Small/Naturally Closed
Successfully Repaired
Complex with Management
Severe with Complications
Important Disclaimer
This article provides insurance guidance only and does not constitute medical or insurance advice. Ventricular Septal Defect requires ongoing professional cardiac care—consult with your cardiologist regarding long-term prognosis, activity recommendations, and cardiac monitoring needs. Insurance underwriting varies significantly between carriers and depends on your complete medical history, VSD type and severity, surgical repair status, current cardiac function, associated conditions, and functional capacity. Individual circumstances determine approval decisions and premium pricing. Always consult licensed insurance professionals and healthcare providers regarding your specific situation.
About the Author
The Insurance Brokers USA Team consists of licensed insurance professionals with extensive experience helping individuals with congenital and acquired cardiac conditions navigate life insurance. Our specialists understand VSD underwriting nuances and work with 50+ carriers experienced in complex cardiac condition evaluation. We focus on comprehensive medical record review, strategic timing optimization, and carrier matching to maximize approval odds and secure the best available rates for your specific VSD situation.
Understanding VSD and Insurance Impact
Key insight: Insurance companies primarily focus on current heart function, surgical history, and long-term prognosis rather than the original diagnosis alone.
VSDs are classified by size, location, and hemodynamic significance. From an insurance perspective, the most critical factors are whether the defect has been repaired, current symptoms, and any associated complications like pulmonary hypertension or heart failure.
Excellent Prognosis
Small VSDs that closed naturally or successfully repaired with normal heart function
- Standard rates possible
- May qualify for preferred rates
- Minimal medical requirements
Good Prognosis
Moderate VSDs with successful repair, stable condition, and regular monitoring
- Standard to table 2 rates
- Comprehensive medical review
- Annual cardiology follow-ups
Complex Cases
Large VSDs, multiple defects, pulmonary hypertension, or heart failure
- Table 4-8 ratings possible
- Specialized carrier selection
- Detailed medical underwriting
Professional Insight
“The insurance industry has become much more sophisticated in evaluating congenital heart defects. A well-documented repair with excellent long-term results can often qualify for standard rates, while even complex cases can find coverage through carriers who specialize in cardiac conditions.”
– InsuranceBrokers USA – Management Team
Key Underwriting Factors
Key insight: Underwriters use a comprehensive risk assessment model that weighs multiple factors rather than simply looking at the VSD diagnosis.
Insurance companies evaluate VSD cases using specific medical criteria that determine both eligibility and premium rates. Understanding these factors helps prepare a stronger application.
| Factor | Favorable | Concerning | Impact on Rates |
|---|---|---|---|
| VSD Size | Small (<3mm), naturally closed | Large (>10mm), residual shunting | High – directly affects risk assessment |
| Surgical History | Successful repair, no complications | Multiple surgeries, recent procedures | High – determines current status |
| Current Function | Normal ejection fraction (>55%) | Reduced function (<45%) | Critical – primary risk factor |
| Associated Conditions | No other heart defects | Pulmonary hypertension, arrhythmias | High-compound risk assessment |
| Age at Repair | Repaired in childhood | Adult repair or delayed treatment | Medium – affects long-term outlook |
| Activity Level | No restrictions, normal exercise | Activity limitations, shortness of breath | Medium – indicates functional status |
Medical Documentation Requirements
Comprehensive medical records are essential for VSD cases. Insurance companies typically require:
- Detailed surgical reports from VSD repair
- Recent echocardiogram results (within 2 years)
- Cardiology consultation notes
- Exercise stress test results (if performed)
- Complete medication list and dosages
- Documentation of any complications or restrictions
Coverage Options by VSD Severity
Key insight: Coverage availability and pricing vary dramatically based on VSD complexity, repair success, and current cardiac function.
Simple VSD – Closed Naturally
Typical Rating: Standard to Preferred rates
Coverage Availability: All major carriers
Requirements: Basic medical questionnaire, possibly routine medical exam
Ideal Candidate Profile:
- Small VSD that closed spontaneously in childhood
- No symptoms or activity restrictions
- Normal echocardiogram results
- No other cardiac conditions
Successfully Repaired VSD
Typical Rating: Standard to Table 2 (25-50% increase)
Coverage Availability: Most carriers with cardiac expertise
Requirements: Detailed medical records, recent cardiology evaluation
Ideal Candidate Profile:
- Successful surgical repair in childhood
- Normal heart function post-repair
- Regular cardiology follow-ups with stable results
- No residual shunting or complications
Complex VSD with Stable Management
Typical Rating: Table 2-6 (50-250% increase)
Coverage Availability: Specialized cardiac underwriters
Requirements: Comprehensive medical review, multiple carrier evaluation
Candidate Profile:
- Large VSD with successful repair
- Mild complications (e.g., trace regurgitation)
- Stable condition with medication management
- Regular specialist monitoring
Severe VSD with Complications
Typical Rating: Table 6-10 (250-500% increase) or specialized products
Coverage Availability: Limited carriers, alternative products
Requirements: Extensive medical underwriting, possible postponement
Candidate Profile:
- Complex repairs or multiple surgeries
- Associated conditions (pulmonary hypertension, heart failure)
- Activity restrictions or symptoms
- Recent changes in condition
For comprehensive guidance on how various cardiac conditions affect coverage decisions, see our detailed resource on Life Insurance Approvals with Pre-Existing Medical Conditions.
Application Strategy & Documentation
Key insight: Proper preparation and complete medical documentation can significantly improve approval odds and premium rates.
Pre-Application Preparation Checklist
- Gather Complete Medical Records: Request all VSD-related medical records from your cardiologist, including surgical reports, recent test results, and consultation notes
- Update Cardiac Evaluation: Ensure your most recent echocardiogram is within the past 24 months, or schedule an update if needed
- Document Current Status: Obtain a letter from your cardiologist summarizing your current condition, prognosis, and any activity restrictions
- Medication List: Compile a complete list of all medications, dosages, and indications
- Lifestyle Documentation: Prepare to discuss your activity level, exercise tolerance, and any symptoms
Timing Strategy
Optimal Application Window: 6-12 months after stable cardiology evaluation
Avoid applying immediately after surgery, during medication changes, or when symptoms are changing. Insurance companies prefer to see stable, well-documented conditions.
Common Application Mistakes to Avoid
- Incomplete Medical History: Failing to disclose all VSD-related treatments and evaluations
- Outdated Information: Using medical records older than 2-3 years
- Wrong Carrier Selection: Applying to companies without cardiac underwriting expertise
- Rushing the Process: Applying before gathering complete documentation
- Multiple Simultaneous Applications: This can lead to automatic declines if not properly coordinated
Choosing the Right Insurance Carrier
Key insight: Different insurance companies have varying expertise and risk tolerance for congenital heart defects, making carrier selection critical.
Not all insurance carriers are created equal when it comes to underwriting VSD cases. Some excel at cardiac conditions, while others may automatically decline or offer poor rates for any heart-related diagnosis.
Cardiac-Friendly Carriers
Best for: Successfully repaired VSDs
- Specialized cardiac underwriters
- Comprehensive medical review process
- Competitive rates for stable conditions
- Experience with congenital defects
Standard Market Carriers
Best for: Simple, naturally closed VSDs
- Prefer straightforward cases
- May offer preferred rates for minimal risk
- Limited appetite for complex cases
- Standard underwriting protocols
Alternative Market
Best for: Complex or high-risk cases
- Specialized high-risk underwriting
- Higher premiums but broader acceptance
- Unique product offerings
- Case-by-case evaluation
Carrier Evaluation Criteria
When selecting carriers for VSD cases, we evaluate:
- Cardiac Underwriting Expertise: Does the carrier have specialized heart condition underwriters?
- Historical Approvals: Track record with similar VSD cases
- Medical Director Input: Availability of cardiologist consultation for complex cases
- Rate Competitiveness: Premium structure for cardiac conditions
- Policy Features: Conversion options, living benefits, and flexibility
Our Top 10 Best Life Insurance Companies in the U.S. (2025): Expert Broker Rankings can help identify carriers most likely to provide favorable consideration for complex cardiac cases.
Optimal Timing for Applications
Key insight: Strategic timing of your life insurance application can significantly impact both approval probability and premium rates.
Avoid: Immediate Post-Surgery Period
Timeframe: 0-6 months after VSD repair
Risk: High decline probability, postponement likely
Insurance companies prefer to see a stable recovery and confirmed surgical success before considering coverage.
Caution: Early Recovery Phase
Timeframe: 6-12 months post-surgery
Risk: Possible postponement or high table ratings
Some carriers may consider applications, but rates are typically higher during this period.
Optimal: Stable Recovery Period
Timeframe: 12+ months post-surgery with stable condition
Advantage: Best rates and approval probability
Full recovery documented, stable cardiac function, and normal activity level restored.
Special Consideration: Pediatric Cases
Timeframe: Young adults with childhood repair
Advantage: Excellent long-term data available
Adults with successful childhood repairs often qualify for the best rates due to proven long-term stability.
Timeline Best Practices
- Plan Ahead: Start the application process 3-6 months before you need coverage
- Coordinate with Medical Care: Schedule applications around routine cardiology appointments
- Document Stability: Ensure at least 6-12 months of stable cardiac function
- Avoid Active Changes: Don’t apply during medication adjustments or symptom changes
- Consider Life Events: Apply before marriage, home purchase, or starting a family when possible
Alternative Coverage Options
Key insight: When traditional life insurance proves challenging, several alternative products can provide meaningful protection for VSD patients.
For individuals with complex VSD cases or those facing traditional coverage challenges, alternative insurance products offer valuable protection options.
No-Exam Life Insurance
Coverage: Up to $500,000
- Simplified underwriting process
- Health questionnaire only
- Faster approval times
- Good for stable VSD cases
Group Life Insurance
Coverage: Usually 1-5x annual salary
- Available through the employer
- Limited or no medical underwriting
- Guaranteed issue amounts
- Portable options available
Graded Benefit Policies
Coverage: Full benefit after 2-3 years
- Guaranteed acceptance
- No medical questions
- Limited initial death benefit
- Good bridge coverage option
Alternative Product Considerations
- Coverage Limits: Alternative products typically offer lower maximum coverage amounts
- Higher Premiums: Simplified underwriting often results in higher rates
- Waiting Periods: Some products have initial waiting periods for full benefits
- Limited Features: May lack riders and benefits available with traditional policies
Our guide on Top 10 Best No-Exam Life Insurance Companies (2025 Update) provides valuable alternatives for those facing traditional coverage challenges.
Frequently Asked Questions
Can I get life insurance if my VSD was never repaired?
Yes, many people with small, asymptomatic VSDs that don’t require repair can qualify for standard life insurance rates. The key factors are the size of the defect, whether it causes symptoms, and your current cardiac function. Small VSDs (under 3mm) with no symptoms often qualify for preferred rates, while larger unrepaired VSDs require more detailed underwriting but remain insurable through specialized carriers.
How long after VSD surgery should I wait to apply for life insurance?
Most insurance companies prefer to see at least 6-12 months of stable recovery after VSD repair before considering applications. The optimal timing is 12+ months post-surgery when you have documented stable cardiac function and normal activity levels. Applying too early often results in postponement or higher premiums.
Will I need a medical exam for life insurance with VSD?
For traditional life insurance, most carriers will require a medical exam for VSD cases, especially for coverage amounts over $250,000. The exam typically includes basic measurements, blood work, EKG, and sometimes an echocardiogram. However, no-exam life insurance options are available for smaller coverage amounts with simplified underwriting.
What if I have other heart conditions along with VSD?
Additional cardiac conditions like pulmonary hypertension, arrhythmias, or heart failure will increase complexity and likely result in higher premiums. However, coverage remains possible through carriers specializing in complex cardiac cases. Each condition is evaluated individually, and stable, well-managed conditions receive more favorable consideration.
Can my children get life insurance if they have VSD?
Yes, children with VSD can often obtain life insurance through child life insurance riders on parents’ policies or standalone juvenile policies. The underwriting requirements are typically less stringent for children, especially for small coverage amounts. Successfully repaired VSDs in children often qualify for standard rates.
How much more expensive is life insurance with VSD?
Premium increases vary significantly based on VSD complexity. Simple, naturally closed VSDs may qualify for standard rates with no increase. Successfully repaired VSDs typically see 0-50% premium increases (standard to table 2 ratings). Complex cases may face 50-250% increases but remain insurable through our specialized carrier network.
Should I disclose VSD if it was repaired in childhood and I have no symptoms?
Absolutely yes. All medical history must be disclosed honestly on insurance applications, regardless of how minor it may seem. Failure to disclose VSD history could void your policy if discovered later. However, childhood repairs with excellent long-term results often qualify for favorable rates, so disclosure rarely prevents coverage.
What medical records will the insurance company need?
Insurance companies typically request complete VSD-related medical records, including: original diagnosis reports, surgical records if repaired, recent cardiology consultation notes (within 2 years), recent echocardiogram results, exercise stress test results if performed, current medication list, and documentation of any activity restrictions or symptoms.
Ready to Explore Your Life Insurance Options?
Don’t let VSD history prevent you from securing the life insurance protection your family deserves. Our cardiac specialists work with 50+ carriers to find the best coverage and rates for your specific situation.
Free confidential consultation – All consultations are HIPAA compliant
Will this information change if the ACA is reverted?
Jacob,
If you are asking if an appeal of the Affordable Care Act (ACA) or “Obamacare” will affect the life insurance industry, the answer to that question is no. This is because the ACA only applies to health care and health insurance.
The fundamental tenant of the ACA is that health insurance is a basic human right and shouldn’t be denied to any citizen. This argument has not been made concerning life insurance.
This is why the life insurance industry remains able to discriminate against those with pre-existing medical conditions among a wide variety of other factors as well.
Thanks,
InsuranceBrokersUSA.