PRE-PLANNING TOOL

Long-Term Care Insurance

Please see the uninsurable medication and conditions list before continuing.  Please note certain drop down selections will open additional fields. To proceed to the health pre-screen, select the health dropdown and choose “I would like to do a pre-screen”. If you have any questions regarding this form, please contact our office at (866) 605-7437.

 

Uninsurable Medications

*Generic versions also uninsurable
  • Antabuse®
  • Aricept®
  • Artane®
  • Avonex®
  • Azilect
  • Betaseron®
  • Campral®
  • Cogentin®
  • Cognex®
  • Comtan®
  • Copaxone®
  • Depade®
  • Donepezil
  • Eldepryl®
  • Exelon®
  • Fentanyl
  • Galantamine
  • Hydergine®
  • Interferon®
  • Larodope/L-Dopa
  • Lucemyra
  • Memantine
  • Methadone
  • Mirapex®
  • Namenda®
  • Namzaric®
  • Parlodel®
  • Permax®
  • Razadyne®
  • Reminyl®
  • ReVia®
  • Rivastigmine®
  • Sinemet®
  • Suboxone®
  • Symmetrel®
  • Vivitrol®

Uninsurable Conditions

  • Activity of daily living deficits (need help with any of the ADL’s)
  • Alcoholism (active)
  • Alzheimer’s/Dementia
  • Amyotrophic Lateral Sclerosis (ALS)
  • Balance disorder/ Gait impairment
  • Cerebral palsy
  • Cirrhosis
  • Depression (severe or hospitalized in the last 5 years)
  • Down syndrome
  • Drug addiction/illicit drug use (within last ten years)
  • HIV positive
  • Huntington’s disease
  • Macular degeneration (progressive/wet)
  • Memory loss
  • Mental retardation
  • Multiple myeloma
  • Multiple sclerosis (MS)
  • Muscular dystrophy
  • Organ transplant (except kidney)
  • Organic brain syndrome
  • Osteoporosis with compression fracture
  • Paralysis (paraplegia/quadriplegia)
  • Parkinson’s disease
  • Pregnancy (current)
  • Stroke (multiple or residual affects)
  • Surgery pending (will review after)
  • Ventricular tachycardia