Coventry Underwriting Guidelines

 

PRODUCER’S GUIDE TO MEDICAL UNDERWRITING

Downloadable Coventry Underwriting Guidelines (pdf)

CoventryOne

Confidentiality Notice: The information contained in this Producer’s Guide to Medical Underwriting is confidential, proprietary and privileged information. This guide is intended for the sole use of agencies and agents appointed with Coventry or it’s subsidiaries or affiliates (collectively “Coventry”). Any additional use, distribution or copying of the following material is strictly prohibited.

Disclaimer: This guide replaces and / or supersedes any previous Coventry or Coventry subsidiary document or partial document that refers to CoventryOne Medical Underwriting practices. These guidelines are subject to change without notice at Coventry’s sole discretion.

 

To the extent that any provision in this guide is inconsistent with any current CoventryOne medical underwriting practices, the current CoventryOne medical underwriting practices will prevail. Only CoventryOne Medical Underwriting may make a final decision to accept or decline an applicant and determine the rate level or effective date. Agents have no authority to bind or guarantee coverage.

 

In Virginia and West Virginia, CoventryOne is a health insurance product offered through a Non-Employer Group Trust to individuals and families; it is not an individual insurance product. The CoventryOne product in West Virginia and Virginia is offered through a trust, which is sitused in West Virginia, and is not subject to Virginia insurance mandates or insurance law.

 

The following are only guidelines, comprising a statement of Coventry’s general approach to the underwriting of individual health business. This information is not considered to be a binding contract, but, rather, is provided for informational purposes only.

 

ABOUT THE PRODUCER’S GUIDE

 

Welcome! We are pleased you have selected to offer CoventryOne as one of your health care coverage options.

 

This Producer’s Guide to Medical Underwriting contains helpful answers and probable underwriting outcomes with regard to prior or existing health conditions in order to aid you in placing business with CoventryOne. It is intended only as a guide. Additional information may be available to medical underwriting that may result in a decision that is different than that presented in this guide. Therefore, this Producer’s Guide to Medical Underwriting should not be construed as a guarantee of underwriting action on any specific case. The medical underwriters’ experience and discretion is the ultimate determining factor of underwriting action toward issuance of an offer for coverage.

 

This guide does not provide product or inclusive state-specific information.

 

 

COVENTRYONE APPLICATION GUIDELINES

 

The following information is intended to highlight details of the application process most relevant to medical underwriting procedures, and should not be interpreted as a comprehensive explanation of the application process.

 

The applicant (or custodial parent/guardian if under age 18) and all dependents 18 years and older, must attest by signature that all statements and disclosures provided on the application are true and factual. Coventry does not accept agent-submitted applications that are not signed by the applicant(s) and agent, or those which are submitted by an unlicensed or non-appointed, non-contracted agent.

 

Applications are valid for 60 days from the date of the applicant(s) signature. All applicable sections must be completed, signed and dated. After 60 days from the application signature date, the application will be withdrawn from consideration and considered closed. A new application will be required after this 60 day period has expired. Coventry does not accept re-submission of the original application with updates to the signature dates.

 

Changes / corrections made to an application must be dated and initialed by the applicant.

 

The underwriting department will not accept incomplete applications. The agent will be informed that an incomplete application was received and that it must be properly completed and re-submitted before it can be processed.

 

Information on the application is considered to have been disclosed / provided by the applicant. The medical underwriters accept that the given answers are full, complete and have not been edited by the agent.

 

In the case of electronic applications, applications initiated by the agent must be sent to the client by email for electronic completion. E-signing on behalf of an applicant is illegal; if a client does not have access to email, a paper application should be used.

 

 

Completing the Application

 

Missing information slows the underwriting process. Make sure that for every “Yes” answer, there are corresponding details in the Medical Details Section and that medication information is provided. This often eliminates the need for telephone interviews, which results in quicker turnaround time and underwriting decisions.

 

Any of the following situations will result in an application being Rejected:

  • Incorrect Application
  • Missing Application Pages
  • Missing Banking Information
  • Missing Applicant Signature/s
  • Missing Broker Signature
  • Missing Date Signed

 

Top information most commonly missed for paper applications:

  • Health questions not answered
  • Details are not given for health questions with “yes” answers
  • Physician information is missing
  • Social Security number is not provided
  • Specific medication names

 

Top information missed for online applications:

  • Details are not given for health questions with “yes” answers
  • Physician information is missing
  • Specific medication names

 

 

Effective Dates

 

At the time of application, an applicant may request one of the following future effective dates depending on market:

  • Date of underwriting approval
  • 1st or 15th of the month following underwriting approval- depending on market
  • Specific day following underwriting approval

 

Market Effective Date Option
Altius (ID UT WY) Any day
Coventry Health and Life (TN MS AR) Any day
Coventry Health Care (VA WV) Any day
Coventry Health Care of Delaware (DE MD) Any day
Coventry Health Care of Florida 1st of month
Coventry Health Care of Georgia Any day
GHP (IL MO) Any day
HealthAmerica (PA OH) Any day
Coventry Health Care of Iowa (IA NE SD) Any day
Coventry Health Care of Kansas (KS MO) 1st & 15th
Coventry Health Care of Louisiana 1st of month
WellPath (NC and SC) 1st of month
Coventry Health Care Nevada Any day
Coventry Health and Life Oklahoma Any day
PersonalCare (IL) Any day

 

 

Health History

 

ALL MEDICAL QUESTIONS MUST BE ANSWERED FOR EACH APPLICANT. Please provide detailed explanatory information for each “Yes” answer indicating to whom the response refers, treating physician, detailed diagnosis, onset and recovery date and treatment, including medications. Full provider information, including full name, address, and phone number is necessary. In most cases, answers to health-related questions are not to be obtained from a third party (except in the case of applicants under the age of 18), where a custodial parent or guardian is expected to provide the information on their behalf.

 

 

Tobacco Usage

 

Tobacco usage is defined as the use of tobacco, tobacco cessation products, or e-cigarettes(electronic cigarettes) in the past twelve (12) months.

 

Each eligible person must answer on the application that he/she has or has not used tobacco, tobacco cessation products in any form, or e-cigarettes(electronic tobacco) during the past consecutive twelve (12) month period.

 

 

ELIGIBILITY

 

Age

 

Issue Age

 

Applicants must be age 64 ½ and under as of the policy effective date and not eligible for Medicare.

 

Exceptions to this may vary by market:

  • ID, UT & WY; the applicant may be older than 65 years if not eligible for Medicare
  • GA; the applicant must be 63 ½ or under as of the policy effective date
  • OH & PA; the applicant must be 65 or under as of the policy effective date

 

 

Maximum Issue Age of Dependents

 

Maximum issue age of a dependent child is 25 years.

 

Exceptions to this vary by state mandates that require coverage over age 25:

  • FL under age 30
  • IA up to age 99 if full-time student
  • OH under age 28
  • SD under age 29

 

 

 

Children-Only Health Coverage

 

CoventryOne only offers children-only coverage in a limited number of states as required by law. Applicants in these states must meet the state specific eligibility requirements and open enrollment dates in order to be considered. Contact your Market Representative for more information.

 

 

Pregnancy/Expectant Parent/Surrogate Parent/Adoption

 

CoventryOne does not offer to male or female applicants who are:

  • Applicants who are currently pregnant
  • Currently expecting a child with anyone
  • An expectant or surrogate parent
  • Applicants in the process of adopting a child

 

*Exception ID,UT & WY; will consider husband on single policy when wife is expecting

 

Applicants Age 55 or Older

 

Individuals age 55 or over who have not had a complete physical exam performed by a physician within the past three years will not be considered for coverage and their application will be withdrawn.

 

 

Residency Requirements

 

An applicant must be:

  • A legal permanent resident of the United States or
  • Have resided in the United States legally for at least 6 months and have established medical care with a physician within the United States.

 

*No short term temporary, or travel visas will be accepted. If a social security number cannot be provided, a copy of each applicant’s visa is required.

 

 

THE UNDERWRITING PROCESS

 

During the underwriting process, each applicant’s medical history is evaluated individually and action is taken based on the severity and prognosis of the disclosed condition(s).

 

Complete and accurate information is required. When reporting on a condition, applicants should consider the detailed questions that are part of the Health Condition Considerations portion of this guide. Further, medical disclosures should include:

 

  • Specific diagnoses
  • Onset and recovery date(s)
  • Medications taken or prescribed and their start/end date(s)
  • Details and results of all testing or treatment
  • Any recommended (pending) testing, procedures, or follow-up visits.

 

Final rates may be based on information, including, but not limited to, that which is submitted or obtained via:

 

  • The application
  • Telephone interviews
  • Medical records
  • Claim history
  • Prescription database searches, and / or
  • Other requests for medical information not limited to the above

 

 

Medical Underwriting Telephone Interviews

 

When underwriting identifies the need for additional information or clarification of information disclosed on the application, the applicant may be contacted directly. Please note that all telephone interviews are recorded and retained for our records. Decisions will not be discussed during the telephone interview. The process is as follows:

 

  • A call is made directly to the applicant (parent or guardian for applicants under age 18)
  • If the applicant cannot be reached, a voice message is left for the applicant (if a recording device is available) with the following information:
Name of applicant;
Name of Coventry employee or representative the applicant is to contact, and;
Instructions describing how and when the applicant is to return the call.
Underwriting makes one follow up phone call if not reached on the first attempt

No mention of the requested medical information and/or condition in question is disclosed in the voice message. Medical Underwriting will not proceed with the application process until the telephone interview is completed.

 

If no response is received after 30 days from the application signature date, the application will be closed as incomplete.

 

 

Medical Records Request

 

CoventryOne has a contracted relationship with a medical records retrieval service in order to collect necessary medical record information for selected applicants. This partnership enables CoventryOne to gather medical records in a consistent and timely manner. The vendor will act on behalf of Coventry to obtain medical records from the appropriate provider(s).

 

You now have the option to help facilitate the underwriting process by including complete medical records with the submission of the application. These records will only be accepted if they are included with the initial submission of the application and will be at the applicant’s expense.

 

In other cases, if records are not submitted with the initial application as detailed above, Coventry Health Care will follow our existing records-gathering procedure and be responsible for any associated costs up to $75.

 

Medical records requests will be limited to five (5) years of medical history unless otherwise specified. Coventry Health Care will bear the burden of any costs associated with medical record gathering up to a maximum of $75 per record request. If a provider charges an amount higher than our pre-determined maximum, the difference in cost will be the burden of the applicant. Coventry reserves the right to require individuals to be responsible for medical records retrieval costs that fall outside of accepted business practices. Coventry will not request medical records from providers or facilities residing out of the United States. Coventry reserves the right to refuse records submitted directly from an applicant or agent.

 

Medical records are required by CoventryOne for the following situations:

 

  • Any applicant age 55 and older (must have seen physician for complete physical exam within the past two 3 years)
  • Individual medical conditions, as deemed necessary, based upon sound underwriting judgment and established underwriting practices
  • Any time medical history is unclear or inadequate to make a precise determination of the risk
  • Discovery of claims history as a previously covered member under a Coventry Health Plan.

 

 

BUILD CHARTS

 

Please refer to your market’s specific rate key for rate definitions. The adult build charts are for age 16 and older.

Applicants under age 16 who are underweight or overweight will be handled on a case by case basis including investigation as to any underlying conditions.

 

Adult MALE Build Chart Adult FEMALE Build Chart
Height Standard R1 R2 Decline Height Standard R 1 R2 Decline
5′ 0″ 106-195 196-210 211-225 226 4′ 8″ 91-165 166-180 181-195 196
5′ 1″ 106-195 196-210 211-225 226 4′ 9″ 91-180 181-195 196-210 211
5′ 2″ 106-195 196-210 211-225 226 4′ 10″ 91-180 181-195 196-210 211
5′ 3″ 106-210 211-225 226-240 241 4′ 11″ 91-180 181-195 196-210 211
5′ 4″ 121-210 211-225 226-240 241 5′ 0″ 91-195 196-210 211-225 226
5′ 5″ 121-210 211-240 241-255 256 5′ 1″ 91-195 196-210 211-225 226
5′ 6″ 121-225 226-240 241-255 256 5′ 2″ 91-195 196-210 211-225 226
5′ 7″ 121-225 226-240 241-255 256 5′ 3″ 106-210 211-225 226-240 241
5′ 8″ 136-240 241-255 256-270 271 5′ 4″ 106-210 211-225 226-240 241
5′ 9″ 136-240 241-255 256-270 271 5′ 5″ 106-210 211-225 226-240 241
5′ 10″ 136-240 241-270 271-285 286 5′ 6″ 106-225 226-240 241-255 256
5′ 11″ 136-255 256-270 271-285 286 5′ 7″ 106-225 226-240 241-255 256
6′ 0″ 151-255 256-285 286-300 301 5′ 8″ 121-225 226-240 241-255 256
6′ 1″ 151-270 271-285 286-300 301 5′ 9″ 121-240 241-255 256-270 271
6′ 2″ 151-270 271-300 301-315 316 5′ 10″ 121-240 241-255 256-270 271
6′ 3″ 151-285 286-300 301-315 316 5′ 11″ 121-255 256-270 271-285 286
6′ 4″ 151-285 286-315 316-330 331 6′ 0″ 136-255 256-270 270-286 286
6′ 5″ 166-300 301-315 316-330 331 6′ 1″ 136-270 271-285 286-300 301
6′ 6″ 166-300 301-330 331-345 346
6′ 7″ 181-315 316-330 331-345 346
6′ 8″ 181-315 316-345 346-360 361

HEALTH CONDITION CONSIDERATIONS

 

The following probable underwriting actions are to be used as a general guide and should not be considered as a guarantee of coverage. Final rates and offers will be determined based on all pertinent details obtained through the application and prescription use history in addition to possible telephone interviews and medical records at the discretion of the underwriting staff.

 

We do not decline dependent applicants under age 19 or children-only applications where applicable and subject to state mandates. If a probable underwriting action listed below is “Decline” then the applicant will be offered with a Guaranteed Issue rate.

 

Exclusionary riders are only offered in situations where the condition would be declined. These riders are currently only available in the following states and a listing of the riders can be found on pages 21 & 22:

 

Arkansas Delaware Georgia Iowa Kansas

Louisiana Maryland Mississippi Missouri-KC Nebraska

North Carolina Ohio Oklahoma Pennsylvania North Carolina

Oklahoma Pennsylvania South Carolina South Dakota Tennessee

 

Please refer to your market’s specific rate key for rate definitions.

 

Medical Condition Probable Action –Non-Rider State Probable Action –Rider State
Acid Reflux / GERD/ Heartburn
Treated with OTC medication Standard Standard
Treated with prescription medication Standard – R1 Standard – R1
Acne
Treated with OTC medication Standard Standard
Treated with daily prescription medication Standard – R2 Standard – R2
Treated currently with Accutane, Claravis, Sotret orIsotretinoin Decline Decline
Alcohol Abuse
>5 years sobriety, no residuals, normal liver function,no further psychiatric intervention or medication(will require medical records) Standard Standard
< 5 years since last treatment Decline Decline
Allergies
Food allergies / Insect Stings & bites Standard Standard
Seasonal/OTC or prescription medication Standard Standard
Year-round /prescription medication Standard – R1 Standard – R1
Immunotherapy / Allergy shots monthly(Rating may be higher if on medication & shots) R1 R1
Immunotherapy / Allergy shots > monthly(Rating may be higher if on medication & shots) R2 R2
Anemia
Iron deficiency present & normal lab values orIron deficiency recovered Standard Standard
Iron deficiency present with abnormal lab values Decline Decline
Aplastic, Hemolytic, Pernicious, Sickle Cell Decline Decline
Anxiety
Medication / Therapy / Counseling Standard – R1 Standard – R1
Any hospitalization Decline Decline
Suicide attempt Decline Decline

 

Medical Condition Probable Action –Non-Rider State Probable Action –Rider State
Asthma
Exercise induced / No ongoing medication ortreatment Standard Standard
Mild through moderate on prescription medicationother than Advair Standard – R1 Standard – R1
Mild through moderate on Advair R2 R2
Severe; two or more ER visits or hospitalizations inthe past 2 years Decline Decline
Attention Deficit Hyperactivity Disorder(ADHD or ADD)
Prescription medication(other than Adderall XR , Concerta, Strattera or Vyvanse) R1 R1
Adderall XR, Concerta, Strattera or Vyvanse R2 R2
Asperger’s Syndrome Standard – R2 Standard – R2
Autism
High functioning / Attending school / Employed; noother psychological or physical issues Standard – R2 Standard – R2
All others Decline Decline
Back Sprain/Strain
No treatment in > 6 months no disk involvement Standard Standard
All others R1 – Decline R1 – Rider
Bladder/ Urinary Tract Infection (UTI)
< 4 episodes within past year Standard Standard
> 4 episodes within past year & no disease or malformations R1 R1
Chronic or Interstitial Decline Decline
Breast Cyst
Ultrasound or fine needle aspiration with benignResults Standard Standard
Present or Recurrent (stable) Decline Rider
Breast Implants
Present & no complications Standard Standard
Present & complications Decline Rider
Bunion
Present, asymptomatic, no surgery recommended orAnticipated Standard Standard
Surgically corrected & recovered Standard Standard
Present & symptomatic Decline Decline
Bursitis / Tendonitis
Single occurrence; recovered Standard Standard
Single occurrence; not recovered / Minimal treatment /No surgery recommended R1 R1
Multiple occurrences or single occurrence withextensive therapy & no surgery recommended Decline Rider
Cancer (other than Skin Cancer)
Carcinoma in situ > 2 years since recovered (will require medical records) Standard – R2 Standard-Rider
No lymph node involvement or metastasis and > 5years recovered (will require medical records) R1 – Decline R1- Rider – Decline
Lymph node involvement or metastasis Decline Decline

 

Medical Condition Probable Action –Non-Rider State Probable Action –Rider State
Carpal Tunnel Syndrome
Operated & recovered Standard Standard
Unoperated & conservative treatment/ Asymptomatic> 1 year Standard Standard
Unoperated & conservative treatment< 6 months Decline Rider
Unoperated & conservative treatment6 months – 1 year R1 R1
Operated & Not Recovered Decline Rider
Cataracts
Surgically corrected & recovered Standard Standard
Present Decline Rider
Chiropractic Treatment
Diagnosed & treated < 1 year R1 R1
Diagnosed & treated > 1 year ago & maintenancetherapy only Standard Standard
Chlamydia
Recovered Standard Standard
Present or under treatment Decline Decline
Cholesterol – Elevated
Well controlled & under 250 total cholesterol Standard – R2 Standard – R2
Well controlled & Hypertension R1 – R2 R1 – R2
Total cholesterol 251-275 R1 – Decline R1 – Decline
Total cholesterol > 275 Decline Decline
Elevated cholesterol with 2 or more cardiacco-morbidities (ratable build, tobacco use,hypertension, any other cardiac concerns) Decline Decline
Cleft Palate or Cleft Lip
Surgically corrected, no further surgery anticipated& > 2 years since surgery Standard Standard
Speech therapy R1 R1
All others Decline Decline
Cochlear Implant
Implant present Standard Standard
Implant anticipated or pending Decline Decline
Colon Polyps
Removed & benign, < 4 polyps & colonoscopyadvised 5-10 years Standard Standard
Removed & benign , < 4 polyps & colonoscopyadvised 2-5 years R1 R1
Unoperated polyps / 4 or more polyps removed /Colonoscopy advised < 2 years/ Malignant polyp/Familial adenomatous polyposis Decline Decline
Concussion
> 1 year since recovered Standard Standard
6 months – 1 year since recovered R1 R1
3 – 6 months since recovered R2 R2
< 3 months since recovered Decline Decline
Congenital Heart DefectsAtrial Septal Defect/ Patent Foramen Ovale/Ventricular Septal Defect
Surgically corrected or spontaneous closure noresiduals > 1 yr Standard Standard
Not surgically corrected Decline Decline
Surgically corrected or spontaneous closure < 1 yearor with residuals Decline Decline

 

Medical Condition Probable Action –Non-Rider State Probable Action –Rider State
Cyst / Growth / Lump / Mass / Tumor
Removed & Benign Standard Standard
Present R1 – Decline R1 – Decline
Deep Venous Thrombosis (DVT)
Superficial, 1 episode & recovered Standard Standard
Deep & 1 episode > 4 years ago Standard Standard
Deep & 1 episode 2-4 years ago R2 R2
Deep & present/ Within 2 years/Currentanticoagulation therapy/ Multiple episodes Decline Decline
Depression – Non Major Depressive Disorders / Therapy / Counseling
Non Major Depressive Disorders /Medication/Therapy / Counseling R1FL – Standard R1
Any hospitalization Decline Decline
Suicide attempt Decline Decline
Deviated Nasal Septum
Surgically corrected & recovered Standard Standard
Present & asymptomatic Standard Standard
Present & symptomatic Decline Rider
Diverticulitis
Surgically corrected > 1 year Standard Standard
Multiple attacks > 2 years /treated non-surgically R1 R1
One attack < 1 year or multiple attacks < 2 years Decline Rider
Present or <1 year since surgically corrected Decline Rider
Diverticulosis
Asymptomatic Standard Standard
Symptomatic Decline Rider
Drug / Substance use or Dependency
>5 years since last use (will require medical records) Standard Standard
< 5 years since last treatment Decline Decline
DUI
Single citation or conviction & > 2 years sinceConviction Standard Standard
Single citation or conviction <2 years sinceConviction Standard-Decline Standard-Decline
Multiple citations or convictions Decline Decline
Ear Infections
< 3 episodes within 1 year Standard Standard
> 3 episodes within 1 year R1 R1
Ear Tubes present Standard Standard
Eating Disorder
> 5 years since last treated with normal build Standard Standard
< 5 years since last treated Decline Decline
Eclampsia / Preeclampsia
With subsequent pregnancy – no complications nofurther eclampsia/ Tubal ligation / Hysterectomy /Over 45 years of age Standard Standard
All others Decline Decline
Eczema
OTC medication Standard Standard
Prescription medication R1 – R2 R1 – R2
Phototherapy / Botox treatment Decline Decline
Medical Condition Probable Action –Non-Rider State Probable Action –Rider State
Endometriosis
> 5 years since last symptoms & treatment Standard Standard
Surgery > 3 years no further treatment Standard Standard
Surgery < 3 years R1 R1
Present or within 5 years of non-surgical treatment Decline Rider
Epilepsy – Grand Mal
> 2 years since last seizure R2 – R3 R2 – R3
< 2 years since last seizure Decline Decline
Epilepsy – Jacksonian
> 2 years since last seizure R2 – R3 R2 -R3
< 2 years since last seizure Decline Decline
Epilepsy – Petit Mal
> 1 year since last seizure R1 – R2 R! – R2
< 1 year since last seizure Decline Decline
Esophageal Stricture Decline Rider
Fibromyalgia
Mild – only 1 medication R1 – Decline R1 – Decline
All others Decline Decline
Fractures / Broken Bones
Present, non-weight bearing R1 R1
Leg or Ankle fracture present Decline Decline
Hip Fracture > 18 months no underlying disease Standard Standard
Hip Fracture < 18 months no underlying disease Decline Rider
Spinal fracture recovered <1 year Decline Rider
Spinal fracture recovered > 1year Standard –R2 Standard – R2
Spinal fracture present Decline Decline
Recovered (non hip or spine) Standard Standard
Recovered (temporary fixation device) Decline Rider
Pathological Decline Decline
Gallbladder Disorders
Gallbladder removed & recovered from surgery Standard Standard
Gallstones present Decline Decline
Cholecystitis > 6 months since last attack & nogallstones Standard Standard
Cholecystitis < 6 months since last attack Decline Decline
Genital Herpes Standard-R1 Standard – R1
Genital Warts
Low Risk HPV Standard Standard
High Risk Decline Females: RiderMales: Decline (no rider available)
Gestational Diabetes
1 occurrence & normal glucose testing no othersignificant conditions Standard Standard
>1 occurrence /pregnancy & most recent pregnancywith no recurrence Multiple occurrences with mostrecent no recurrence of condition Standard Standard
All others Decline Decline
Glaucoma
Surgically corrected Standard Standard
Present, well controlled with eye drops R1 –R2 R1-R2
Present, not well controlled Decline Decline
Gonorrhea
Recovered Standard Standard
Present Decline Decline
Gout
Normal build, no history of kidney stones R1 R1
All others Decline Decline
Medical Condition Probable Action –Non-Rider State Probable Action –Rider State
Hearing Loss (See cochlear implant if applicable) Standard Standard
Heartburn Standard-R1 Standard-R1
Heart Murmur
Innocent / Functional / Grade I or II Standard Standard
Organic / Grade III or greater / Continuous Decline Decline
Hemorrhoids
> 1 year since symptomatic or surgically corrected Standard Standard
Present & asymptomatic / Treated with OTC medsonly / No other treatment Standard Standard
Present & symptomatic / Severe or recurrent / Treatedwith prescription medication < 1 year R2 R2
Hepatitis A
> 6 months recovered with normal liver testing Standard Standard
< 6 months since treated Decline Decline
Hernia (other than hiatal)
Surgically corrected Standard Standard
Present > 5 years & asymptomatic Standard Standard
Present < 5 years Decline Decline
Hiatal Hernia
Surgically corrected Standard Standard
Present & controlled with prescription medication R1 R1
Present & not controlled with prescription medication Decline Rider
Hip Dislocation
Congenital & surgically corrected Standard Standard
Congenital & present Decline Rider
Non-congenital & no surgery required > 1 year Standard Standard
Non-congenital & no surgery required < 1 year R1 R1
Hip – Replacement Decline Rider
Human Papilloma Virus (HPV)
Low Risk HPV Standard Standard
High Risk Decline Females: RiderMales: Decline (no rider available)
Hypertension / High Blood Pressure
Well controlled by medication > 3 months Standard-R1 Standard –R1
< 3 months since diagnosis Decline Decline
Hypertension & 2 or more cardiac co-morbidities (ratable build, tobacco use, elevated cholesterol, any other cardiac concerns) Decline Decline
Uncontrolled or more than 3 medications to control Decline Decline
Infertility Treatment: Female & Male
> 2 years since last attempt Standard Standard
< 2 years since last attempt (both primary & spouse) Decline Decline
Internal Fixations (pins/plates/screws)
Permanent Standard Standard
Temporary Decline Rider
Insomnia
OTC medication Standard Standard
Prescription medication Standard – R1 Standard – R1
Irritable Bowel Syndrome
OTC medication Standard Standard
Prescription medication Standard – R1 Standard – R1
Kidney Infection / Nephritis
Single episode recovered with normal urinalysis &blood pressure > 1 year Standard Standard
Single episode recovered with normal urinalysis &blood pressure < 1 year Decline Rider
Chronic / Multiple attacks Decline Decline
Medical Condition Probable Action –Non-Rider State Probable Action –Rider State
Kidney or Bladder Stones
1 episode > 1 year Standard Standard
1 episode < 1 year R1 R1
Multiple episodes < 1 year Decline Rider
Multiple episodes 1-3 years since last episode R1 R1
Multiple episodes & recovered > 3 years Standard Standard
Any of the above with history of Gout Decline Decline
Knee – Ligament Injury
Tear, surgically corrected > 1 year Standard Standard
Tear, surgically corrected < 1 year Decline Rider
Tear, not surgically corrected / No anticipated surgery Decline Rider
Non-tear / recovered < 1 year R1 R1
Non-tear/recovered > year Standard Standard
Not recovered Decline Rider
Multiple occurrences Decline Rider
Knee – Meniscus Injury
Surgically corrected > 1 year Standard Standard
Present / Surgically corrected < 1 year Decline Rider
Knee – Replacement Decline Rider
Lyme Disease
Recovered > 6 months Standard Standard
Present/ < 6 months since recovered /Persistent orrecurrent symptoms Decline Decline
Macular Degeneration
Early Dry Macular Degeneration Standard Standard
Advanced Dry Macular Degeneration Decline Decline
Wet Macular Degeneration Decline Decline
Menopausal Disorder Standard-R1 Standard-R1
Mental Retardation will require telephone interview and possible medical records Standard-Decline Standard-Decline
Migraine / Chronic Headaches
Controlled with OTC meds Standard Standard
Controlled with prescription medication (rating basedon frequency of headaches & treatment) R1-R2 R1-R2
Severe /Not controlled with medication Decline Rider
Miscarriage
1-3 occurrences Standard Standard
>3 occurrences – testing not completed, cause notdetermined Decline Decline
Mitral Valve Prolapse (MVP)
No treatment (other than antibiotics for medicalprocedures) & no arrhythmia, endocarditis ormoderate to severe mitral regurgitation Standard Standard
Medication (other than antibiotics) & no arrhythmia,endocarditis or moderate to severe mitral regurgitation R1 – R2 R1 – R2
Arrhythmia/ History of endocarditis/Moderate to severe mitral regurgitation Decline Decline
Osteoarthritis
Back / Hip / Knee – mild or moderate R1 – R2 R 1- R2
Back / Hip / Knee – severe Decline Decline
Non- Back / Hip / Spine – mild or moderate R1 – R2 R1 – R2
Non- Back / Hip / Spine – severe Decline Decline
Osteoporosis or Osteopenia
Current use of prophylactic medications only R1 – R2 R1- R2
Reclast Injection 1 time per year Standard Standard
Reclast Injection > 1 time per year Decline Decline
Injections other then Reclast Decline Decline
Severe history of pathologic fractures Decline Decline
Medical Condition Probable Action –Non-Rider State Probable Action –Rider State
Ovarian Cyst
Removed or resolved > 1 year Standard Standard
Removed or resolved < 1 year R1 R1
Present > 1 year with no growth or changes R1 R1
Present < 1 year Decline Rider
PAP smear – Abnormal
ASCUS / LGSIL followed by two normal consecutivepap smears – no high risk HPV Standard Standard
HGSIL / Severe dysplasia treated & followed bytwo normal consecutive pap smears no high risk HPV R1- R2 R1- R2
Any abnormal pap without a normal follow up Decline Decline
Pelvic Inflammatory Disease (PID)
Single occurrence & recovered Standard Standard
Multiple Occurrences > 2 years R2 R2
Present Decline Rider
Multiple occurrences < 2 years Decline Rider
Phlebitis
One episode recovered > 1 year Standard Standard
One episode recovered < 1 year or multiple episodes Decline Rider
Ongoing anti-coagulant therapy Decline Decline
Plantar Fasciitis Standard Standard
Premenstrual Syndrome
On prescription medication Standard – R1 Standard – R1
Prostate disorder / Benign Prostatic Hypertrophy (BPH)
Surgically corrected > 1 year Standard – R1 Standard – R1
Unoperated & asymptomatic with normal PSA Standard – R1 Standard – R1
Unoperated & PSA 4.0 – 9.9 with negative biopsy> 3 years Standard – R1 Standard – R1
Unoperated & PSA 4.0- 9.9 with negative biopsy2 -3 years R2 – R3 R2 – R3
Surgically corrected < 1 year R2 – R3 R2 – R3
Unoperated & PSA 4.0- 9.9 with negative biopsy< 2 years Decline Rider
Prostatitis
Acute/Resolved > 1 year Standard Standard
Acute/normal PSA/<1 year R2 R2
Chronic or abnormal PSA Decline Decline
Prosthetic Devices
Eye > 1 year Standard Standard
All others Decline Decline
Psoriasis
Controlled with prescription medication R1 – Decline R1 – Decline
Phototherapy Decline Decline
Psoriatic Arthritis Decline Decline
Rotator Cuff Tendonitis / Bursitis / Impingement Syndrome
> 1 year since last occurrence & complete recovery Standard Standard
Present or < 1 year since last occurrence Decline Decline
Rotator Cuff Tear
Surgically corrected > 1 year Standard Standard
Surgically corrected < 1 year R2 R2
Present Decline Decline
Scoliosis
Present/no treatment/asymptomatic Standard Standard
Surgically corrected Standard Standard
Present/symptomatic/current treatment (PT, bracing,surgery recommended) Decline Decline
Cardiac, pulmonary or spinal cord involvement Decline Decline

 

Medical Condition Probable Action –Non-Rider State Probable Action –Rider State
Sinus Infection
> 2 years since last occurrence Standard Standard
< 4 episodes within the past 1 year Standard Standard
> 4 episodes per year within the past 2 years Decline Rider
Surgery anticipated Decline Decline
Skin Cancer
Basal Cell Carcinoma
Single occurrence, removed > 2 years ago Standard Standard
Single occurrence, removed < 2 years ago R1 R1
Multiple occurrences R2 R2
Present Decline Decline
Melanoma- will require pathology report and follow-up information
Removed (Clark’s Level I or In Situ) > 5 years Standard Standard
Removed (Clark’s Level I or In Situ) 2 – 5 years R1 R1
Removed (Clark’s Level II) > 5 years R1 R1
Removed (Clark’s Level III) > 7 years R2 R2
Present or removed (Clark’s Level IV or V) Decline Decline
Removed (Clark’s Level I or In Situ) < 2 years Decline Decline
> 1 occurrence in past 10 years Decline Decline
Sleep Apnea
Surgery performed, recovered Standard Standard
No co-morbidities (tobacco use/ratablebuild/hypertension), CPAP used, controlled symptoms Decline Rider
With any co-morbidity (tobacco use/ratablebuild/hypertension) Decline Decline
Central or mixed Decline Decline
Spinal Fusion
Asymptomatic >1 year R1 R1
Asymptomatic < 1 year Decline Rider
Symptomatic/ Physical Therapy/ Medication required Decline Rider
Syphilis
Recovered > 1 year Standard Standard
Present or < 1 year from date of treatment Decline Decline
Temporomandibular Joint Disorder (TMJ)
No coverage contractually Standard Standard
Asymptomatic & no treatment Standard Standard
Surgically corrected & recovered Standard Standard
Symptomatic Decline Rider
Testosterone Deficiency/Hypogonadism
No adrenal or pituitary disorder & treated withmedication or injections R1- R3 R1 – R3
Caused by adrenal or pituitary disorder Decline Decline
Thyroid Disorder – Goiter
Surgically corrected with normal thyroid function> 1 year Standard Standard
Surgically corrected with normal thyroid function< 1 year R1 R1
Present & normal thyroid function <1 year Decline Rider
Present & normal thyroid function >1 year R2 R2
Abnormal thyroid function Decline Decline
Thyroid Disorder – Hyperthyroidism
Surgically corrected/Completion of radioactiveiodine/ Controlled with thyroid medication& thyroid levels controlled Standard Standard
Present & controlled Standard Standard
Present & not controlled Decline Rider

 

Medical Condition Probable Action –Non-Rider State Probable Action –Rider State
Thyroid Disorder – Hypothyroidism- Controlled Standard Standard
Thyroid Disorder – Thyroiditis
Recovered & thyroid levels controlled Standard Standard
Present Decline Rider
Tics / Tremors Rating-Decline Rating-Decline
Tonsillitis
< 3 episodes a year Standard Standard
3-5 episodes a year R2 R2
> 5 episodes a year Decline Decline
Ulcer – Peptic
1 episode; recovered Standard Standard
History of bleeding or perforation > 2 years &recovered Standard Standard
> 1 episode & well controlled with medication R1 R1
History of bleeding or perforation < 2 years Decline Decline
Uterine Bleeding – abnormal / Dysfunctional Uterine Bleeding
Recovered/no surgery/no medication Standard Standard
Hysterectomy or D & C/ recovered Standard Standard
Hysterectomy or D & C/not recovered Decline Rider
Present & complete work up /ruled out otherconditions Decline Rider
Present & no work up Decline Decline
Uterine Fibroids
Hysterectomy or removal procedure & recovered Standard Standard
Present or hysterectomy/removal procedure & not recovered Decline Rider
Uterine Prolapse
Surgically corrected Standard Standard
Present Decline Rider
Vaginal Prolapse
Surgically corrected Standard Standard
Present Decline Rider
Varicose Veins – Legs
Present & asymptomatic Standard Standard
Surgically corrected or treated > 1 year Standard Standard
Surgically corrected or treated < 1 year R1 R1
Ventricular Tachycardia
> 2 years since treated Standard Standard
< 2 years since treated Decline Decline
Wolff-Parkinson White Syndrome (WPW)
Cardiac ablation > 1 year; recovered Standard Standard
Cardiac ablation < 1 year Decline Decline
Present Decline Decline

EXCLUSIONARY RIDER LISTING

 

An applicant requiring more than three exclusionary riders will be declined
Exclusionary riders are permanent unless otherwise state mandated
No exclusionary riders will be offered on applicants under age 19

 

Exclusionary riders are currently only available in the following states:

 

Arkansas Delaware Georgia Iowa Kansas

Louisiana Maryland Mississippi Missouri-KC Nebraska

North Carolina Ohio Oklahoma Pennsylvania North Carolina

Oklahoma Pennsylvania South Carolina South Dakota Tennessee

 

Exclusionary Rider Exclusionary Rider Verbiage
Breasts Breasts, Both: Any disease or disorder of both breasts/the right breast/the left breast or surgical implants of both breasts/the right breast/the left breast, including metastases, including any treatment or testing for, or operation for or any complications thereof.NOT APPROVED: HAPA , KC, LA, MD, NC, OK & SC
Carpal TunnelSyndrome Carpal Tunnel Syndrome: Carpal Tunnel Syndrome of both/right/left wrists, including any treatment or testing for, or operation for or any complications thereof.
Cataracts Cataracts, Both/Right/Left Eye(s): Cataract(s) of both/the right/the left eye(s), including but not limited to any treatment or testing for, or operation for or any complications thereof.]
Cervical Spine Cervical Spine: Any injury to, disease or disorder of the cervical spine, including but not limited to the vertebrae, intervertebral discs, surrounding ligaments and muscles, lumbosacral and sacroiliac articulations, complicating sciatic neuritits, radiculitis, and any treatment or testing for, or operation for or any complications thereof. NOT APPROVED: LA
Cesarean Section Cesarean Section: Cesarean section, including any treatment or testing for, or operation for or any complications thereof.]NOT APPROVED: HAPA, KC, LA, & MD
Diverticulitis/Diverticulosis Diverticulitis and Diverticulosis: Diverticulitis and Diverticulosis of the small intestine, large intestine and colon including but not limited to any treatment or testing for, or operation for or any complications thereof.NOT APPROVED: OK
Endometriosis Endometriosis: Endometriosis or any disease or disorder of the abdominal or pelvic organs due to endometriosis, including but not limited to adhesions and any treatment or testing for, or operation for or any complications thereof.NOT APPROVED: KC
Female Reproductive Organs Female Reproductive Organs: Any disease or disorder of the female reproductive organs, including but not limited to any treatment or testing for, or operation for or any complications thereof. NOT APPROVED: KC, LA & MD
HeadachesMigraine Headaches Headaches and Migraine Headaches: Headaches and migraine headaches, including any treatment or testing for, or operation for or any complicationsthereof. NOT APPROVED: OK
Heart BurnAcid RefluxGERDEsophagitis Heart Burn, Acid Reflux, GERD, Esophagitis: Heart burn, acid reflux, GERD (Gastro Esophageal Reflux Disease), Barrett’s Esophagitis disease or disorder of the esophagus, esophageal sphincter, and stomach including but not limited to any treatment or testing for, or operation for or any complications thereof. NOT APPROVED OK
Hiatal Hernia Hiatal Hernia: Hiatal hernia, including but not limited to any treatment or testing for, or operation for or any complications thereof. NOT APPROVED: HAPA
Hip Hips, Both/Right/Left: Any disease, injury or disorder of both/the right/the left hip(s) and the associated bones, tendons and ligaments including any treatment or testing for, or operation for or any complications thereof. NOT APPROVED: LA
Internal Fixation of Bones Internal Fixation of Bones: Any internal fixation of bones (for example; pins, screws, plates and braces) including the insertion of, removal of, any treatment or testing for, or operation for or any complications thereof.
Kidney Kidneys, Both/Right/Left: Any disease or disorder of both/the right/the left kidney(s) or urinary tract, including kidney stones, and renal failure, including any treatment or testing for, or operation for or any complications thereof.NOT APPROVED: LA & OK
Knee Knees, Both/Right/Left: Any injury to, disease or disorder of both/right/left knee(s), including but not limited to the associated bones, tendons and ligaments including any treatment or testing for, or operation for or any complications thereof. NOT APPROVED: LA
Lumbosacral spine Lumbo-Sacral Spine: Any injury to, disease or disorder of the lumbo-sacral spine, including but not limited to the vertebrae, intervertebral discs, surrounding ligaments and muscles, lumbosacral and sacroiliac articulations, complicating sciatic neuritits, radiculitis, and any treatment or testing for, or operation for or any complications thereof. NOT APPROVED: LA
Nasal Nasal/Sinus/Deviated Septum: Any disease or disorder of the sinuses, nasopharyngeal tract, and accessory sinuses, including but not limited to sinusitis, nasal polyp(s), and deviated septum and any treatment or testing for, or operation for or any complications thereof.
Prostate Prostate: Any disease or disorder of the prostate, including but not limited to, the seminal vesicles, urinary bladder or urethra, including any treatment or testing for, or operation for or any complications thereof.NOT APPROVED: KC, LA, MD, OK & SC
Sleep Apnea- no co-morbidities Apnea, Sleep Apnea: Any diagnostic study, treatment or testing for, or operation for or any complications resulting from but not limited to, sleep apnea, obstructive apnea, central apnea, hypopneas.NOT APPROVED: OK
Temporomandibular Joint Temporomandibular Joint (TMJ): Any misalignment of the upper or lower teeth and/or improper positioning of how the jaw bone connects to the skull, including temporomandibular joint, its associated tendons, ligaments, musculature, including any treatment or testing for, or operation for or any complications thereof.NOT APPROVED: GA, HAPA, IA , KC, MD, NC, OK & SD
Tendonitis/Bursitis Tendonitis, Bursitis: Tendonitis, bursitis, including any treatment or testing for, or operation for or any complications thereof.
Thoracic Spine Thoracic Spine: Any injury to, disease or disorder of the thoracic spine, including but not limited to the vertebrae, intervertebral discs, surrounding ligaments and muscles, lumbosacral and sacroiliac articulations, complicating sciatic neuritits, radiculitis, and any treatment or testing for, or operation for or any complications thereof. NOT APPROVED: LA
Thyroid Thyroid: Any disease or disorder of the thyroid gland including but not limited to; Goiter, Hyperthyroidism, Hypothyroidism, and thyroiditis and any treatment or testing for, or operation for or any complications thereof. NOT APPROVED: OK
Varicose Veins Varicose Veins: Varicose veins, varicose or stasis ulcer, phlebitis, including any treatment or testing for, or operation for or any complications thereof

AUTO DECLINE MEDICATIONS

 

Any applicant taking one or more of the medications listed below within the past year will be ineligible for coverage.

This is not an all-inclusive list and is subject to change.

 

Abilify Fentanyl Leukeran Remicade
Accutane Flolan Lithium Remodulin
Actigall Forteo Lovenox Retrovir
Actoplus Met Fuzeon Lupron Rilutek
Actos Gabapentin Marinol Risperdal
Agrylin Galantamine Metaglip Rythmol
Amaryl Genotropin Metformin Saizen
Amevive Genotropin Intra-Mix Methadone Saizen Click.Easy
Amnesteem Genotropin Miniquick Methotrexate Sandimmune
Amodapine Geref Methylprednisolone Sandostatin
Antabuse Gleevec Morphine Sulfate In Dextr Sandostatin Lar Depot
Apokyn Glimepiride Ms Contin Seroquel
Appformin Glipizide Neoral Serostim
Arava Glucophage Neurontin Somatuline Depot
Aricept Glucotrol Nitro-Bid Somavert
Arimidex Glucovance Nitroglycerin Soriatane
Aromasin Glyburide Nitroglycerin In 5% Dextr Sotret
Asacol Haldol Nitroquick Stelazine
Ascendin Heparin Norditropin Suboxone
Atripla Heparin Combination Norditropin Cartridge Symbyax
Avandamet Heparin Sodium Dcu Norditropin Nordiflex Pen Synagis
Avandaryl Heparin Sodium/D5w Novantrone Synarel
Avandia Hepsera Novolog Mix Synvisc
Avinza Herceptin Nutropin Tamoxifen
Avonex Humalog Nutropin Aq Targretin
AZT Human Growth Hormone Nutropin Aq Pen Tev-Tropin
Baraclude Humatrope Nutropin Depot Therapentin-90
Betaseron Humatrope Combo Pack Octreotide Acetate Thorazine
Cellcept Humira Olanzapine Tracleer
Claravis Humulin Omnitrope Tranxene SD
Clozaril Hyalgin Oxsoralen-Ultra Tranxene SD
Combivir Increlex Oxycodone/Acetaminophen Trizivir
COMBUNOX Insulin Oxycodone/Aspirin Truvada
Copaxone Insulin Pump Oxycontin Tysabri
Coumadin Iplex Plaquenil Urso
Crixivan Isotretinoin Plavix Ursodiol
Cytovene Ivig Prednisone Viread
Dostinex Janumet Prograf Warfarin
Duetact Januvia Prolastin Xolair
Duragesic Kadian Protropin Xyrem
Enbrel Kaletra Rapamune Zelnorm
Epivir Kineret Raptiva Ziagen
Epzicom Lamictal Razadyne Zorbtive
Faslodex Lamotrigine Rebif Zydis
Lantus Regranex Zyprexa

 

 

 

 

AUTO DECLINE CONDITIONS

 

Listed below are the most common conditions that result in a decline of coverage.

This is not an all-inclusive list and is subject to change.

 

A

Achalasia

Achondroplasia

Acromegaly

Addison’s Disease

Adrenal Gland Disorders

Adrenal Insufficiency

AIDS

Alport Syndrome

Alzheimer’s Disease

Amputation (s) due to disease

Amyloidosis

Amyotrophic Lateral Sclerosis (ALS)

Aneurysm

Angina

Angioplasty

Ankylosing Spondylitis

Anticardiolipin Syndrome

Anticoagulant Therapy

Antiphospholipid Syndrome

Aortic Arch Arteritis

Aortic Insufficiency / Stenosis/ Regurgitation

Aplastic Anemia

ARC

Arnold-Chiari Malformation

Arterial Embolism (clot)

Arterial Occlusion

Arteriosclerotic Heart Disease

Arteriovenous Malformation (AVM)

Arteritis

Artificial Heart Valve

Ascites

Ataxia Telangiectasia

Atherosclerosis

Atrial Fibrillation

 

B

Banti’s Disease

Barrett’s Esophagus

Behcet’s Syndrome

Berger’s Disease /IgA Neohropathy

Biliary Cirrhosis

Bipolar Disorders

Blood Clot

Brain Aneurysm

Brain Attack

Brain Hemorrhage

Bright’s Disease

Bruit

Buerger’s Disease

Bypass Surgery

 

 

C

Cachexia

Cancer- lymph node/metastasis

Cardiac Decompensation

Cardiac Defibrillator

Cardiac Hypertrophy

Cardiac Pacemaker

Cardiac Risk Factors (3 of the following; overweight/ tobacco usage/ elevated cholesterol or triglycerides/hypertension)

Cardiac Stent

Cardiomegaly

Cardiomyopathy

Carotid Artery Disease

Cerebral Hemorrhage

Cerebral Embolism/Thrombosis

Cerebral Palsy

Cerebrovascular Accident

Cerebrovascular Disease

Charcot-Marie-Tooth Disease

Chronic Granulomatous Disease

Chronic Interstitial Cystitis

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Renal Failure

Cirrhosis

Coarctation of Aorta

Collagen Vascular Disease

Congenital Heart Anomalies-present

Congenital Lymphedema

Congestive Heart Failure

Coronary Artery Bypass Surgery

Coronary Artery Disease

Coronary Heart Disease

Coronary Insufficiency

Coronary Ischemia

Coronary Stent

Cor Pulmonale

CREST Syndrome

Crohn’s Disease

Cushing’s Disease

Cyclothymic Disorder

Cystic Fibrosis

 

D

Dementia

Demyelinating Diseases

Dermatomyositis

Diabetes (other than gestational)

Down Syndrome

Dysmetabolic Syndrome

 

 

 

E

Embolism

Emphysema

Encephalopathy

Esophageal Varices

 

 

F

Factor Deficiencies

Familial Polyposis

Fatty Liver

Fragile X Syndrome

Friedreich’s Ataxia

 

G

Gastric Bypass

Gastric Lap Banding

Gastric Stapling

Gender Identity Disorder

Gender Reassignment

General Paresis

Generalized Scleroderma

Glomerulonephritis, chronic

 

H

Heart Attack

Heart Block

Heart Bypass Surgery

Heart Disease

Heart Enlargement/Hypertrophy

Heart Failure

Heart Pacemaker

Heart Transplant

Heart Valve Replacement

Hemiplagia

Hemochromatosis

Hemophilia

Hepatitis B

Hepatitis C

Hepatomegaly

HIV

Hodgkin’s Disease

Human T-Cell Leukemia / Virus

Huntington’s Chorea

Hydrocephalus

Hyperparathyroidism

Hyperpituitarism

Hypersplenism

Hypertensive Nephropathy

Hypoparathyroidism

Hypoplastic Anemia

Hypoplastic Left Ventricle Syndrome

 

I

Idiopathic Thrombocytopenic Purpura

IgA Nephropathy

Immune Deficiency Disorder(s)

Intermittent Claudication

Intestinal Bypass

Ischemic Heart Disease

 

J

Juvenile Rheumatoid Arthritis

 

K

Kahler’s Disease

Karposi’s Sarcoma

Kidney Transplant

Klinefelter’s Syndrome

 

L

Left Ventricular Hypertrophy

Legg –Calve Perthes Disease

Leiomyosarcoma

Leukemia

Leukoencephalopathy

Liver Enlargement

Liver Transplant

Lou Gehrig’s Disease (ALS)

Lung Transplant

Lupus Erythematosus, Systemic

Lymphoblastoma

Lymphoma

Lymphomatoid Papulosis

 

M

Malabsorption Syndrome

Manic Depression /Manic Disorders

Marfan’s Syndrome

Medullary Cystic Kidney

Medullary Sponge Kidney

Metabolic Syndrome

Microcephaly

Mitral Insufficiency

Mitral Stenosis

Multi-cystic Kidney

Multiple Myeloma

Multiple Sclerosis

Muscular Dystrophy

Myasthenia Gravis

Myelitis

Myelocele

Myeloma

Myelopathy

Myocardial Infarction

Myocardial Ischemia

 

N

Nephrosclerosis

Nephrotic Syndrome

Neurofibromatosis

Neurogenic Bladder

Niemann-Pick Disease

 

O

Organ Transplant Recipient

Osteogenesis Imperfecta

 

P

Pacemaker, Heart

Paget’s Disease

Pancreatitis, Chronic

P (continued)

Paraplegia

Paralysis

Parkinson’s Disease

Peripheral Artery Disease

Peripheral Neuritis

Peripheral Vascular Disease (PVD)

Personality Disorders

Pituitary Disorder

Pituitary Dwarfism

Pneumocystis/ Pneumocystosis

Poliomyelitis

Polyarteritis

Polycystic Kidney Disease

Polycystic Ovarian Disease /Syndrome

Polycythemia Vera

Polyglandular Autoimmune Syndrome

Polyneuritis

Polyneuropathy

Pregnancy

Psoriatic Arthritis

Psychosis

Psychotic Disorders

Pulmonary Embolism or Thrombosis

Pulmonary Fibrosis

Pulmonary Heart Disease

Pulmonary Hypertension

Pulmonic Insufficiency

Pulmonic Stenosis

Pyogenic Arthritis

 

Q

Quadriplegia

 

R

Reflex Sympathetic Dystrophy

Regional Enteritis

Reiter’s Disease / Syndrome

Renal Agenesis

Renal Dialysis

Renal Hypertension

Renal Insufficiency

Respiratory Failure

Retinopathy

Rhabdomyosarcoma

Rheumatic Heart Disease

Rheumatoid Arthritis

 

S

Sarcoidosis

Sarcoma

Schizo-affective Disorders

Schizophrenia

Scleroderma

Shunt

Sick Sinus Syndrome

Sickle Cell Anemia

Sjogren’s Disease / Syndrome

Still’s Disease

Stroke

Sturge-Weber Syndrome

Suicide Attempt

Syndrome X

Syringomyelia

System Lupus Erythematosus

Systemic Sclerosis

 

T

Tetralogy of Fallot

Thalassemia Major

Thrombocythemia

Transient Ischemic Attack (TIA)

Transplants – organ

Transposition of Great Vessels

Tricuspid Atresia

Tricuspid Insufficiency /Regurgitation/Stenosis

Trisomy 21 Syndrome

Turner’s Syndrome

 

U

Ulcerative Colitis

Ulcerative Proctitis

 

V

Valve Disorder, Heart

Valve Replacement, Heart

Vascular Hemophilia

Vascular Insufficiency

Ventricular Arrhythmias

Ventricular Fibrillation or Flutter

Von Willebrand Disease

 

W

Wegner’s Granulomatosis

Weight Reduction Surgery/ Gastric Bypass / Lap Band /Stapling

Wilson’s Disease