Underwriting for Sleep Apnea

Underwriting for Sleep Apnea

One of the common underwriting concerns we see is Sleep Apnea, which is a potentially serious sleep disorder. Essentially, it is a disorder in which breathing repeatedly starts and stops.  Millions are affected by this, with most cases being considered moderate to severe obstructive.

There are multiple types of Sleep Apnea…

  • Obstructive: Occurs when throat muscles relax
  • Central: The brain doesn’t send proper signals to the muscles that control breathing
  • Complex: Both obstructive and central Sleep Apnea

Underwriting is handled differently depending on the type of coverage…

  • Life: Commonly ranges from Standard to Table 3 when compliant with treatment plan
  • Disability: If mild, the rating can range from Table 1 or 2 to a decline.  If moderate, the rating can range from Table 2 or 3 to a decline.  If severe, non-compliant with treatment, sleep study pending, or with a history of cardiac disease, chronic lung disease, or diabetes, it will generally be a decline.
  • Medicare Supplement: To be approved, the client must be compliant with their treatment plan
  • LTC: Standard/Select rating is common for mild cases where the client is compliant and has shown a period of stability, generally for at least 3 months.  If moderate, the rating could be Standard to Individual Consideration if the client is compliant.  If severe, and the client is compliant with treatment, Individual Consideration.  If the client uses oxygen, has a sleep study pending, is non-compliant with their treatment plan, it will be a decline.

It is important to gather as much detail as possible from a client with Sleep Apnea…

  • Specific diagnosis
  • Date of diagnosis
  • Current HT/WT
  • Current medications
  • Treatment
  • Compliance with treatment
  • Any other health conditions

Typical treatment options are use of a CPAP, BiPAP, or a dental device, or in some cases, surgery is needed.

For more information, please contact Kathy Brooks with Insurance Advisors.

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