LTCG has dedicated itself to providing the most up-to-date and evidence-based LTC insurance underwriting standards in the industry. Our standards and processes are focused on carefully balancing morbidity and mortality risks while accepting as many applicants as possible without detrimentally impacting our clients’ LTC insurance risk pools. LTCG relies on a seasoned staff of underwriters with a wide variety of backgrounds and training experiences. When assigning cases, we match the level of underwriting knowledge, skills and experience necessary to handle the complexity of the underwriting decision. We ensure that our underwriters have a strong knowledge of medical terminology and a deep understanding of functional and cognitive loss and LTC risk selection. Most of our underwriters are RNs with extensive geriatric experience and each underwriter undergoes a comprehensive training program to enable them to make appropriate underwriting decisions designed to maximize acceptance rates while protecting clients against adverse selection and early claims.
LTCG’s data-driven underwriting is focused on safely accepting as many applicants as possible and our LTC underwriting process contributes to rate stability by ensuring a strong and long-lasting underwriting effect. Our underwriters are trained to screen for applicants who have already lost or are on the verge of losing their functional or cognitive abilities, as well as those who present a high lifetime risk of experiencing a claim event. The emphasis is on the applicant’s functional ability, cognition, medical conditions, therapies, comorbidity and overall health status. Appropriate assessment tools, approved underwriting guidelines and protocols and other risk management information all play a critical role in making an informed and effective underwriting decision. The cornerstone of our team is quality, and ongoing high-caliber auditing, oversight and training include daily case consults with senior underwriters and medical directors, weekly peer reviews, monthly reviews with LTCG medical directors, early claim reviews by senior underwriters and primary underwriting decision reviews by LTCG’s Appeal committee.
LTCG’s Guide to Long Term Care Underwriting is in its 13th edition and is considered the industry’s gold standard. LTCG has experience underwriting against our criteria, our client’s criteria or a combination of the two at the client’s direction. Our standards have been reviewed by a national panel of physicians in general practice, specialists in aging, and physicians in various clinical specialties. To further validate these standards and ensure end-user acceptability, usability and appropriateness, experienced long term care medical directors and senior underwriters from several major insurance companies have provided input to LTCG’s clinical development team. Each of the thirteen revisions of LTCG’s Guide to Long Term Care Underwriting is the result of a collaborative approach that includes:
In addition, LTCG also has a separate multi-rate class Underwriting Criteria Manual and Standards to accommodate a diverse risk stratification based on the product design and pricing. This manual is reviewed and revised regularly with updates based on underwriting and claims experience, changes in medical practice, and new medications for specific medical conditions.