When a client tells you, “I had breast cancer,” what is your first thought? For some agents, it may be: They probably won’t qualify for long-term care insurance. But that assumption could cause you and your client to walk away from an extended care planning opportunity before you have enough information to know whether coverage is possible.
A client’s history of breast cancer does not necessarily mean an automatic decline. The better question is, “What does the client’s complete cancer history and current health tell us about their insurability?” That’s the focus of our upcoming webinar, Underwriting Beyond the Diagnosis: Breast Cancer & Long-Term Care.
Breast Cancer Is Not One Underwriting Scenario
One of the biggest mistakes we can make in field underwriting is treating every cancer history the same. In reality, breast cancer can vary significantly by type, stage, treatment, recurrence history, and current status. A client with a remote history of early-stage breast cancer who completed treatment years ago with no recurrence presents a very different underwriting picture than someone currently undergoing treatment or with a history of metastatic disease.
That’s why asking, “Have you ever had breast cancer?” isn’t enough. Agents need to know what questions to ask next.
Read More: Why Field Underwriting Is the Key to Placing Extended Care Cases
What Does the Underwriter Want to Know?
You don’t need to become an oncologist to properly prequalify a client but understanding the information an underwriter may need can make a significant difference. The underwriting process considers:
- Type and stage of cancer
- Date of diagnosis
- Tumor grade, size, and lymph node involvement
- Treatment received and completion date
- Recurrence or metastatic history
- Current medications or treatment
- Most recent oncology follow-up
- Current functional status and other health conditions
Think of the underwriting timeline as: Diagnosis → Staging → Treatment → Completion → Follow-up → Current Status
Sometimes what matters more than the diagnosis is what has happened since.
Underwriting Red Flags and Favorable Factors
A recent diagnosis, active treatment, recurrence, metastatic disease, aggressive pathology, or significant complications may create underwriting challenges. On the other hand, early-stage disease, successful treatment, a remote history, no recurrence, stable follow-up, and good functional status may present a different picture.
And underwriting doesn’t stop with the cancer history. Age, medications, cardiovascular health, diabetes, neurological history, mobility, cognition, falls, ADLs, and other conditions can all contribute to the overall assessment. In other words, two clients with the same breast cancer diagnosis may have very different underwriting outcomes.
Traditional or Hybrid? Don’t Assume the Answer Is the Same
Traditional LTCI and hybrid life/LTC solutions may evaluate risk differently. Carrier guidelines, underwriting models, eligibility requirements, and product designs can vary.
That means agents should be careful about assuming that being declined for traditional LTCI means being declined everywhere. Before ruling out extended care coverage altogether, consider whether another carrier or product type may be worth investigating.
Putting It into Practice
During the webinar, we’ll walk through several breast cancer case studies—from a client with a remote early-stage history to clients with a recent diagnosis or recurrence.
We’ll look at the same questions agents should be asking in the field: What additional information do we need? What are the favorable and unfavorable factors? Should we consider traditional LTCI, a hybrid solution, or another approach? And most importantly: Should we prequalify this client before applying?
Prequalify. Don’t Assume.
As agents, our job isn’t to make the underwriting decision for the carrier. Our job is to gather the right information, understand the client’s circumstances, identify potential options, and use prequalification to determine the best next step.
A medical history that initially looks challenging may deserve a closer look. So, the next time a client says, “I had breast cancer,” don’t immediately think decline. Think questions. Think timeline. Think current health. Think prequalification.
Join us for Underwriting Beyond the Diagnosis: Breast Cancer & Long-Term Care, where we’ll take a deeper look at breast cancer histories, what underwriters want to know, traditional versus hybrid considerations, and case studies designed to help you identify potential LTC opportunities.
Don’t decline the client before the underwriter does. Prequalify. Don’t assume.