Schmalberg Associates  

A Value-Added Broker: Long-Term Care, Disability Income, Life Insurance & Annuities

We Appreciate Your Business and Always Work Hard for You!

 State Licensed and Authorized Agent

Call Today!  (718)467- 3860    Fax: (718)467- 3864

Insurability Questions

The purpose of this page is twofold.

First to inform the consumer that the cost of waiting to purchase long-term care insurance does not only mean the older the purchase age the larger the premium.  In addition, as a person ages she or he also faces the risk of developing medical conditions that may not allow preferred rates, may impose a sub-standard rating, may only allow the purchase of a sub-standard policy and in some cases may cause the person to have difficulty obtaining coverage.

Secondly, we want to stress that even when a person has undesirable health problems, we exert the maximum effort to provide each client with coverage.  There are many options available and we will always do our best for you.

Please contact us if you would like us pose borderline or clarification health issues to the underwriters.  All inquiries will be handled in the strictest confidence.  Call us at (718) 467-3860 or if you prefer you can reach us via our on-line Helpdesk form or e-mail us at helpdesk@schmalberg.com. 

Instrumental Activities of Daily Living (IADLs)

Some carriers may not extend standard coverage to applicants seeking LTC insurance who cannot perform the Instrumental Activities of Daily Living (IADLs), while other carriers have more lenient underwriting guidelines and will issue standard full-coverage policies.  Our value-added services include guiding each of our clients to the appropriate carrier with the underwriting guidelines that best match the need of the client.  The following is a list of the IADLs:

• Using the telephone

• Managing finances

• Taking transportation

• Shopping

• Preparing/cooking meals

• Laundry

• Housework

• Taking all medications

Activities of Daily Living (ADLs)

Generally, long-term insurance carriers will not extend standard coverage to an individual that needs assistance in performing any of the following Activities of Daily Living (ADLs).

• Transferring in/out of chair or bed

• Bathing

• Dressing

• Eating

• Toileting

• Continence

• Ambulating (walking)

The following is a partial list of other conditions for which carriers may not issue standard long-term care insurance policies:

• An individual that resides in a nursing home or assisted living facility; or is receiving home health care services or attending adult day care.

• Alzheimer’s disease, organic brain syndrome, dementia, frequent or persistent forgetfulness, mental retardation, or senility.

• Parkinson’s disease or syndrome, multiple sclerosis, amyotrophic lateral sclerosis (Lou Gehrig’s disease) or muscular dystrophy.

• Stroke or any other type of cerebral vascular accident (CVA) or transient ischemic attack (TIA): (a) within the last five years; (b) with residual impairment; (c) with multiple events; or (d) in combination with diabetes, circulatory or heart disease, or tobacco use.

• Cancer with metastasis; or cancer treated in the past 24 months with chemotherapy, radiation, surgery or bone marrow transplant (except basal cell cancer, or early stage of breast or prostate cancer).

• Cirrhosis of the liver.

• Emphysema, chronic obstructive pulmonary disease or any chronic respiratory disease, in combination with smoking.

• Congestive heart failure for which the individual is currently being treated (including treatment by medication).

• Diabetes with amputation or complications affecting the kidney.

• Schizophrenia; or any other mental or nervous disorder for which the individual has been hospitalized in the past two years or has had multiple hospitalizations.

• An individual that has had or been advised by a physician to have an organ transplant.

• An individual that uses a walker, wheelchair or respirator.

• An individual that is currently receiving dialysis or oxygen treatment.

• An individual that has been treated for or diagnosed as having an Immune Deficiency Disorder, AIDS (Acquired Immune Deficiency Syndrome), ARC (AIDS related complex) or any AIDS related condition.

However once a long-term care policy has been issued, should the insured later be diagnosed with any of these conditions and consequently require long-term care assistance, the insured will be entitled to benefits in accordance with the terms set-forth in the policy.

Furthermore, it is important to note that should an individual submit an application for LTC insurance coverage with the minimum agreed upon premium deposit and receive a Conditional Premium Receipt, then any changes to the applicant’s health after the date of this receipt will not affect the underwriting decision.  This means that as of the date of the application, should the carrier determine that the applicant is insurable based on their underwriting criteria and standards for the insurance coverage applied for, then the policy will take effect retroactively on the date that the application was signed.

Notice:  All information on this site is subject to change without notice.

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