Congenital Cardiac Patients and Insurance

Season: 2003
Submitted By: Jeanine Harrison (with special thanks to Dr. Ross Mackenzie)

Thinking about Insurance for life, disability, mortgage or health. This article should help you to understand how your cardiac condition will effect getting insurance.

Can I get Insurance?
Companies usually assess cardiac patients on an individual case basis. It is not an easy process for the patient or the company to determine if and what insurance policy can be offered.

What Type of Insurance will I need?
Many different types are available but the ones we will discuss are: Health, Disability and Life. These are offered in many different forms by many different companies and are not the only types available. Health insurance is usually not possible for congenital patients who need regular follow up. Disability insurance (income replacement insurance) is usually given to those with non-medical needs and is not easy for cardiac patients to obtain. The best chance for congenital cardiac patients to get health or disability coverage is through group programs where they do not conduct individual assessments.

The remainder of this article will be focused on Life insurance.

How do they decide Life Insurance?
Companies usually use a ratio created by the number of deaths (mortality) at each age in the general population and then compare that to the number of deaths at each age in the population with a specific medical condition. So, if the number is the same in both groups then the ratio is 100%.

If there were 3 times the number of deaths in the group with the medical condition then the ratio would be 300%. Companies charge a premium (a payment) based on this rating system and that payment increases about 90% with every added 100% in mortality. They also provide ratings for a person’s sex and smoking status.

What should I look for in a company?
Most large companies have manuals with a rating system that help the insurance agents with straight forward cases. Any variation, like a medical condition, is called an IC or individual case.

Companies do not always view condtions the same and one company may turn down a client while the other will accept a client. You should find company that offers all of the types of insurance you might need. It will be easier to add an insurance policy to an existing account then to have to begin shopping around again. Find an insurance agent who is willing to fully understand your individual case. The representative should spend extra time to be sure that you are appropriately covered and they should give detailed information about the potential problems that could arise with your policy.

Is there an age that you should get insured?
If you are reading this article then you should probably be insured. Definitely for congenital cardiac patients it is wise to seek insurance at a young age. This allows you to take time and find the insurer that is right for you.

As you age, depending on your individual situation you may encounter difficulty in obtaining a policy. If you do obtain an assessment and rating the premium (payments) will certainly be higher if you start looking for a policy at an older age.

How can my Cardiologist help?
Your cardiologist will advise you on your likeliness of being insurable. The cardiologist can also help the insurance company to understand your individual case. Your insurance company may request information from your Cardiologist and this can be provided with your approval. This will allow the insurance company to accurately evaluate your individual insurability. The more information they have may mean you don’t need to do a lot of extra tests

How do I know if my condition is one of the ones that will not get life insurance?

  • Ask your cardiologist.
  • Few companies provide written rates for those over 300% mortality ratio. Most complex congenital conditions are therefore assessed individually.
  • If your mortality ratio is greater than 500% most companies will not offer you an insurance policy
  • If you are turned down by one company that does not mean you will be turned down by another or if you are turned down at 30 you may be accepted at 50.

How Do I begin?

  1. Internet: Use the Internet to review companies and their policies.
  2. Ask companies to mail you their complete information so you can review it.
  3. Review larger firms, as they are more likely to be able to accept higher risk clients.
  4. If you suspect that the company is going to turn you down. Pull your application Most companies ask if you have been turned down before.
  5. Use the CACHNET website – patient bulletin to communicate with other congenital patients and get their experiences.

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