Standard Issue (Day One Coverage) vs Guaranteed Issue (2‑Year Waiting Period)
Common Health Conditions Quick Reference

Purpose

Commonly asked whether a client can be approved for Standard Issue (Day One Coverage) or if the client should be quoted for Guaranteed Issue (2‑Year Waiting Period). This article provides a quick reference for common health conditions.

Final eligibility is determined by the application flow and eligibility verification (including prescription history and health questions).

What the Agent Should Say (Expectation Setting)

Use language like:
• “Standard Issue is subject to eligibility verification. Once we complete the authorization step, the system will confirm whether Standard Issue is available.”
• “If Standard Issue is not available, the system will offer the Guaranteed Issue option so we can continue the application.”
Avoid guaranteeing approval or quoting outcomes as certain.

How to Use This Quick Reference

1) The agent will have to identify the client’s reported condition(s) and whether the client is actively being treated (as noted below).
2) The agent will have to reference the table to set expectations on Standard Issue vs Guaranteed Issue.
3) The agent will have to proceed through the application flow and complete HIPAA Authorization.
4) After HIPAA Authorization is completed and **Next Step(s)** is selected, eligibility verification will determine Standard Issue eligibility; if the client does not qualify, Guaranteed Issue will be presented as an option.

Common Health Conditions: Quick Reference

Fast Lookup Lists 

Standard Issue / Day One Coverage

• Amputation

• Cardiomyopathy (being treated by a physician/medication)

• CHF (being treated by a physician/medication)

• Chronic Pancreatitis

• COPD (being treated by a physician/medication)

• Past cancer (no recurrence, no metastasis, no multiple occurrences)

• Dialysis (being treated by a physician/medication)

• Heart attack (being treated by a physician/medication)

• Heart disease (being treated by a physician/medication)

• Hepatitis

• Insulin use (only if diabetes is under control) — Standard (any age / amounts)

• Kidney Failure (being treated by a physician/medication)

• Obesity — Standard (no height/weight requirement)

• Organ transplant – over 5 years ago

• Oxygen use

• Pacemaker

• Sickle Cell Anemia

• Single cancer occurrence (no metastasis, not currently being treated, no more than one occurrence of any type of cancer)

Guaranteed Issue / 2‑Year Waiting Period

• AIDS / HIV

• Aneurysm

• Current cancer (excluding basal cell or squamous cell)

• Cystic Fibrosis

• Dementia

• Diabetic coma

• Multiple Sclerosis

• Organ transplant – under 5 years ago

• Parkinson’s

• Wheelchair confinement

Common Questions

**Q: Can the agent promise Standard Issue approval based on this chart?**

A: No. This is a quick reference only. Eligibility verification and the application workflow determine the final outcome.

**Q: What if the client has multiple conditions across both lists?**

A: The agent will have to proceed with the application and eligibility verification. If any information suggests the client may not qualify for Standard Issue, set expectations early that the system may require Guaranteed Issue.

**Q: Where does eligibility verification occur in the flow?**

A: After HIPAA Authorization is completed and the agent selects **Next Step(s)**, the system will run eligibility verification and confirm Standard Issue eligibility.