RetirementGuard

Brown University

Long-Term Care Underwriting

The process of reviewing your health status to determine whether you will qualify for coverage is called 'underwriting.' You must answer health questions on an application. Depending on your age and /or your health status, the insurance company may request additional information from your physician. If you have any questions about your health and qualifying for coverage, please call RetirementGuard toll free at 888.793.6111. Your questions will be handled confidentially.

Self-Screening Questionnaire

To help you determine whether you are likely to be accepted for coverage, we suggest that you review this Self-Screening Questionnaire before you apply.

  1. Do you currently, and on an ongoing basis, need or use assistance or supervision of another person or need mechanical aids such as a cane, crutches, a wheelchair, or a walker in performing any of the following activities?
    • Bathing
    • Eating
    • Transferring from bed or chair
    • Controlling bowel or bladder
    • Taking Medication
    • Walking
    • Dressing
    • Toileting

     Yes  No

  2. Are you currently confined to a hospital or nursing home, or are you receiving adult day care services, paid or unpaid home health care services, or at-home physical, occupational, speech, or respiratory therapy?

     Yes  No

  3. Within the past 24 months have you been diagnosed with, received medical advice or treatment from a physician or other health care professional for, or had any known indication of, any of the following?
    • Arthritis treated with Gold or Methotrexate
    • Heart attack
    • Cancer (not local skin cancer)
    • Schizophrenia
    • Chronic lung disease (e.g. emphysema) requiring oxygen
    • Transient ischemic attack (TIA)
    • Diabetes (Insulin)

     Yes  No

  4. Within the past 5 years have you been diagnosed with, received medical advice or treatment from a physician or other health care professional for, or had any known indication of, any of the following?
    • Alzheimer's disease / dementia / memory loss
    • Leukemia (Chronic lymphocytic)
    • Pancreatitis (chronic)
    • Cardiomyopathy
    • Multiple sclerosis
    • Parkinson's disease
    • Cerebral palsy
    • Muscular dystrophy
    • Pulmonary fibrosis
    • Chronic kidney disease requiring dialysis/renal failure
    • Myasthenia gravis
    • Spinal cord injury/paraplegia/quadriplega
    • Chronic liver disease/cirrhosis
    • Obesity
    • Stroke
    • Lou Gehrig's disease (ALS)
    • Organ or bone marrow transplant

     Yes  No

  5. Within the past 5 years, have you been medically treated for or diagnosed as having either Acquired Immune Deficiency Syndrome (AIDS) or AIDS-Related Complex (ARC)?

    ARC, is a condition with signs and symptoms which may include generalized lymphadenopathy (swollen lymph nodes), loss of appetite, weight loss, fever, oral thrush, skin rashes, unexplained infections, dementia, or other psychoneurotic disorders with no known cause.)

     Yes  No

If you answered YES to any of the above questions, you will not be able to obtain insurance at this time. In addition, co-morbid situations involving several health problems may result in not being able to obtain insurance. Should you have questions please call 888-793-6111. We will respond to your questions with extreme confidentiality.

In addition the insurance company is primarily interested in the following information:

  1. Do you have any limitations in activity? How far can you walk without resting or having pain in your extremities? Do you have any difficulty climbing stairs?
  2. Do you use an assistive device, such as a cane, walker, etc?
  3. Have you had any recent falls? Any falls within the last two years?
  4. Do you have any significant illnesses, such as cancer, heart disease, diabetes or any hospitalizations that we have not discussed?
  5. Are you currently being treated for any medical condition? If yes, what is that condition?
  6. How often do you see your doctor? When did you last see your doctor?
  7. Does your doctor feel your condition is stable? (An example of an unstable condition would be a response such as "my doctor would like to see my blood pressure lower.")
  8. What medications are you currently taking?
  9. Have you had any recent medication changes?
  10. Do you see any specialists? If yes, for what reason?
  11. What is your height and weight?
  12. Have you been advised to have surgery which has not been performed?

Again, please call 888.793.6111 if you would like to discuss your health profile prior to scheduling an appointment or applying for insurance.

Who Cares? Kiplinger's No-Nonsense look at long-term care -- and how to pay for it. A 22 Minute Video from Kiplinger (this may take a few seconds to load)

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