the heart attack affect the price of insurance as it is more of a concern than the BBB.

If an applicant has an isolated finding of a BBB with no known heart disease or history of changing EKG patterns we expect to find the following rates or better.

• For incomplete right bundle branch block (IRBBB) no extra rating.
• For complete right bundle branch block (CRBBB) no extra rating.
• For left anterior or posterior hemiblock (LAHB or LPHB) no extra rating.
• For a complete left bundle branch block (CLBBB) or for a complete right bundle branch block with a left hemiblock (Bifascicular block) under age 40 150% of standard, age 40 and over 175% of standard.

Time since discovery can change the rating. For example for a person who would have been charged 175% of the standard rate soon after discovery of a CLBBB could pay only 150% of standard after 3 years and have no rating after 6 years. Of course this assumes that the CLBBB was stable over that time with no other cardiovascular impairments. Having a current normal thallium stress test could result in a reduced rating as well.

The treatment of a person with this or other medical history varies enormously from insurance company to insurance company. It is difficult to shop for life insurance as individual companies don't publish rates for people with medical histories. An experienced agent will ask for informal quotes from all companies that we believe may give our customers their best rate regarding their specific medical history. That way the customer gets his personal best quote without getting an official rejection or rating, which stays on their record for life.

Dan Johnson has been in the Life Insurance industry for 30 years, and as the President of RescueQuote Insurance, strives to make the most of your insurance dollar every day. Visit http://www.rescuequote.com for more articles and free instant quotes for your life insurance needs.

Health Insurance and Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder, more commonly referred to as ADHD is classified as a chronic neurological condition that can manifest in many observable ways including an innate affinity or propensity for impulsivity and inability to pay attention. The patient diagnosed with ADHD has obstructive difficulty with even minimal focus of concentration, and engaging in passive activities, or both simultaneously. Although ADHD is present at birth, diagnosis before the ages of 4 and 5 is difficult unless a child exhibits severe or prominent symptoms. Some patients, however are not diagnosed until they reach adulthood. The disorder occurs in an estimated 8% of adolescent school children within The United States and according to The National Institute of Health this figure is expected to grow exponentially.

There is a lot of controversy regarding ADHD when it comes to major medical health insurance. Some plans cover the condition while others do not and yet some will consider providing coverage under very specific guidelines or stipulations.

This article was created to assist interested applicants with proper preparation to obtain a health insurance plan that will cover the treatment of ADHD without endorsing limitable riders or attached exclusions written on the policy when placed and issued.

In the individual private healthcare market ADHD specialty coverage is categorized under mental health treatment benefits so generally speaking as a guideline any plan excluding mental health related benefits will not provide coverage for ADHD. Most plans specifically exclude ADHD coverage altogether in their schedule of benefits so be especially prudent when considering a plan and ask your broker to quote you only on plans that do.

Now that we have the worst behind us there is some good news. First, most states have enacted mental heath parity laws to cover ADHD if a proposed applicant is approved, so if the health insurance company approves an application after an initial medical underwriting review screen then they have to provide coverage for ADHD. The federally mandated states which are applicable for the individual private healthcare market constitute of Alabama, California, Connecticut, Delaware, District of Columbia, Georgia, Indiana, Kansas, Maine, Maryland, Massachusetts, Minnesota, Missouri, Montana, Nevada, New Jersey, Ohio, Oklahoma, Rhode Island, South Dakota, Vermont, Washington, and West Virginia.

Secondly, if the applicant is domiciled in a resident state not enlisted above and a plan covering treatment of ADHD has been applied for, it is imperative to prepare for the ensuing interrogative underwriting questionnaire screening. There are basically three underwriting concerns with ADHD and preparation with underwriters is vitally paramount or key to obtain a successful outcome.

(1) The first concern is that there is a high incidence of depression with ADHD. Depression carries its own underwriting risk. In addition, stimulants have been known to increase the severity of depression, which could pose a cumulative risk for co-morbid conditions.

Tip: Insurance companies are very skeptical about approving an application on behalf of an applicant with a diagnosis of certain anxiety disorders or depression. The confusion relies on the fact that medications currently being used to treat ADHD are all considered "off label" treatment, meaning its clinical utilization has not been approved by the United States Food and Drug Administration. These prescriptions include stimulant preparation such as Ritalin, Concerta, Metadate, or Adderal as well as non-stimulant medications including Wellbutrin, Effexor, and Strattera which are commonly used to treat depression. If any of these drugs are being used, clarification to the health insurance underwriter along with notes from the physician about their role in treating ADHD and not depression will aid tremendously. At present, the only medication that looks like it will have official approval by the FDA for the treatment of ADHD is Strattera.

(2) The second concern is that there is a motor vehicle driving risk with ADHD. This includes a higher risk for fatal accidents, casualties, and more citations for speeding or reckless driving.

Tip: Statistically ADHD is associated with an increased risk for hazardous accidents, collisions, and fatalities. Stimulant treatment along with immediate release Methylphendiate has demonstrated to improve driving performance and neuropsychological functioning. A clean driver record along with a written prescription from a licensed practitioner of medicine has worked well for medical clearance in underwriting decision making.

(3) The third concern is that there is a higher incidence of substance abuse present with ADHD. This includes an early onset of chemical addiction, a longer frequent period of induced intoxication, and a lower rate of recovery.

Tip: There is statistical epidemiologic data indicating that ADHD and substance abuse coexist or occur together more frequently than chance alone. In some aspects studies have found the root of this problem may be linked to overtly being overmedicated to stimulants therefore cultivating neurotransmitters to the drugs addictive properties. This one is tough to beat, health insurance underwriters reserve the right to request a paramedical examination if there is reason to have suspicion. In this case consider detoxification protocols several days before an application is submitted. There are numerous methods of accomplishing this and proving the information here may be beyond the scope of this article but at least now there is sufficient time for preparation.

If you or someone you now is diagnosed with ADHD and is experiencing a difficult time obtaining health insurance at reasonable prices or conditions because of this, please visit our website at http://www.health-insurance-buyer.com and leave your contact information so one of our licensed agents can help you.

Carlos Diez is a senior benefits consultant for Health Insurance Buyer a referral service that refers consumers to the insurance carriers that can best fit their wants and needs. He holds life, health, and annuity licenses in 48 states and is appointed with over 88 carriers. For contact information please reach him at http://www.health-insurance-buyer.com

Life Insurance Underwriting - An Overview

Life insurance underwriting is about risk assessment just as life insurance is about risk management. The premise for underwriting does not arise from the mere existence of risk, but from the reality that all risks are not equivalent. Since the premium level is associated with the risk level, life insurance underwriting is necessary to review each risk so that the insurer could apply a commensurate premium.

Underwriting in a general sense is concerned with the insurer's risk selection. Insurers employ life underwriters to review life insurance applications. However, insurance agents or sales representatives often do the initial underwriting- hence, they are referred to a 'field underwriters'. The insurer trains 'field underwriters' to ensure that only suitable risks are referred to the insurer's underwriting department for consideration.

Life insurance underwriting is based on the hazards presented by an applicant. Physical hazards, moral hazards and occupational hazards are just some of the risk areas examined. Physical hazard refers to conditions of the body that increase likelihood of the insured's death. Moral hazard refers to the likelihood that the applicant may be seeking to gain unlawfully, speculate on the life of another or otherwise act dishonestly in applying for the policy. Based on the hazards present, underwriting can be subdivided into groups.

Medical underwriting

This type of underwriting can take place with or without medical examinations. Sometimes the underwriter requires a combination of warranties and representations from the applicant and medical tests. This depends of the applicant's age and coverage sought typically. Information such as family history and personal medical history will be sought in this phase.

Occupation/Lifestyle underwriting

The underwriter also requires basic information about activities undertaken for employment or enjoyment. Risky jobs include the armed services, pilots and construction. Activities that are considered hazards include racing and skydiving for instance. Lifestyle considerations may also include sexual orientation and drug use. Non-disclosure of such activities may constitute misrepresentation that can lead to an insurance contract being modified or cancelled.

Financial underwriting

Financial underwriting involves the policy owner and insured (if the two are different persons). It is used to detect moral hazard and also to ensure that persons don't speculate on their own lives by taking out far more insurance than they are worth. A person, who takes out a large policy on the life on his or her spouse, while having a small amount of life insurance themselves, will raise eyebrows. Financial underwriting broadly states that no one should seek individual life cover more than 30 times their income without justifying it.

Major underwriting factors

Life insurance underwriters must use the information to assess the risk of loss (death) of a particular applicant. This is not done by a whim, but by placing the applicant in a risk group that is defined by a specified rating system. Information about age, height, weight, occupation, hobbies, medical condition, finances and medical history (personal and family) is used to classify an applicant according to risk. The questions on a life insurance application and non-medical form are designed to uncover warranties and representations necessary for the underwriting process.

Underwriting action

Once a life insurance application is reviewed, it is then assessed in terms of the risk posed by the applicant. The proposed insured is classified into one of four risk groups:

a) Standard risk- This is the 'normal' rating.

b) Substandard risk- Can be accepted but at a higher premium rate.

c) Declined risk- This is a risk that it too high for the insurer to accept

d) Preferred risk- One that is granted a premium lower than the standard rate.

The result of life insurance underwriting is that an application is declined, deferred or accepted. With a deferral, the underwriter temporarily refuses to accept the policy until a particular condition is addressed. The applicant is free to reapply once the condition of concern is addressed. Once a policy is accepted, it can be accepted at a higher rate, standard rate or preferred rate.

Life insurance underwriting is about safeguarding the insurer against anti-selection (the tendency of high risk groups to actively seek insurance). It also allows the insurer to select suitable risks in order to prevent guaranteed underwriting losses. Underwriting also serves to ensure that the insurer charges a premium that is related to the level of risk presented. Although some persons view the underwriting process cynically, it ensures that the risk that insurers accept is insurable.

High Blood Pressure and Health Insurance Underwriting

Hypertension is an intermittent or sustained elevation of diastolic or systolic blood pressure. If left untreated hypertension can attribute directly as major predicator of stroke, cardiac disease, and renal failure. Complications occur late in the disease and can attack any susceptible organ system. Cardiac complications include coronary artery disease, angina, myocardial infarction, heart failure, arrhythmias, and sudden death. Neurologic complications include cerebral infarctions and hypertensive encephalopathy. Hypertensive retinopathy can cause blindness. Renovascular hypertension can lead to renal failure. There are basically three separate classifications utilized to categorize prognosis.

The Three Phases of Blood Pressure Readings,

(1) Pre-hypertension is classified as systolic blood pressure greater than 120 but less than 140 mm Hg or diastolic blood pressure greater than 80 but less than 90 mm Hg.

(2) Stage 1 Hypertension is classified as systolic blood pressure greater than 139 but less than 160 mm Hg or diastolic blood pressure greater than 89 but less than 100 mm Hg.

(3) Stage 2 Hypertension is classified as systolic blood pressure greater than 159 mm Hg or diastolic blood pressure greater than 99 mm Hg.

What Underwriters are concerned with.

The cause of essential hypertension is unknown. Family history, race, stress, obesity, a diet high in sodium or saturated fat, tobacco, hormonal contraceptives, excess alcohol intake, sedentary lifestyle, and aging have all been studied extensively to determine their role in the progressive development of hypertension.

Because of the multitude of co-morbidities which are prevalent during progression of a hypertensive condition, insurers are hesitant to issue a policy on a proposed applicant. This article was intended to assist applicants diagnosed with hypertension or high blood pressure in obtaining a approval for a health insurance policy in the individual private healthcare marketplace at standard rates.

Although essential hypertension has no cure, drug therapy and diet or lifestyle modification can systematically control it. Generally, nondrug treatment is attempted first, especially in early mild cases. If this proves ineffective, treatment progresses to include various types of antihypertensive measures. Treatment for a patient with secondary hypertension includes correcting the underlying origin and stabilizing hypertensive effects. Severely elevated blood pressure or a hypertensive crisis may be refractory to medications and may be fatal.

Health insurance underwriters are essentially concerned with the intermittent stages of a progressive hypertensive condition and consequently interrogate an applicant to determine propensity for his or her risk. The following are questions commonly asked during the underwriting screening and useful tips for proper preparation.

Health Insurance Underwriting Questions and Tips.

(1) Does the applicant smoke?

Tip: Habitual smokers who are hypertensive are often insurable. However, smoking only adds cumulatively to the potential negative prognosis of hypertension even if systolic and diastolic pressures are under control. Consider eliminating cigarettes or tobacco prior to application submission. If a paramedical examination is requested a urinalyses can only detect presence of nicotine for three days after ingestion or consumption. The body metabolizes or breaks nicotine levels down within 72 hours. Life insurance policies have a 2 year contestability period to contest the validity of a claim upon death and may find out about the smoking, however for health insurance companies underwriting a hypertensive case, this transparent difference in smoking or not smoking can be a matter of eligibility to be covered if at all.

(2) When was the applicant diagnosed with hypertension?

Tip: Hypertension that is not well controlled meaning a reading that is greater than 140/90 with one or both numbers is a lethal condition. It can lead to heart attack, stroke, and kidney failure. The longer an applicant has hypertension that is poorly controlled, the greater possibility of a target organ being affected such as heart, brain, kidneys, or liver damage. Knowledge of when the applicant was initially diagnosed with hypertension is the first stage of the risk assessment process. If the diagnosis dates back several years the underwriter might request an attending physician statement from the general practitioner. If documentation is readily available demonstrating the previous three visits show blood pressure to be controlled then providing this information during application submission will aid tremendously not only in reference to approval but rate pricing as well.

(3) What are the medications that the applicant is currently taking?

Tip: With hypertension if the blood pressure can not be kept in the normal range with a single medication then a second prescription is usually added. If a combination of prescribed drugs result in failure to preserve a normal range than a third one is added. The more medicated the applicant is as far as treatment, the more severe the hypertensive prognosis is and more likely some form of irreparable damage will develop in major organs. Simply put, if one medication has the same effect as two or three it would be prudent to ask the prescribing physician to consider utilizing a single treatment for underwriting purposes.

(4) Has the applicant had any previous hyperactive complications such as heart disease, TIA, stroke, or kidney problems?

Tip: Hypertension is officially classified as a form of heart disease. The cardiac complications of hypertension could very well include angina, heart attack, coronary angioplasty, coronary artery bypass surgery or heart failure. It is important for a health underwriter to know the intricate details of any possible complications to accurately assess risk. If an applicant has a medical history involving hospitalization for the cardiovascular system in conjunction with hypertension a declination with most major medical carriers is the most probable underwriting decision. If that is the case, consideration of guaranteed or simplified issue plans would be worth entertaining.

(5) Has the applicant undergone any form of cardiac testing?

Tip: The biggest concern with a hypertensive applicant is the potential for heart disease. Applicants who have undergone cardiac testing such as an exercise treadmill with good results may qualify for preferred rates. If documentation is available indicative of the applicants responsiveness to exercising performance, providing such data upon application submission will greatly improve a final underwriting decision making process.

(5) Has the applicant undertaken any lifestyle changes to treat his or her hypertension?

Tip: Weight loss, exercise, low fat diet, and reducing alcohol intake all have beneficial effects on blood pressure. Any of these lifestyle changes also have a positive impact on underwriting decisions. If such information is available from a counselor, dietician, nutritionist, clinician, or any other licensed professional that can attest to this, a certified letter remarking on physical improvement will also expedite and benefit towards the underwriting decision.

If you or someone you know is having a difficult time obtaining an approval for major medical health insurance or receiving standard rating because of high blood pressure, please visit our website at http://www.health-insurance-buyer.com and leave your contact information. One of our licensed agents will contact you to provide the solution.

Carlos Diez is a senior benefits consultant for Health Insurance Buyer a referral service that refers consumers to the insurance carriers that can best fit their wants and needs. He holds life, health, and annuity licenses in 48 states and is appointed with over 88 carriers. For contact information please reach him at http://www.health-insurance-buyer.com