Specifics of Underwriting Requirements:

As a Producer, be sure your client is aware that a Phone Interview, Medical Records Review, Face to Face Assessment and Medical Exam may be required. The best indicator of the requirements for your client will be in the Underwriting Guide for the carrier(s). It is important for the Producer to realize that underwriters are part of the team and can be utilized to answer questions prior to taking an application.

Phone Interview - Personal History Interview (PHI)
The goal of the telephone interview is to learn more about the applicant and make the most informed decision about their application, and in most instances eliminate the need to contact the applicant’s primary care physician for medical records enabling a quick and efficient underwriting process.

This is an assessment interview conducted by a nurse or trained examiner and is part of the underwriting process for most applications, especially older applicants. The underwriter will determine when and if it is necessary and schedule the phone interview. This interview takes about 15 -30 minutes. To save time during the interview ask your client to have the following available:

current medications
names of physicians
dates of any surgeries or hospitalizations
paper and pen to make notes for recall

It is also important to advise your client to take this telephone interview seriously and cooperate with the caller.

Medical questions such as height, weight, or blood pressure would be examples of questions asked during telephone interviews. Specific questions related to ADLs, such as, “Does you, the applicant, have difficulty dressing?” will be asked on every interview. The interview may also include some cognitive tests. Normal health status might not require a review of medical records, depending on the age of the applicant, but would probably require a telephone interview. If the information obtained from a telephone interview does not match the information on the application, medical records or a face to face assessment may be required by the underwriter.

Medical Records Request – Attending Physician Statement (APS)
All applications for individual LTCi plans require the applicant’s signature to release medical records for underwriting review, depending on the age of the applicant and conditions noted on the application. The underwriter will determine when and if the record review is necessary and order copies of the records. The APS is a copy of an applicant’s medical records obtained by the insurer from a treating physician and is requested routinely for applicants age 65 and older and at younger ages for cause. An APS may be required from not only the attending physician but physicians or specialists involved in past or recent treatments.

Face to Face Interview – (F/F)
Sometimes called an in-person health interview by a health professional and is conducted in the applicant’s residence. This is often required by the underwriter based on the age of the applicant or health conditions on the application, and is used to gather information regarding current functionality and cognition. This interview will include questions about daily activities and a brief cognitive exercise or memory test. The interview takes approximately 1 hour and consists of several categories of questions and observations:

Paramedical Exam
This exam by a health professional consists of a series of questions related to an applicant’s medical history and can include a check of one’s height, weight, pulse, blood pressure and sometimes a urine sample. This exam is normally required for older applicants who have not had a complete physical exam by a physician within the last 2-3 years or medical records are not available. This exam may be performed in instances where the applicant is a self-treating physician or the applicant’s family member is their physician.

If abnormalities are notes on the exam, coverage will normally be postponed until they can be addressed and treated or resolved by a physician. Follow-up to the exam will usually be at the applicant’s expense.

Medical Exam
In rare cases an underwriter may request the applicant to have a physical exam. If the applicant has not seen a physician in the last 2-5 years, the underwriter will usually schedule a physical exam at the applicant’s or carrier’s expense.

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