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Carrier Specifics Declinable Conditions Drugs Lookback Periods FINAL JEOPARDY
100
What is Mutual of Omaha/GPM?
These carriers would be the best chance of approval for a client diagnosed with Congestive Heart Failure three years ago.
100
What is Restless Legs Syndrome?
Medications like Requip, Mirapex, and Carbidopa/Levodopa are major declinable drugs for a serious health condition, however they can also be used to treat this common issue that can be approved by the carriers.
100
What is Prednisone?
Most carriers will decline for rheumatoid arthritis treated with certain medications, however ENL/GCU, Manhattan Life/WULA, and MOO/GPM will consider clients taking less than 10mg of this drug.
100
What is 7 years?
Maryland's applications ask for this lookback period.
100
Yes, because his part B started 7/1/2019 and he will be grandfathered in.
A client signed up for part B 1/1/2019 and part B six months later in July. He just retired and wants to start a plan F in January 2020. Will he be able to?
200
What is ENL/GCU, Aetna/SGIC/Puritan/USIC?
These carriers would be the best choice for a non-smoker client with COPD who uses a CPAP machine and two inhalers.
200
What is angina?
This condition, often simply described as "chest pain" is often a symptom of coronary artery disease. Both are declinable conditions within a 2 year look back period.
200
What Plavix/Clopidogrel?
Cigna will automatically decline a client taking this medication commonly used after a stent placement.
200
What is 12 months?
Aetna companies and ENL/GCU have this lookback period for pacemaker implantation or battery change.
300
What is Mutual of Omaha/GPM?
Barbara fell off a horse two years ago and hurt her back and hips. She now takes Hydrocodone and Celebrex for the pain. This carrier would not consider this ongoing treatment because it was an injury.
300
What is declined by all except AARP?
A client is taking metformin, glipizide, losartan, and hydrochlorothiazide, along with 30 units of insulin daily, all stable for 2 years. If they were inquiring to switch, you would know they would be this.
300
What is fewer than 3 meds for COPD, including inhalers.
A client takes symbicort and fluticasone for COPD, metoprolol and lisinopril for high blood pressure and an a-fib event 5 years ago.They also take pseudoephedrine for allergies and omeprazole for heartburn. This is the UW rule that will mean they are declined with all carriers (except AARP, which would be Level 2).
300
What is the 2x2x2 rule?
A client takes metformin, glipizide, lisinopril, metoprolol, and Aetna companies are one of the few carriers you can submit them with because of this rule.
400
What is Aetna/SGIC/Puritan/USIC, ENL/GCU?
A client was diagnosed with Lymphoma 10 years ago and has been cancer free since treatment was completed. These carriers will decline this client.
400
What is neuropathy?
This condition is frequently declinable in combination with other conditions, however AARP, Cigna, Manhattan Life/WULA, and MOO/GPM may consider if the client has this condition alone.
400
What is Furosemide/Lasix?
This diuretic medication is on nearly every declinable drug list, however it is okay as long as the client is taking less than 60mg (40mg with Aetna carriers/ENL/GCU)
400
What is 2 years
Cigna has a this lookback period for osteoporosis and fractures.
500
(Any carrier but Aetna family) AARP, Americo, Cigna, Humana, Manlife, MOO
A client has asthma and uses a nebulizer every night before bed. These are the carriers you can submit him with.
500
What is four?
Cigna will decline for more than this number of psychiatric visits per year.
500
What are blood thinners?
Aetna will decline a client taking common high blood pressure medications like atenolol, if used in combination with this type of drug. Hint: used to treat a-fib.
500
What is cancer?
Every company except Aetna has a 2 year lookback for this condition. Aetna looks back 3 years.






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