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AARP Prostate Cancer Case

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This case study is a Canadian who wanted to know his eligibility for individual insurance with AARP

AARP is a Florida individual health insurance plan underwritten by Aetna and promoted by AARP.  It is a much better policy than the one from last year offered by United health care.  Their underwriting is much more lax and they are willing to entertain cases like these.

 AARP Florida health insurance quotes

Gender: M
Age: 59

Height (Feet): 5
Height (Inches): 8
Weight (lbs): 182
Smoker: No

Family Member: Primary Applicant
Diagnosis or Condition: Prostate Cancer 5 yrs ago
Medication: None
Details: He had prostate cancer 5 yrs ago, completely recovered, they caught it very early on and he has not had treatment nor medications in the last 5 yrs (this November 4th)/ His PSA tests are perfect, just had one in September with .45 reading.

 

This is an AARP prospect is a Canadian citizen and although he and his wife live here, he does work in Toronto 1 week every month and does not have permanent resident status in the US.

 

If he has had all his medical exams performed in Canada would he need to have a paramedical exam or a physical with a US provider or can he submit medical records from Canadian provider?

 

He currently has Great West Life, a supplement to OHIP (National Canada coverage) through a business policy – would this be considered creditable coverage? And finally, kindly advise if he would be eligible for coverage and at what risk category with AARP?

 

He had prostate cancer 5 yrs ago, completely recovered, they caught it very early on and he has not had treatment nor medications in the last 5 yrs (this November 4th)/ His PSA tests are perfect, just had medical exam performed in September and PSA reading was .45. Since AARP only performs a 5 year look back – would he be able to not provide these details regarding the prostate condition since there has not been any treatment performed in the last 5 years as of the 5th of November

 

Answer  a

 Florida Health Insurance Broker Opinion 

 Regarding the residency requirements with relation to your eligibility with AARP you would need to have one of the following documents that would suffice as being proof of residency, that is, medical records, mortgage or rental documents, utility bills, or employment in USA (although I know that you work in Toronto and does not apply to you).

 

Your prior coverage through Great West can be considered creditable coverage as long as it’s a full medical plan and not a short term policy; as far as I understood I am almost certain your plan is not a short term policy since it is through a business but I did want to relay all information I obtained from AARP/Aetna.

 

With regards to your medical history, we would just need to indicate the details of your last physical exam on the application accordingly and if medical records are requested then the underwriter will need to decide on how to proceed.  So if they decide to have medical records pulled from your provider in Canada then they will do so, or if they requested an exam, whatever the case may be I would be sure to contact you and advise how they decided to proceed.

 

 

And finally, I was advised that the best case scenario for the actual underwriting would be a possible B risk category in which would mean a 25% rate up with review of records for final determination. Attached you will find the rate and benefit proposal for the plans available through AARP, please note however that those are the preferred premium amounts and that you would need to add 25% in order to calculate what your total monthly premium

Here is the AARP Florida Health Insurance Premium Rate Proposal for This Case

And Here is The AARP Florida Health Insurance Application

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