Congenital heart disease (CHD) has undergone a remarkable transformation over the past several decades, with medical and surgical advances significantly improving survival rates. Today, more than 90% of infants born with serious CHD are expected to reach adulthood, resulting in a growing population of adult survivors. Adults with CHD now outnumber children with CHD. However, despite these improvements, long-term survival data, especially beyond age 50, remain limited, posing challenges for life insurers tasked with assessing risk. Medical officers and underwriters encounter a broad spectrum of congenital heart disease (CHD), ranging from common isolated lesions such as atrial septal defect (ASD), patent ductus arteriosus (PDA), ventricular septal defect (VSD), pulmonary stenosis (PS), or coarctation of the aorta (CoA), to more complex conditions such as Ebstein anomaly, tetralogy of Fallot (TOF), transposition of the great arteries (TGA), tricuspid atresia, and single ventricle physiology. This chapter examines the limitations of current survival data across the lifespan of individuals with congenital heart disease (CHD), highlights advances in interventional outcomes, and explores the challenges insurers face when assessing life insurance eligibility.