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Long gone are the days of US Financial Life Insurance and their clinical underwriting that gave so many clients competitive rates, rates they really deserved, within 6 months of an angioplasty or bypass surgery.

While those are tough shoes to fill, other companies have managed to fill the void and, within certain parameters are able to offer reasonable rates for those needing to purchase new insurance or perhaps extend the term of their present coverage.

A discussion of those criteria may help you to understand better where you might fit into the rate structure.

1. Age of onset is a big deal in underwriting. In general if coronary artery disease is diagnosed prior to age 50, either because you have a heart attack or because you have arteries with enough blockage to require surgical intervention, rates will be higher. I learned early on in the life insurance business that dying of natural causes prior to age 50 is an oxymoron. There isn’t anything natural about dying prior to age 50 period, and there isn’t anything natural about having coronary artery disease in your 40’s. Even if you are genetically predisposed to CAD, with today’s testing and medical treatment, no one should be having bypasses at that age.

2. Was there a heart attack (an MI, or myocardial infarction)? Once you have a heart attack, the heart muscle has been damaged. Those that catch it before the MI and get treatment, 1. don’t die and 2. don’t have a damaged heart that will likely never recover completely.

3. How many vessels were involved? Simply put, a single blocked artery would indicate mild or early CAD. Multiple vessels would indicate chronic or late detection of CAD. Better underwriting goes to the least involvement.

4. Post incident left ventricular ejection fraction, LVEF. This is a measurement taken from either a nuclear or echocardiogram stress test. It is simply a measure of how effectively your heart empties the left ventricle with each beat. Normal is 65% to 75%. With heart damage that goes down. With most companies a LVEF under 50% is cause for an immediate decline. Because this is a critical component of underwriting, virtually all companies require completion of a stress test before they will approve a policy. If you are applying several years after the cardiac event most companies will want to see a stress test within the past two years.

5. No recurrence. If you have to go back in for a tune up, in an underwriter’s eyes that is called chronic CAD. Simply put, you should have applied for life insurance after the first incident. You aren’t going to like the price with chronic CAD.

Bottom line. There are some very good “clinical underwriting” companies out there and good rates are not out of the question even though you now have a cardiologist.