Carrier: United Home Life (UHL) / United Farm Family Life

Product: Whole Life Product Suite

Product Types: Guaranteed Issue, Express Issue (Standard, Deluxe, Premier), Provider Whole Life (Standard, Preferred, Juvenile)

Issue Ages: 0–80 (varies by product and tier)

Face Amounts: $2,500–$100,000+ (varies by product)

Target Market: Final Expense, No Exam Whole Life, Juvenile Plans, or applicants seeking simplified permanent coverage

Underwriting Notes: Simplified issue for all tiers. No medical exams. MIB, Rx history, build chart, and optional PHI or APS review. Preferred criteria for Provider require excellent health and ADL independence for seniors.

Guaranteed Issue Whole Life

Carrier: United Home Life / United Farm Family Life

The Guaranteed Issue Whole Life policy is designed for clients who may not qualify for traditional coverage due to age or health history. It features guaranteed issue underwriting with no health questions or medical exams.

Product Highlights

• Available for ages 0 to 80
• Yes/no applications only — no medical exams or fluids required
• Guaranteed level premiums
• Guaranteed cash value accumulation
• Initial premium can be drafted at point of sale
• First-year commission paid daily (if EFT is used)
• Applications can be taken over the phone
• eApp submission with point-of-sale decisioning is available

Target Markets

Designed for the middle market, including clients who may have been declined elsewhere or who are looking for simple, affordable final expense protection without underwriting barriers.

Express Issue Whole Life

Carrier: United Home Life / United Farm Family Life

The Express Issue Whole Life plan is a simplified issue product that offers basic whole life coverage with streamlined underwriting and fast approvals. It is ideal for clients looking for straightforward permanent protection.

Product Highlights

• Yes/no application with simplified underwriting
• No medical exams or bodily fluid tests required
• Fast point-of-sale decisioning available through eApp
• Permanent, level benefit coverage with guaranteed cash value
• Coverage builds guaranteed cash value and has level premiums
• Targeted toward the middle market, including modest-income families

Ideal Clients

This plan is suited for individuals who want lifetime protection but prefer a simple, fast-issue policy without complex underwriting or traditional exam requirements.

Express Issue Deluxe Whole Life

Carrier: United Home Life / United Farm Family Life

The Express Issue Deluxe Whole Life product offers enhanced permanent protection with limited underwriting and faster issue compared to fully underwritten whole life plans. It is designed for clients seeking better coverage amounts than standard express issue without full underwriting requirements.

Product Highlights

• Available for ages typically between 20 and 80 (exact age limits vary by state)
• Simplified underwriting with yes/no health questions
• No parameds or bloodwork required
• Coverage builds guaranteed cash value over time
• Fast approvals through eApp with point-of-sale decisioning
• Intended for healthier clients who want a balance between speed and benefit size

Target Market

This product is well-suited for applicants in good to average health who want immediate whole life coverage without a long underwriting process, and are seeking higher coverage amounts than Guaranteed Issue or base Express Issue allow.

Express Issue Premier Whole Life

Carrier: United Home Life / United Farm Family Life

The Express Issue Premier Whole Life product offers the highest tier of simplified issue whole life coverage from UHL/UFFL. It is designed for healthier clients who qualify based on favorable answers to health questions and seek fast, permanent coverage with stronger benefit amounts.

Product Highlights

• Available for adult applicants generally ages 20–80 (check state guidelines)
• Simplified underwriting with a broader set of qualifying health questions
• No medical exams or labs
• Designed for clients in excellent health with stable medical history
• Cash value accumulation and guaranteed level premiums for life
• Faster issue via eApp platform

Best Fit Clients

Ideal for adults with good health history who want permanent coverage quickly — without exams — but who qualify for better rates and higher coverage than other Express Issue tiers.

Provider Whole Life (Standard, Preferred, Juvenile)

Carrier: United Home Life / United Farm Family Life

The Provider Whole Life series offers permanent life insurance with strong guarantees, simplified underwriting, and expanded eligibility including juvenile applicants. It is designed for clients seeking lifetime protection, consistent premiums, and cash value accumulation without full medical underwriting.

Provider Standard

• Available for adult applicants with minor health conditions
• Yes/no health question underwriting — no medical exams or labs
• Issue ages typically range from 20 to 80 (check state variations)
• Offers guaranteed death benefit and cash value accumulation

Provider Preferred

• For applicants in excellent health
• Offers the best rates within the Provider series
• Same simplified underwriting — fast issue and no fluids required

Provider Juvenile

• Coverage for children and grandchildren from birth through age 18
• Level premiums and lifetime protection
• Ideal for early planning, gifting, and long-term value

Shared Features

• All policies accumulate guaranteed cash value
• Riders such as Accidental Death and Waiver of Premium may be available
• Policies are eApp compatible with fast decisions and EFT drafting

Underwriting and Build Chart Guidelines

General Underwriting

All Whole Life products from United Home Life / United Farm Family Life use simplified issue underwriting. There are no medical exams or fluids. Underwriting is based on yes/no health questions, MIB, prescription database, and in some cases, a Personal History Interview (PHI).

Provider Whole Life Underwriting

• All Provider Whole Life applications require a Personal History Interview (PHI)
• The interview is ordered by the Home Office after application is received

Preferred Underwriting Criteria (Only for Provider Whole Life)

• Standard risks only – no ratable conditions.
• Must have current MD and adequate health care.
• No current or past treatment for high cholesterol or high blood pressure.
• No history of mental illness or depression in past 10 years.
• No bankruptcy in past 10 years.
• No felony or misdemeanor convictions in past 10 years.
• No family history of death of a parent or sibling from Cardiovascular Disease or Cancer prior to age 60.
• Must have valid driver’s license. No more than two moving violations in past three years. No DUI in past five years.
• No excessive use of alcohol, history of alcohol abuse or treatment.
• Not an active member of the military.
• Must have legally resided in US for the past three years.
• Must be employable on a full-time basis; cannot be receiving any form of disability compensation.
• Aviation: No participation as a pilot or crew member in the past two years.
• No ratable avocation (i.e., racing, scuba diving, mountain climbing, rodeo, sky-diving).

Preferred Criteria Ages 66–80 (Only for Provider Whole Life)

Previously listed criteria plus all of the following:

• No history of fractures or falls in past 10 years.
• Must be able to perform Activities of Daily Living (ADLs) without assistance:
• Feeding
• Bathing
• Dressing
• Taking own medications
• Toileting
• Transferring (mobility)
• Telephone use, shopping, housekeeping, yard work
• Must answer an additional set of supplemental health questions during the PHI (Personal History Interview).

Supplemental Health Questions for Ages 66–80 (Only for Provider Whole Life)

All preferred underwriting criteria must be met along with a total of five (5) points from answers to the following questions. Each “yes” answer is 1 point. Questions are asked during the PHI interview:

• Does the Proposed Insured exercise a minimum of two days per week, for a total of one hour per week?
• Does Proposed Insured have a valid driver’s license, and still drive?
• Is the Proposed Insured currently employed for a minimum of 10 hours per week?
• Does the Proposed Insured currently volunteer for a minimum of two hours per week?
• Does the Proposed Insured live with a spouse or roommate, or have pet ownership?
• Does the Proposed Insured participate in recreational travel, hobbies, or sports?
• Does the Proposed Insured handle all financial transactions independently without requiring outside assistance to pay bills and perform normal banking transactions?

Preferred is available only for Provider Whole Life applicants who meet strict standards. These include:

• No ratable medical conditions
• Must have a current MD and active health management
• No treatment for high cholesterol or high blood pressure
• No mental illness or depression in the last 10 years
• No bankruptcy or criminal conviction in past 10 years
• No family history of cardiovascular disease or cancer death in parents/siblings before age 60
• Valid U.S. driver’s license, no more than 2 moving violations in 3 years, and no DUI in 5 years
• No alcohol abuse or treatment history
• Not active-duty military
• U.S. residency for 3+ years
• Must be fully employable; not receiving disability income
• No aviation or hazardous hobbies (racing, diving, climbing, rodeo, etc.)

Preferred Criteria for Ages 66–80

• All previous Preferred criteria must be met
• No history of falls or fractures in past 10 years
• Must perform all Activities of Daily Living (ADLs) unassisted

Activities of Daily Living (ADL) Required:

• Feeding
• Bathing
• Dressing
• Taking medications
• Toileting
• Transferring (mobility)
• Telephone use, shopping, housekeeping, yardwork

Supplemental Health Scoring (Ages 66–80 Only)

Applicant must score at least 5 points from the following to qualify:

• Exercises ≥ 1 hour/week over 2 days = 1 point
• Has valid driver’s license and still drives = 1 point
• Currently employed ≥ 10 hours/week = 1 point
• Volunteers ≥ 2 hours/week = 1 point
• Lives with spouse/roommate or owns a pet = 1 point

Build Charts

Simplified Issue Build Chart

Maximum allowable weights by height for various simplified issue products:

Height	Provider	EI Premier	EI Deluxe
5’0”	190 lbs	210 lbs	240 lbs
5’4”	215 lbs	240 lbs	270 lbs
5’8”	245 lbs	270 lbs	305 lbs
6’0”	275 lbs	305 lbs	340 lbs
6’4”	305 lbs	340 lbs	385 lbs

Use EIWL Graded Benefit for people outside these ranges.

Provider Preferred Build Chart

Maximum allowable weights by height for applicants seeking Provider Preferred underwriting classification:

Height	Max Weight
4’10”	149 lbs
4’11”	154 lbs
5’0”	161 lbs
5’1”	165 lbs
5’2”	171 lbs
5’3”	177 lbs
5’4”	181 lbs
5’5”	186 lbs
5’6”	192 lbs
5’7”	197 lbs
5’8”	203 lbs
5’9”	209 lbs
5’10”	214 lbs
5’11”	220 lbs
6’0”	226 lbs
6’1”	233 lbs
6’2”	239 lbs
6’3”	246 lbs
6’4”	252 lbs
6’5”	258 lbs
6’6”	265 lbs
6’7”	273 lbs
6’8”	279 lbs
6’9”	286 lbs

Attending Physician Statements (APS)

An APS may be required based on the Proposed Insured’s:

• Medical history
• MIB (Medical Information Bureau) findings
• Pharmaceutical (Rx) history

APS Guidelines:

• Agents will be notified by the underwriter if an APS is needed
• The underwriter will specify the physician and time frame for the records
• Clients are responsible for requesting the APS from their provider
• The APS cost is paid by the client

Delivery Requirements:

• Only accepted via fax directly from the medical provider’s office
• Or mailed in a sealed envelope from the provider (USPS or overnight)
• APS Fax Number: 317-692-7636

Medication Restrictions Notice

United Home Life / United Farm Family Life does not currently provide a publicly available prescription medication exclusion list or individual consideration guide.

If an agent encounters a case involving complex medications or unclear eligibility, they are advised to contact United Home Life underwriting directly for a risk assessment.

Agent Underwriting Contact:
United Home Life
Phone: 1-800-428-3001
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Riders, Conversions, and Eligibility

Included and Optional Riders

The following riders may be included or optionally added depending on product type and applicant eligibility:

• Accidental Death Benefit Rider
• Children’s Term Rider (available on most products)
• Waiver of Premium Rider (for disability)
• Accelerated Death Benefit Rider (included on most plans)
• Return of Premium Rider (on select Express and Deluxe plans)
• Identity Theft Waiver and Terminal Illness Accelerated Rider — no additional cost

Conversion Options

United Home Life’s simplified issue products are not convertible. The whole life plans are permanent, with level premiums and guaranteed death benefit for life.

Other Eligibility Restrictions

• Applicants must reside in an approved state (product availability varies by state)
• United States citizenship or legal permanent resident status required
• Applicants must have resided in the U.S. for at least 3 consecutive years
• Applicants must have a valid U.S. address and SSN/ITIN
• No coverage for active-duty military
• Maximum issue ages may vary by product and state (typically up to age 80)

Application Submission

All UHL products are eligible for electronic applica

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Carrier: Mutual of Omaha (United of Omaha Life Insurance Company)

Product: Fully Underwritten Term, IUL, Whole Life

Product Types: Term Life Answers (10, 15, 20, 30-Year), Income Advantage IUL, Life Protection Advantage IUL, AccumUL Answers, Whole Life

Issue Ages: 15 days to age 85 (varies by product); adults and juveniles included

Face Amounts: $25,000 to $10,000,000+ (up to $500,000 for juveniles with justification)

Target Market: Income protection, estate planning, business insurance, high-net-worth cases, medically underwritten applicants

Comprehensive underwriting, application, and eligibility guide for agent reference and AI training. No examples or summaries. All criteria, conditions, and decision rules included.

1. Product Overview and Underwriting Philosophy

Carrier: United of Omaha Life Insurance Company (Mutual of Omaha affiliate)

This guide applies to all fully underwritten Term and Permanent Life Insurance products issued by United of Omaha. It is intended for internal producer use only and is designed to reduce dependency on underwriters for routine case questions. All rules, requirements, impairments, and underwriting programs are fully described.

Available Products:

• Term Life Answers (10, 15, 20, 30-Year)
• Income Advantage IUL
• Life Protection Advantage IUL
• AccumUL Answers
• Whole Life (varies by state)

Underwriting Philosophy:

Mutual of Omaha considers the full applicant profile, offering favorable consideration through multiple programs such as Fit Credits, Accelerated and Fluidless Underwriting, and occasional reinsurance facilitation. Preferred consideration is available for several non-standard conditions based on full disclosure and control of risk.

Support Contact Numbers:

• Underwriting Support: 1-800-775-7896
• iGO eApp Support: 1-800-641-6557
• Sales Support: 1-800-693-6083

2. Issue Ages, Face Amounts, and Underwriting Classes

Issue Ages and Face Amount Limits

• Face amounts available: $25,000 to $10,000,000+
• Juvenile (15 days – 17 years): Up to $250,000 (or $500,000 with full financial justification and cover letter)
• Coverage must be supported by appropriate financial and insurable interest documentation.

Income Replacement Multiples (For Earned Income)

• Under age 30: 40× income
• 30–39: 35× income
• 40–49: 30× income
• 50–59: 20× income
• 60–64: 10× income
• 65 and older: 7× income

Risk Classes Available

• Preferred Plus Non-Tobacco
• Preferred Non-Tobacco
• Standard Plus Non-Tobacco
• Standard Non-Tobacco
• Preferred Tobacco
• Standard Tobacco
• Table Rated (Table 1 through Table 12)

Nicotine-free eligibility is based on time since last use and urinalysis. Mutual of Omaha allows limited cigar use (up to 24/year) with negative urinalysis for Preferred and Standard Plus classes.

Non-Tobacco Criteria by Class

• Preferred Plus: No nicotine/tobacco use for 36 months
• Preferred: No use for 24 months
• Standard Plus: No use for 12 months
• Preferred Tobacco: Available with qualifying health and labs

Build requirements, cholesterol ratios, blood pressure levels, family history, driving records, aviation, and medical impairments must meet the carrier's criteria for each class. Full details follow in the Build Chart and Medical History sections.

3. Build Chart (Complete - Tables 1 to 12)

The following Build Chart must be used for underwriting Mutual of Omaha fully underwritten life insurance. All weights are measured in pounds. Each height is aligned with maximum allowable weight limits for each underwriting class or table rating. Applicants whose weight falls outside these limits are not eligible for that rating class.

Note: Juvenile builds are evaluated separately. This chart applies only to adults (age 18+).

Height	Preferred Plus	Preferred	Standard Plus	Standard	Table 1	Table 2	Table 3
4’ 8”	125	144	153	158	170	184	NaN
4’ 9”	131	150	160	165	176	189	NaN
4’ 10”	135	155	165	170	182	194	NaN
4’ 11”	141	160	170	176	187	199	NaN
5’ 0”	146	166	177	184	193	205	NaN
5’ 1”	152	173	185	191	199	211	NaN
5’ 2”	158	179	190	197	205	215	NaN
5’ 3”	164	184	195	203	213	220	NaN
5’ 4”	169	189	200	209	221	225	NaN
5’ 5”	174	194	205	215	226	231	NaN
5’ 6”	180	200	210	222	232	239	NaN
5’ 7”	185	205	215	228	239	245	NaN
5’ 8”	189	209	220	235	246	251	NaN
5’ 9”	195	215	225	242	254	258	NaN
5’ 10”	200	221	232	250	262	266	NaN
5’ 11”	206	227	237	258	269	274	NaN
6’ 0”	211	232	244	265	275	281	NaN
6’ 1”	217	239	252	271	282	289	NaN
6’ 2”	222	244	257	279	289	296	NaN
6’ 3”	228	250	262	285	296	303	NaN
6’ 4”	233	255	268	292	301	311	NaN
6’ 5”	239	261	274	298	307	319	NaN
6’ 6”	246	268	280	307	313	328	NaN
6’ 7”	252	274	286	313	320	336	NaN
6’ 8”	258	280	294	320	327	345	NaN
6’ 9”	264	287	302	326	335	352	NaN
6’ 10”	270	294	310	334	343	359	NaN
Underwriting Build Chart (continued)	NaN	NaN	NaN	NaN	NaN	NaN	NaN
Height	Weight	NaN	NaN	NaN	NaN	NaN	NaN
4’ 8”	190	197	204	212	221	230	240
4’ 9”	195	202	209	216	225	234	244
4’ 10”	201	208	214	222	231	240	249
4’ 11”	207	214	220	228	237	245	254
5’ 0”	213	220	226	235	244	253	262
5’ 1”	218	226	233	242	250	259	269
5’ 2”	223	232	239	248	257	266	277
5’ 3”	228	238	246	255	264	275	284
5’ 4”	235	245	252	261	270	281	292
5’ 5”	242	251	259	268	277	286	299
5’ 6”	248	258	268	276	285	293	308
5’ 7”	254	265	275	284	293	303	316
5’ 8”	262	274	283	291	300	312	324
5’ 9”	270	282	291	299	309	319	331
5’ 10”	278	289	300	307	316	327	340
5’ 11”	287	298	307	315	325	339	349
6’ 0”	292	305	315	322	333	348	356
6’ 1”	300	313	322	330	340	355	365
6’ 2”	308	321	331	339	349	366	374
6’ 3”	317	329	339	348	358	376	383
6’ 4”	325	338	348	357	367	385	394
6’ 5”	334	347	357	366	376	393	402
6’ 6”	345	358	366	375	385	405	413
6’ 7”	354	367	375	384	394	413	422
6’ 8”	363	376	385	395	405	422	431
6’ 9”	372	385	395	406	415	435	444
6’ 10”	382	395	407	418	427	444	462
Accelerated Underwriting Build Chart	NaN	NaN	NaN	NaN	NaN	NaN	NaN
Height	Weight	Height	Weight	NaN	NaN	NaN	NaN
4’ 8”	74 - 158	5’ 8”	109 - 235	NaN	NaN	NaN	NaN
4’ 9”	77 - 165	5’ 9”	112 - 242	NaN	NaN	NaN	NaN
4’ 10”	79 - 170	5’ 10”	115 - 250	NaN	NaN	NaN	NaN
4’ 11”	82 - 176	5’ 11”	119 - 258	NaN	NaN	NaN	NaN
5’ 0”	85 - 184	6’ 0”	122 - 265	NaN	NaN	NaN	NaN
5’ 1”	88 - 191	6’ 1”	126 - 271	NaN	NaN	NaN	NaN
5’ 2”	91 - 197	6’ 2”	129 - 279	NaN	NaN	NaN	NaN
5’ 3”	94 - 203	6’ 3”	133 - 285	NaN	NaN	NaN	NaN
5’ 4”	97 - 209	6’ 4”	136 - 292	NaN	NaN	NaN	NaN
5’ 5”	100 - 215	6’ 5”	140 - 298	NaN	NaN	NaN	NaN
5’ 6”	103 - 222	6’ 6”	143 - 307	NaN	NaN	NaN	NaN
5’ 7”	106 - 228	6’ 7”	147 - 313	NaN	NaN	NaN	NaN

4. Initial Underwriting Requirements

All applicants are subject to varying medical and non-medical requirements based on age and face amount. Mutual of Omaha evaluates risk using a multi-layered underwriting approach. The following diagnostic tools may be required:

• Pharmaceutical Check (Rx)
• Paramedical Exam (Blood, Urine, Height/Weight, Pulse, Blood Pressure)
• Motor Vehicle Record (MVR)
• Attending Physician’s Statement (APS)
• Senior Assessment (SA), if applicable
• NT-Pro BNP blood test for senior ages
• Tax Transcripts (TT), Electronic Inspection Report (EIR)
• Personal Financial Supplement (PFS)

Below is a complete breakdown of required evidence for fully underwritten life insurance based on the insured’s age and the face amount applied for.

Underwriting Requirements by Age and Face Amount

Age	$25K–$99K	$100K–$249K	$250K–$499K	$500K–$750K	$750K–$1M
Under 18	Nonmedical, Rx	Nonmedical, Rx	Nonmedical*, Rx	N/A	N/A
18–30	Nonmedical, Rx	Paramed, Blood & HOS, MVR, Rx
31–35	Nonmedical, Rx	Paramed, Blood & HOS, MVR, Rx
36–45	Nonmedical, Rx	Paramed, Blood & HOS, MVR, Rx
46–55	Nonmedical, Rx	Paramed, Blood & HOS, Rx
56–60	Nonmedical, Rx	Paramed, Blood & HOS, Rx
61–65	Nonmedical, Rx	Paramed, Blood & HOS, Rx			+BNP
66–70	Nonmedical, APS, Rx	+APS		Paramed, SA, Blood & HOS, BNP, APS, Rx
71+	Nonmedical, APS, Rx	Paramed, Blood & HOS, APS, Rx	+BNP	Paramed, SA, Blood & HOS, BNP, APS, MVR, Rx

Key:
APS = Attending Physician Statement
SA = Senior Assessment
Rx = Pharmaceutical Report
BNP = NT-Pro BNP blood test
HOS = Blood and Urine Specimen
MVR = Motor Vehicle Report

5. Underwriting Programs

5.1 Fit Underwriting Credit Program

The Fit Credit Program allows up to two table credits for applicants through age 75 applying for up to $5 million in face amount. Applicants must be non-tobacco users and start no worse than Table 4. It is not available for flat extras or high-risk medical histories including early CAD, stroke, HIV, and ratable cancers.

Medical Criteria for Fit Credit: (3 = 1 table credit, 5 = 2 credits)

• No death of parent/sibling before age 70
• Cholesterol/HDL ratio < 5.0
• A1C under 5.7
• Serum Albumin > 4.2 (ages 61–75)
• Negative cardiac testing within 2 years (GXT, Echo, EBCT, Angio)
• Blood pressure ≤ 135/85 (treated or untreated)
• Preferred or better build (age 18–60); Std+ or better (61–75)
• BNP < 100 (ages 61–75)
• Normal CBC (ages 61–75)

Lifestyle Criteria for Fit Credit:

• Regular preventive medical care with compliance
• No tobacco use in past 10 years
• Income > $100,000 or Net Worth > $1 million
• Clean driving record

---

5.2 Accelerated Underwriting Program

For healthy clients ages 18–60 applying for $100,000 to $2 million. If eligible, no paramed exam required and decisions may arrive within 48–72 hours.

Requirements:

• Electronic drop ticket submission
• U.S. citizen or permanent resident
• No tobacco/nicotine (standard guidelines)
• Build must fall within standard build chart
• No uninsurable medical or driving history
• No STOLI/red-flag cases

Ineligible Medical Conditions:

• Cancer (except basal/squamous skin)
• Diabetes
• CAD, COPD, Hepatitis, Sleep Apnea
• Substance abuse, epilepsy/seizure
• Any ratable medical condition

---

5.3 Fluidless Underwriting Program

Available for ages 30–65 applying for $2 million to $10 million. No labs or parameds required if qualified.

Requirements:

• Recent annual physical within 18 months ($2M–$5M) or 12 months ($5M–$10M)
• Complete Part 2 of application
• Documentation of executive physical including all vital metrics and age-appropriate bloodwork
• For ages 61–65 over $5M: ECG within 12 months

Applications must include a cover letter explicitly requesting Fluidless consideration.

6. Application and Submission Requirements

6.1 Submission Instructions

Only one base policy may be applied for per application. Submit applications and all required forms to:

Mutual of Omaha
3300 Mutual of Omaha Plaza
Omaha, NE 68175
Fax: (402) 997-1804

6.2 Required Forms and Authorizations

• Application (must match product and state where signed)
• Producer Statement
• MIB Authorization
• HIPAA Authorization
• Illustration (or Certification) for IUL/UL products
• Accelerated Death Benefit Disclosure
• HIV Consent (if $100,000+ face amount)
• State replacement and disclosure forms
• Statement of Policyowner Intent (age 65+, $1M+)
• Premium Funding Acknowledgement (if financed)
• Authorization to Release and IRS 4506-C (if $5M+)

6.3 Temporary Insurance Agreement (TIA)

• Max face amount: $1,000,000
• Premium payment must be submitted at app time
• All 6 TIA eligibility questions must be answered “no”
• Coverage ends at earliest of 90 days, policy delivery, withdrawal, or declination

6.4 Paramedical Exams and APS

Mutual of Omaha uses ExamOne and APPS. Exams can be conducted at home or workplace. APS required for many conditions or age/amount combinations. If producer orders the APS, notify the carrier at time of submission or risk duplicate delay.

Underwriting requirements are valid:

• Up to 12 months through age 70
• Up to 6 months for ages 71 and older

6.5 Inspection Reports and MVR

• Inspection reports: Required for face amounts over $10M or age 71+
• MVR required for: Ages 18–45 ($100K+), 46–70 ($1M+), 71+ ($500K+)

Applications signed by Power of Attorney (POA) are not accepted. The applicant must personally sign and authorize all releases.

7. Medical Impairments Underwriting Guide (A–Z)

This section lists all medical conditions that impact underwriting decisions. Each impairment is categorized with Mutual of Omaha’s best-case underwriting outcome. The presence, severity, duration, treatment response, and applicant age at diagnosis may affect final offer.

Risk Classifications: Standard, Table Ratings (1–12), Decline, or Individual Consideration (IC).

This impairment guide is exhaustive. Agents and Assistants should reference it when determining insurability or preparing for potential APS requests.

A – B Medical Impairments

Condition	Underwriting Outcome
Acromegaly	Table 4–8
Acquired Immunodeficiency Syndrome (AIDS)	Decline
Addison’s Disease	Standard – Table 3
ADHD / ADD	Standard – Table 2
Alcoholism (Treatment, No Use)	Standard – Table 8 (Postponed 2 yrs)
Alzheimer’s Disease	Decline
Anemia – Aplastic	Standard – Decline
Anemia – Sickle Cell	Decline
Anemia – Sickle Cell Trait	Standard
Aortic Aneurysm (Unoperated)	Table 6 – Decline
Aortic Aneurysm (Surgery, Stable 6+ months)	Table 2 – 6
Angina	Table 2 – 8
Angina, Unstable (Under Age 40)	Decline
Angioedema	Standard – Table 2
Ankylosing Spondylitis	Standard – Table 4
Anorexia Nervosa (Current)	Decline
Anorexia Nervosa (Recovered 4+ years)	Standard – Table 2
Anxiety Disorders (Mild)	Standard
Anxiety Disorders (Other)	Standard – Table 4
Aortic Murmurs/Insufficiency	Standard – Table 8
Arrhythmias – Atrial Fibrillation	Standard – Decline
Arrhythmias – Atrial Flutter	Standard – Decline
Arrhythmias – Infrequent PVC(s)	Standard
Arrhythmias – Multiple PVC(s)	Standard – Table 8
Arteriosclerosis Obliterans	Table 4 – Decline
AV Malformations – Cerebral (Unoperated)	Decline
AV Malformations – Post-Surgery Stable 6+ months	Table 4 – 8
Arthritis – Osteoarthritis	Standard
Asbestosis – Mild	Standard – Table 4
Asbestosis – Severe	Decline
Ascites	Decline
Asthma – Mild Intermittent	Standard
Asthma – Persistent	Table 2 – Decline
Atrial Septal Defect (No Surgery)	Standard – Decline
Atrial Septal Defect (Surgery, No Residuals)	Standard
Atrioventricular Block – 1st/2nd Degree	Standard – Table 2
Atrioventricular Block – 3rd Degree	Table 2 – Decline
Bacterial Endocarditis – Recovered	Table 2 – 4
Barlow’s Syndrome	Standard – Table 3
Basal Cell Carcinoma (Resolved)	Standard
Bell’s Palsy – Recovered	Standard
Benign Prostatic Hypertrophy (Normal PSA)	Standard
Berger’s Disease (IgA Nephropathy)	Table 2 – 8
Bicuspid Aortic Valve	Standard – Table 8
Bigeminy	Standard – Table 8
Bipolar Disorder – Stable	Table 2 – 8
Blood Pressure – Controlled	Standard
Bright’s Disease – Acute Recovery	Standard – Table 2
Bright’s Disease – Chronic Good Function	Standard – Table 8
Bright’s Disease – Chronic Poor Function	Decline
Bronchiectasis – Mild/Moderate	Standard – Table 6
Bronchiectasis – Severe	Table 8 – Decline
Bronchitis – Chronic Mild/Moderate	Standard – Table 3
Bronchitis – Severe	Table 4 – Decline
Buerger’s Disease – Nonsmoker, No Surgery	Standard – Table 4
Bundle Branch Block – Hemiblock	Standard
Bundle Branch Block – Right	Standard – Table 4
Bundle Branch Block – Left (1+ year)	Table 4

C – D Medical Impairments

Condition	Underwriting Outcome
Cancer – Most Malignancies	Postponed 2–5 yrs, Individual Consideration
Cardiac Pacemaker (Artificial)	Standard – Decline
Cardiomyopathy	Table 4 – Decline
Carotid Bruits (Asymptomatic)	Standard – Table 2
Celiac Disease (Controlled)	Standard – Table 4
Cerebral Embolism/Thrombosis (Single, Stable)	Table 2 – Table 8
Cerebral Embolism/Thrombosis (Multiple)	Decline
Cerebral Palsy – Mild to Moderate	Standard – Table 3
Cerebral Palsy – Severe	Decline
Cerebrovascular Accident (Single)	Standard – Table 8
Cerebrovascular Accident (Multiple)	Decline
Charcot-Marie-Tooth Disease	Standard – Decline
Chest Pain – Non-cardiac	Standard
Chest Pain – Cardiac	Individual Consideration
Cholangitis / Cholecystitis / Cholelithiasis (Resolved)	Standard
Christmas Disease (Factor IX Deficiency)	Table 2 – 8
Chronic Heart Failure	Decline
Chronic Obstructive Pulmonary Disease (COPD)	Standard – Table 8
Cirrhosis	Decline
Cocaine Use – Past	Postpone 3 yrs, Standard – Table 8
Colitis (Ulcerative, Controlled)	Table 2 – 8
Colon Polyps – Benign	Standard
Colon Polyps – Malignant	Individual Consideration
Congestive Heart Failure (Chronic)	Decline
Convulsions	Table 2 – 8
Cor Pulmonale (Chronic)	Decline
Costochondritis	Standard
Crohn’s Disease	Standard – Table 8
Cushing’s Syndrome	Standard – Table 4
Cystic Fibrosis	Decline
Cystitis – Resolved	Standard
Dementia	Decline
Depression (Controlled)	Standard – Table 3
Diabetes – Type I (Over age 20)	Table 2 – 8
Diabetes – Type II (Over age 20)	Standard – Table 8
Dialysis / Renal Failure	Decline
Diverticulitis / Diverticulosis	Standard – Table 3
Down’s Syndrome	Decline
Drug Addiction – Post Recovery	Postpone 3 yrs, Standard – Table 8
Duodenal Ulcer (No Bleeding)	Standard

E – H Medical Impairments

Condition	Underwriting Outcome
Eating Disorder (Anorexia/Bulimia, Resolved)	Standard – Table 4
Emphysema	Table 4 – Decline
Encephalitis (Recovered)	Standard – Table 2
Endometriosis	Standard
Epilepsy (Petit Mal / Grand Mal)	Table 2 – 6
Epstein-Barr Virus	Standard – IC
Eye Disorders – Retinitis Pigmentosa	Standard – Decline
Eye Disorders – Uveitis	Standard – Table 2
Factor V Leiden	Standard – Table 4
Fatty Liver	Standard – Table 4
Fibromyalgia	Standard – Table 3
Fractures – Major (Recovered)	Standard
Gastric Bypass/Banding (2+ yrs stable)	Standard – Table 4
Gastritis – Mild/Controlled	Standard
Gastroesophageal Reflux Disease (GERD)	Standard
Glaucoma	Standard
Gout (Controlled)	Standard
Guillain-Barré Syndrome (Recovered)	Standard – Table 4
Hashimoto’s Thyroiditis	Standard
Head Injury (Mild)	Standard
Head Injury (With LOC or Seizure)	Table 2 – Decline
Heart Attack – Single (2+ years ago)	Table 2 – 8
Heart Attack – Multiple or Recent	Decline
Heart Murmur – Innocent/Benign	Standard
Heart Surgery – Bypass or Valve (Stable)	Table 2 – 6
Heart Transplant	Decline
Hematuria (Resolved)	Standard
Hemochromatosis – No Liver Impairment	Standard – Table 2
Hemophilia (A or B)	Decline
Hemorrhoids	Standard
Hepatitis A (Resolved)	Standard
Hepatitis B (Carrier or Resolved)	Standard – Table 2
Hepatitis C (Treated, No Cirrhosis)	Table 2 – 8
Hernia (Repaired)	Standard
Hiatal Hernia	Standard
Hidradenitis Suppurativa	Standard – Table 2
High Cholesterol (Controlled)	Standard
HIV Positive	Decline
Hodgkin’s Disease (In Remission 5+ yrs)	Standard – Table 4
Huntington’s Disease	Decline
Hypertension – Controlled	Standard
Hyperthyroidism	Standard
Hypothyroidism	Standard

I – M Medical Impairments

Condition	Underwriting Outcome
Iritis	Standard
Irritable Bowel Syndrome (IBS)	Standard
Joint Replacement (No Complications)	Standard – Table 2
Keratoconus	Standard
Kidney Stones (Single Episode)	Standard
Kidney Stones (Recurrent)	Standard – Table 2
Kidney Transplant	Decline
Labyrinthitis (Resolved)	Standard
Laryngeal Cancer (Remission 5+ yrs)	Table 2 – 8
Laryngitis (Chronic)	Standard – Table 2
Lennox-Gastaut Syndrome	Decline
Leukemia (Remission 5+ yrs)	IC – Decline
Liver Transplant	Decline
Liver Function Abnormalities	Table 2 – Decline
Low Testosterone	Standard
Lupus (Discoid)	Standard – Table 2
Lupus (Systemic)	Table 2 – Decline
Lyme Disease (Acute Resolved)	Standard
Lyme Disease (Chronic/Neurological)	Table 4 – Decline
Lymphoma (Remission 5+ yrs)	Table 2 – Decline
Macular Degeneration	Standard – Table 2
Malaria (Treated/Resolved)	Standard
Marfan Syndrome	Table 4 – Decline
Mastocytosis	Decline
Melanoma (Stage 0–1, 5+ yrs ago)	Standard – Table 4
Melanoma (Advanced or Recent)	Decline
Memory Loss (Mild, Evaluated)	Table 2 – Decline
Menopause (No Complications)	Standard
Menorrhagia	Standard
Mental Retardation (Moderate/Severe)	Decline
Mitral Valve Prolapse (No Regurgitation)	Standard
Mitral Valve Prolapse (With Regurgitation)	Table 2 – 4
Monoclonal Gammopathy of Unknown Significance (MGUS)	Standard – Table 4
Multiple Myeloma	Decline
Multiple Sclerosis (Mild, Stable)	Table 4 – Decline
Muscular Dystrophy	Decline

N – Z Medical Impairments

Condition	Underwriting Outcome
Nephrectomy (Single Kidney, Normal Labs)	Standard – Table 4
Nephrotic Syndrome	Table 4 – Decline
Neurofibromatosis	Table 2 – Decline
Obesity (See Build Chart)	Refer to Tables 1–12
Obsessive Compulsive Disorder (OCD)	Table 2 – 4
Organ Transplant (Any)	Decline
Osteoarthritis	Standard
Osteomyelitis (Recovered)	Standard
Osteoporosis	Standard – Table 2
Paget’s Disease	Standard – Table 2
Pancreatitis – Acute, Resolved	Table 2 – 4
Pancreatitis – Chronic or Alcohol-Related	Decline
Parkinson’s Disease	Table 4 – Decline
Peptic Ulcer Disease	Standard
Peripheral Artery Disease (PAD)	Table 4 – Decline
Polycystic Kidney Disease	Table 4 – Decline
Pregnancy (No Complications)	Standard
Prostate Cancer (Stage 1–2, Treated)	Standard – Table 4
Psoriasis (Mild)	Standard
Psychosis (Any History)	Decline
Pulmonary Fibrosis	Decline
Quadriplegia	Decline
Raynaud’s Disease	Standard – Table 2
Renal Failure – Chronic or Dialysis	Decline
Retinopathy (Diabetic)	Table 4 – Decline
Rheumatoid Arthritis (Mild)	Standard – Table 2
Rheumatoid Arthritis (Moderate/Severe)	Table 4 – Decline
Sarcoidosis	Standard – Table 4
Schizophrenia	Decline
Scleroderma	Decline
Seizure Disorder	Table 2 – 4
Sickle Cell Anemia	Decline
Sickle Cell Trait	Standard
Sleep Apnea – Controlled with CPAP	Standard – Table 2
Stroke – Single (2+ yrs)	Table 2 – 8
Stroke – Multiple or Recent	Decline
Systemic Lupus Erythematosus (SLE)	Table 4 – Decline
TIA (Mini-Stroke, Resolved 1+ yrs)	Table 2 – 6
Thrombophlebitis (Resolved)	Standard
Tourette’s Syndrome	Standard – Table 2
Tuberculosis (Treated, Resolved)	Standard
Ulcerative Colitis (Controlled)	Standard – Table 4
Urinary Tract Infection (Frequent)	Standard – Table 2
Varicose Veins	Standard
Vertigo (Benign Positional)	Standard
Wilson’s Disease	Standard – Table 4
Wolff-Parkinson-White Syndrome	Standard – Table 4
Zollinger-Ellison Syndrome	Table 4 – Decline

8. Non-Medical Risk Criteria and Financial Justification

8.1 Occupational and Avocational Risks

• Hazardous Occupations: Decline or require flat extra (e.g., offshore oil, bomb squad, commercial diving, active military)
• Avocations: Activities like skydiving, base jumping, hang gliding, motor racing, and rock climbing typically rated or declined
• Aviation: Private pilots must submit an Aviation Questionnaire. Non-commercial flight is often rated or excluded

8.2 Foreign Travel and Residency

• Citizenship: U.S. citizens and permanent residents (green card holders) eligible with no special restrictions
• Temporary Visa Holders: Must be in U.S. 2+ years, valid U.S. income, and visa types E, H, L, O only
• Travel: Any plans to travel or reside outside U.S. in next 12 months must be disclosed. Unstable or sanctioned countries result in declination

8.3 Financial Underwriting Guidelines

Income Replacement – Personal Life Insurance

Age	Maximum Multiple of Income
18–29	40×
30–39	35×
40–49	30×
50–59	20×
60–64	10×
65+	7× (if employed)

Estate Planning Justification

Up to 50% of net worth for single applicants, 100% for joint applicants. Estate valuation worksheet required over $5M face amount.

Juvenile Coverage Guidelines

• Coverage limited to $250,000 unless financially justified
• Parental or guardian coverage must be in place at equal or greater amount
• Grandparents may not be owner unless legal guardian

Business Insurance Guidelines

• Buy-Sell, Key Person, and Loan Indemnification accepted with proper documentation
• Financial underwriting required over $1M. Business tax returns and CPA verification may be requested
• 100% face amount limit applies to Buy-Sell; Key Person capped at 10–20× salary

Carrier: Mutual of Omaha (United of Omaha Life Insurance Company)

Product: Living Promise (Final Expense), Term Life Express (TLE), Indexed Universal Life Express (IULE)

Product Types: Final Expense Whole Life (Level & Graded), Simplified Term, Simplified IUL

Issue Ages: TLE & IULE: 18–75 (varies by face amount); Living Promise Level: 45–85; Graded: 45–80

Face Amounts: TLE & IULE: $25,000–$300,000; Living Promise: $2,000–$50,000 (Level), $2,000–$20,000 (Graded)

Target Market: Final Expense, Mortgage Protection, Return-of-Premium, Income Replacement, IUL Growth Strategies

Product Name and Carrier
This guide covers simplified issue life insurance products offered by Mutual of Omaha, specifically:

• Living Promise (Final Expense)

• Term Life Express (TLE)

• Indexed Universal Life Express (IULE) All products are underwritten by United of Omaha Life Insurance Company.

Issue Ages and Face Amounts
Each product has distinct age and coverage guidelines:

• Term Life Express (TLE) and Indexed Universal Life Express (IULE):

  • Ages 18–50: $25,000 to $300,000

  • Ages 51–60: $25,000 to $250,000

  • Ages 61–75: $25,000 to $150,000

• Living Promise Final Expense:

  • Level Benefit: Ages 45–85; $2,000 to $50,000

  • Graded Benefit: Ages 45–80; $2,000 to $20,000

  • Face amounts and issue ages may vary by state.

Available Terms and Plan Types

• Term Life Express: Simplified term life coverage

• IUL Express: Indexed universal life with simplified issue

• Living Promise: Whole life insurance with level and graded death benefit options

Underwriting Requirements and Automated Underwriting All policies are simplified issue and may include:

• Build chart review

• MIB (Medical Information Bureau) check

• Pharmaceutical (Rx) check

• Medical Data Check

• Motor Vehicle Report (MVR):

  • Mandatory for ages 18–35

  • Discretionary for ages 36–50 (TLE/IULE)

• Phone interview as needed or random (required for Living Promise)

For applications submitted via iGO e-App, Mutual of Omaha offers automated underwriting that can return instant approvals, referrals, or declines.

Build Chart
The underwriting build chart includes minimum and maximum weight limits by height for each product. The chart below must be used to determine eligibility. Each height is matched with:

Height	TLE/IULE/LP Min Weight	TLE/IULE Max Weight	DI Rider Max Weight	Table 2 Max Weight	Living Promise Level Max Weight	Living Promise Graded Max Weight
4’ 8”	74	197	170	184	204	221
4’ 9”	77	202	176	189	209	225
4’ 10”	79	208	182	194	214	231
4’ 11”	82	214	187	199	220	237
5’ 0”	85	220	193	205	226	244
5’ 1”	88	226	199	211	233	250
5’ 2”	91	232	205	215	239	257
5’ 3”	94	238	213	220	246	264
5’ 4”	97	245	221	225	252	270
5’ 5”	100	251	226	231	259	277
5’ 6”	103	258	232	239	268	285
5’ 7”	106	265	239	245	275	293
5’ 8”	109	274	246	251	283	300
5’ 9”	112	282	254	258	291	309
5’ 10”	115	289	262	266	300	316
5’ 11”	119	298	269	274	307	325
6’ 0”	122	305	275	281	315	333
6’ 1”	126	313	282	289	322	340
6’ 2”	129	321	289	296	331	349
6’ 3”	133	329	296	303	339	358
6’ 4”	136	338	301	311	348	367
6’ 5”	140	347	307	319	357	376
6’ 6”	143	358	313	328	366	385
6’ 7”	147	367	320	336	375	394
6’ 8”	151	376	327	345	385	405
6’ 9”	154	385	335	352	395	415
6’ 10”	158	395	343	359	407	427

• Minimum Weight (TLE/IULE and Living Promise)

• Maximum Weight (TLE/IULE)

• Maximum Weight (DI Rider)

• **Maximum Weight under Table 2 for Multiple Impairments)

• Maximum Weight for Living Promise Level Benefit

• Maximum Weight for Living Promise Graded Benefit

Prescription Drug Exclusions If the proposed insured is currently taking any of the following medications, they are ineligible for coverage under the respective simplified issue product. This list is exhaustive and overrides any general guidance.

• Term Life Express / IUL Express: Medications include Abacavir, Adcirca, Aggrenox, Alkeran, Amiodarone, Ampyra, Anoro Ellipta, Antabuse, Aricept, Arimidex, Atripla, Avonex, Azilect, Baraclude, Betaseron, Calcium Acetate, Campath, Campral, Caprelsa, Carbidopa/Levodopa, Casodex, Cellcept, Chlorpromazine Hcl, Clozapine, Cognex, Combivir, Copaxone, Crixivan, Cyclosporine, Cytoxan, Daliresp, Digitek, Digoxin, Dobutamine Hcl, Donepezil, Droxia, Eligard, Eliquis, Enbrel, Epivir Hbv, Ergoloid Mesylates, Exelon, Femara, Floxuridine, Fluorouracil, Galantamine Hydrobromide, Gammagard, Gamunex, Gengraf, Geodon, Haldol, Haloperidol, Hepsera, Humira, Hydrea, Hydroxyurea, Infergen, Invega, Invirase, Isentress, Kalydeco, Keytruda, Lanoxin, Latuda, Leucovorin Calcium, Lexiva, Lithium, Megestrol Acetate (Megace), Methadone, Methotrexate, Mitomycin, Morphine Sulfate, Mycophenolate Mofetil, Myfortic, Nabi-Hb, Naloxone Hcl, Naltrexone Hcl, Namenda, Neupogen, Opdivo, Panretin, Pegasys, Peg-Intron, Perphenazine, Prograf, Ranexa, Razadyne, Rebif, Retrovir, Revia, Revlimid, Ribavirin, Risperdal, Rituxan, Sandimmune, Saphris, Sinemet, Spiriva, Stalevo, Stribild, Suboxone, Sustiva, Symbyax, Tamoxifen, Targretin, Teslac, Tudorza, Tysabri, Viracept, Viramune, Viread, Xarelto, Xeljanz, Zenapax, Zerit, Ziagen, Zidovudine, Zoladex, Zyprexa

• Living Promise: Same as above, with some medications marked eligible for Graded Benefit only. Additional excluded drugs include Abilify, Carvedilol, Clopidogrel, Coreg, Coumadin, Enoxaparin Sodium, Infergen, Lovenox, Plavix, Pradaxa, Seroquel, Truvada, Warfarin. Every medication listed must be disclosed with reason for use.

Medications Requiring Individual Consideration The following medications do not guarantee decline but require a reason for use provided on the application. Failure to include justification may delay processing or result in an unfavorable decision. Mutual of Omaha will determine eligibility using pharmacy data, MIB, or phone interview.

• Abilify, Aggrenox, Arimidex, Baraclude, Carvedilol, Clopidogrel, Coreg, Coumadin, Digitek, Digoxin, Eliquis, Enoxaparin Sodium, Femara, Infergen, Lanoxin, Lovenox, Pegasys, Peg-Intron, Plavix, Pradaxa, Seroquel, Tamoxifen, Truvada, Warfarin, Xarelto

Impairments That May Affect Eligibility The following list includes all known impairments flagged by Mutual of Omaha for simplified issue underwriting. These conditions may lead to a modified offer or outright decline:

• Abnormal/Irregular Heart Rhythm

• Alcohol or Drug Treatment History

• ALS (Lou Gehrig’s Disease)

• Amputation due to Disease

• Asthma (Chronic or Severe)

• Bipolar Disorder

• Schizophrenia

• Major Depression

• Cardiomyopathy

• Cerebral Palsy

• Chronic Kidney Disease

• Congestive Heart Failure (CHF)

• Crohn’s Disease

• Ulcerative Colitis

• Coronary Artery Disease

• Heart Attack

• Heart Surgery

• COPD (Chronic Bronchitis, Emphysema, Cystic Fibrosis)

• Any form of Cancer

• Defibrillator Use

• Diabetes (Early onset or uncontrolled)

• Diabetes with Complications (Retinopathy, Nephropathy, Neuropathy)

• Hepatitis B

• Hepatitis C

• Hodgkin’s Disease

• Liver Disease (including Cirrhosis)

• Leukemia

• Lymphoma

• Melanoma

• Mental Incapacity

• Metastatic Cancer

• Recurrent Cancer

• Neurological Disorders (Muscular Dystrophy, MS, Parkinson’s Disease)

• Pacemaker Use

• Chronic or Alcohol-Related Pancreatitis

• Paralysis

• Organ Transplant

• Bone Marrow Transplant

• Peripheral Vascular Disease (PVD, PAD)

• Renal Insufficiency

• Renal Failure

• Moderate/Severe Rheumatoid Arthritis

• Scleroderma

• Sickle Cell Anemia

• Stroke or TIA (mini-stroke)

• Systemic Lupus

Multiple Impairments Rule (TLE/IULE) Applicants presenting more than one of the above impairments or conditions that together equate to Table 4 or higher rating will be declined. The following combinations are explicitly uninsurable:

• Diabetes diagnosed after age 45 with Table 2+ build

• Diabetes over age 45 with tobacco or nicotine use

• Diabetes over age 45 with peripheral vascular disease (PVD)

• Diabetes with any complications (retinopathy, nephropathy, neuropathy)

• Table 2 or higher build with hypertension

• Table 2 or higher build with asthma and nicotine use

• Table 2 or higher build with PVD

Included and Optional Riders Available riders include Accidental Death Benefit (ADB), Disability Income Rider (DIR, subject to occupation), and Children’s Term Rider. Riders must be selected at application. They are only convertible if they already exist on the policy.

Conversion Options (TLE Only) TLE policies may be converted to permanent coverage:

• Products available: IUL Express, Whole Life Conversion Product

• Minimums: $25,000 for IUL Express; $5,000 for Whole Life

• Term conversions with substandard ratings must convert into fully underwritten UL products (e.g., AccumUL, Life Protection Advantage)

• Riders are not guaranteed to convert unless already in place

Eligibility Restrictions

• Permanent Residents must:

  • Possess a valid green card

  • Live in the U.S. for 12+ months

  • Have $20,000+ U.S. income (excluding SSI or SSDI)

  • Complete Foreign National Questionnaire

• Temporary Visa Holders accepted only with the following valid visas:

  • E-1, E-2, H-1B, H-4, L-1, L-2

Restricted Occupations and Avocations Applicants will be declined for any of the following:

• Law enforcement (e.g., narcotics, bomb squad, undercover work)

• Military involving hazards (e.g., explosives, parachuting, diving)

• High-risk construction (tower erector, structural steel, >49 feet)

• Private duty or home health aides: acceptable for life, declined for DIR

• Travel to war zones or unstable political regions

• Recreational hazards: skydiving, base jumping, hang gliding, etc.

Ownership and Beneficiary Rules Acceptable owners: spouse, parent, child, trust, business partner. Trusts require documentation. Beneficiaries may include estate, siblings, grandparents, ex-spouse, and in-laws. Any other combination will not be approved. POA is never acceptable for application signing.

Submission Tips Applications must include all required documents:

• e-App or paper application

• Signed illustration (IULE)

• Allocation forms (IULE)

• Conditional receipt (if premium collected)

• State-specific forms

• Producer report, buyer’s guide, MIB notice

Maximum Combined Coverage

• Ages 18–50: $300,000

• Ages 51–60: $250,000

• Ages 61–75: $150,000

• Living Promise: $50,000 max (Level), $25,000 max (Graded)

• ADB Rider: $250,000 max ($100,000 if 18–25)

• Child Rider: $10,000 max

Height/Weight Build Chart Each height is matched with specific minimum and maximum weights for different product eligibility. This includes:

• Minimum weights for TLE, IULE, and Living Promise

• Maximum weights for TLE and IULE

• Maximum weights for the Disability Income Rider

• Maximum Table 2 weights for multiple impairment consideration

• Living Promise Level and Graded Benefit maximum weights

!-- AgentAI: Coach Kelly should use this guide when asked about Senior Choice Final Expense products from Occidental or AmAm, or when comparing final expense plans with immediate, graded or ROP payout structures. -->

Carrier: Occidental/American-Amicable Life Insurance Company of Texas (AmAm)

Product: Senior Choice

Product Types: Immediate Death Benefit, Graded Death Benefit, Return of Premium (ROP)

Issue Ages: 50–85 (Immediate), 50–85 (Graded & ROP)

Face Amounts: $2,500–$50,000

Target Market: Final expense clients age 50+ or seniors with varying health histories

Carrier

Occidental/American-Amicable Life Insurance Company of Texas (AmAm)

Product Overview

Senior Choice is a simplified issue final expense whole life insurance policy. It provides lifetime coverage with level premiums and includes three plan types: Immediate Death Benefit, Graded Death Benefit, and Return of Premium (ROP). The product offers living benefits and optional riders and is underwritten without medical exams or labs.

Issue Ages and Face Amounts

• Immediate Benefit Plan: 50–85
• Graded Benefit Plan: 50–80
• ROP Plan: 50–80
• Minimum Face Amount: $2,500
• Maximum Face Amount: $35,000

Available Plan Types

• Immediate Death Benefit
• Graded Death Benefit (limited payout in first 2 years)
• Return of Premium (ROP) with full coverage after year 3

Underwriting Guidelines

Senior Choice uses simplified issue underwriting. There is no medical exam or labs. Eligibility is based on Yes/No application responses, MIB check, prescription history (Rx), build chart, and potential telephone interview. APS may be requested at the underwriter’s discretion. Plans are assigned based on health questions and prescription use. Height and weight must fall within accepted build chart ranges. If any disqualifying answer is present, the application is either declined or moved to a mo...

Build Chart

Ht.	MAXIMUM WEIGHT FOR PLAN	MAXIMUM WEIGHT FOR PLAN	MAXIMUM WEIGHT FOR PLAN	MINIMUM WEIGHT FOR PLAN	MINIMUM WEIGHT FOR PLAN
Ht.	IMMEDIATE	GRADED	ROP	IMMEDIATE	ROP
4' 5"**	173	174 - 180	181 - 190	82	77 - 81
4' 6"**	180	182 - 188	189 - 198	84	79 - 83
4' 7"**	187	189 - 196	197 - 206	86	81 - 85
4' 8"	197	198 - 204	205 - 214	88	83 - 87
4' 9"	204	205 - 212	213 - 222	90	85 - 89
4' 10"	211	212 - 220	221 - 230	92	87 - 91
4' 11"	218	219 - 228	229 - 238	94	89 - 93
5'	225	226 - 236	237 - 246	96	91 - 95
5' 1"	233	234 - 244	245 - 254	99	94 - 98
5' 2"	241	242 - 252	253 - 262	101	96 - 100
5' 3"	248	249 - 260	261 - 271	105	100 - 104
5' 4"	256	257 - 268	269 - 280	107	102 - 106
5' 5"	264	265 - 276	277 - 288	110	105 - 109
5' 6"	273	274 - 285	286 - 297	112	107 - 111
5' 7"	281	282 - 294	295 - 306	116	111 - 115
5' 8"	289	290 - 303	304 - 316	119	114 - 118
5' 9"	298	299 - 312	313 - 325	123	118 - 122
5' 10"	307	308 - 321	322 - 335	126	121 -1 25
5' 11"	315	316 - 330	331 - 344	131	126 - 130
6'	324	325 - 339	340 - 354	135	130 - 134
6' 1"	334	335 - 349	350 - 364	139	134 - 138
6' 2"	343	344 - 359	360 - 374	142	137 - 141
6' 3"	352	353 - 368	369 - 384	146	141 - 145
6' 4"	361	362 - 378	379 - 394	149	144 - 148
6' 5"	370	371 - 388	389 - 404	152	147 - 151
6' 6"	379	380 - 398	399 - 414	156	151 - 155
6' 7"	388	398 - 408	409 - 424	160	155 - 159
6' 8"	397	398 - 418	419 - 434	164	159 - 163
6' 9"	406	407 - 428	429 - 440	168	162 - 167
4' 5" - 4' 7" (**) These heights are not programmed when using the mobile application decision engine and will generate a Refer to Home Office decision.	4' 5" - 4' 7" (**) These heights are not programmed when using the mobile application decision engine and will generate a Refer to Home Office decision.	4' 5" - 4' 7" (**) These heights are not programmed when using the mobile application decision engine and will generate a Refer to Home Office decision.	4' 5" - 4' 7" (**) These heights are not programmed when using the mobile application decision engine and will generate a Refer to Home Office decision.	4' 5" - 4' 7" (**) These heights are not programmed when using the mobile application decision engine and will generate a Refer to Home Office decision.	4' 5" - 4' 7" (**) These heights are not programmed when using the mobile application decision engine and will generate a Refer to Home Office decision.

Medical Impairment Guide – Complete

Condition / Concern	Criteria	Plan to Apply For	Question on App
Activities of Daily Living	Require assistance (from anyone) with bathing, dressing, eating, or toileting	No Coverage	1
AIDS / HIV	Medically treated or diagnosed by a medical professional as having	No Coverage	3
Alcoholism / Alcohol Abuse	Within the past 2 years abused alcohol, or recommended to have treatment or counseling for alcohol use or advised to discontinue use of alcohol	Return of Premium	7d
Alzheimer’s disease	Medically diagnosed	No Coverage	2
Amputation	Have had an amputation caused by disease	No Coverage	1
Amyotrophic Lateral Sclerosis (ALS) / (Lou Gehrig's Disease)	Medically diagnosed	No Coverage	2
Aneurysm	Medically diagnosed, treated, or hospitalized for within the past 2 years	Return of Premium	7b
Angina (Chest Pain)	Medically diagnosed or treated within the past 2 years	Return of Premium	7a
Angioplasty	Medically diagnosed, treated, or hospitalized for within the past 2 years	Return of Premium	7b
Bed Confinement	Currently confined to a bed	No Coverage	1
Cancer (excluding basal cell skin cancer)	Currently have cancer or history of metastatic cancer	No Coverage	1
Cardiomyopathy	Medically diagnosed, treated, or hospitalized for	Return of Premium	7a
Catheterization (Heart)	Medically diagnosed, treated, or hospitalized for within the past 2 years	Return of Premium	7b
Chronic Bronchitis	See Chronic Obstructive Pulmonary Disease (COPD).	nan	nan
Chronic Hepatitis	Medically diagnosed or treated within the past 2 years	Return of Premium	7a
Chronic Kidney Disease	Medically diagnosed, treated, or hospitalized for	Return of Premium	5
Chronic Pancreatitis	Medically diagnosed or treated within the past 2 years	Return of Premium	7a
Chronic Obstructive Pulmonary Disease (COPD)	Medically diagnosed or treated within the past 2 years	Return of Premium	7a
Circulatory Surgery	Medically diagnosed, treated, or hospitalized for within the past 2 years	Return of Premium	7b
Cirrhosis of the Liver	Medically diagnosed or treated within the past 2 years	Return of Premium	7a
Congestive Heart Failure (CHF)	Medically diagnosed, treated, or hospitalized for	No Coverage	2
Coronary Artery Bypass Surgery	Medically diagnosed, treated, or hospitalized for within the past 2 years	Return of Premium	7b
Defibrillator	Inserted within the past 2 years	Return of Premium	7b
Dementia	Medically diagnosed, treated, or hospitalized for	No Coverage	2
Diabetes	Combined with any medical history of any of the following: Retinopathy, Nephropathy, Neuropathy	Return of Premium	4
Diagnostic Testing, Surgery, or Hospitalization	Recommended within the past 2 years by a medical professional which has not been completed or for which the results have not been received	Return of Premium	6
Drug Abuse / Addiction	Used illegal drugs, abused drugs, recommended to have treatment or counseling for drug use or advised to discontinue use of drugs within the past 2 years	Return of Premium	7d
Emphysema	See Chronic Obstructive Pulmonary Disease (COPD)	nan	nan
Heart Attack	Medically diagnosed, treated, or hospitalized for within the past 2 years	Return of Premium	7b
Heart Surgery	Medically diagnosed, treated, or hospitalized for within the past 2 years	Return of Premium	7b
Hepatitis C	Medically diagnosed, treated, or hospitalized for within the past 2 years	Return of Premium	7a
Home Health Care	Currently receiving	No Coverage	1
Hospice Care	Currently receiving	No Coverage	1
Hospitalization	Currently hospitalized	No Coverage	1
Kidney Dialysis	Medically advised to have	No Coverage	2
Kidney Failure	Medically diagnosed, treated, or taken medication for	Return of Premium	5
Liver Disease	Medically diagnosed, treated, or taken medication for liver failure	No Coverage	2
Mental Incapacity	Medically diagnosed	No Coverage	2
Multiple Sclerosis (MS)	Medically diagnosed, treated, or hospitalized for within the past 3 years	Graded	8c
Muscular Dystrophy	Medically diagnosed, treated, or hospitalized for within the past 3 years	Graded	8c
Nursing Facility	Currently confined	No Coverage	1
Organ Transplant	Medically advised to have	No Coverage	2
Oxygen Equipment	Currently used to assist in breathing	No Coverage	1
Pacemaker	Inserted within the past 2 years	Return of Premium	7b
Paralysis	Medically diagnosed, treated, or hospitalized for paralysis of 2 or more extremities within the past 3 years	Graded	8c
Parkinson's Disease	Medically diagnosed, treated, or hospitalized for within the past 3 years	Graded	8c
Renal Insufficiency	Medically diagnosed, treated, or taken medication for	Return of Premium	5
Respiratory Failure	Medically diagnosed, treated, or hospitalized for	No Coverage	2
Seizures	Medically diagnosed, treated, or hospitalized for within the past 3 years	Graded	8c
Stroke	Medically diagnosed within the past 2 years	Return of Premium	7a
Systemic Lupus (SLE)	Medically diagnosed, treated, or hospitalized for within the past 2 years	Return of Premium	7a
Terminal Medical Condition or End Stage Disease	Medically diagnosed or treated for a condition that is expected to result in death in the next 12 months	No Coverage	2
TIA (Transient Ischemic Attack)	Medically diagnosed, treated, or hospitalized for within the past 2 years	Return of Premium	7a
Ulcerative Colitis	Medically diagnosed, treated, or hospitalized for within the past 3 years	Graded	8b
Wheelchair Use	Currently confined to a wheelchair due to chronic illness or disease	No Coverage	1
Note: Applies to standard life application Form Form No. 9466 (AA, OL, PA, PS) and Form ICC15-GL213 (iA). The question numbers on some state-specific applications may vary. Refer to the state-specific section of this agent guide for plan availability. If you have any questions about medical conditions not listed here, you can do a risk assessment using our live chat option (click on Risk Assessment) or email This email address is being protected from spambots. You need JavaScript enabled to view it.	nan	nan	nan

Prescription Medication Guide – Complete

Medication	Common Uses	RX Fill Within	Plan Eligibility
Abilify	Psychotic Disorder	nan	Immediate
Accupril	Hypertension CHF	N/A N/A	Immediate No Coverage
Accuretic	Hypertension CHF	N/A N/A	Immediate No Coverage
Acebutolol HCL	Hypertension CHF	N/A N/A	Immediate No Coverage
Aceon	Hypertension CHF	N/A N/A	Immediate No Coverage
Actoplus	Diabetes *	nan	Immediate
Actos	Diabetes *	nan	Immediate
Advair	Asthma	nan	Immediate
Aggrenox	Stroke / TIA	2  years	Return of Premium Graded
Albuterol	Asthma	nan	Immediate
Aldactazide	Hypertension CHF	N/A N/A	Immediate No Coverage
Aldactone	Hypertension CHF	N/A N/A	Immediate No Coverage
Allopurinol	Gout	nan	Immediate
Altace	Hypertension CHF	N/A N/A	Immediate No Coverage
Amantadine HCL	Parkinson’s	nan	Graded
Amaryl	Diabetes *	nan	Immediate
Ambisome	AIDS	nan	No Coverage
Amiloride HCL	Hypertension CHF	N/A N/A	Immediate No Coverage
Amlodipine Besylate / Benaz	Hypertension CHF	N/A N/A	Immediate No Coverage
Amyl Nitrate	Angina	2  years	Return of Premium Graded
Antabuse	Alcohol / Drugs	2 years	Return of Premium
Apokyn	Parkinson’s	nan	Graded
Apresoline	Hypertension CHF	N/A N/A	Immediate No Coverage
Aptivus	AIDS	nan	No Coverage
Aranesp	Kidney Dialysis	N/A N/A N/A	No Coverage Return of Premium Return of Premium
Aricept	Alzheimer’s / Dementia	nan	No Coverage
Arimidex	Cancer	2 years	Return of Premium Graded
Atacand	Hypertension CHF	N/A N/A	Immediate No Coverage
Atamet	Parkinson’s	nan	Graded
Atenolol	Hypertension CHF	N/A N/A	Immediate No Coverage
Atgam	Organ / Tissue Transplant	nan	No Coverage
Atripla	AIDS	nan	No Coverage
Atrovent / Atrovent HFA Atrovent (Nasal)	Allergies	nan	Immediate
Avalide	Hypertension CHF	N/A N/A	Immediate No Coverage
Avandia	Diabetes *	nan	Immediate
Avapro	Hypertension CHF	N/A N/A	Immediate No Coverage
Avonex	Multiple Sclerosis	nan	Graded
Azasan	Organ / Tissue Transplant Rheumatoid Arthritis Systemic Lupus	N/A N/A N/A	No Coverage Immediate
Azathioprine	Organ / Tissue Transplant Rheumatoid Arthritis Systemic Lupus	N/A N/A N/A	No Coverage Immediate
Azilect	Parkinson’s	nan	Graded
Azmacort	Asthma	nan	Immediate
Azor	Hypertension CHF	N/A N/A	Immediate No Coverage
Baclofen	Multiple Sclerosis	nan	Graded
Baraclude	Liver Disorder / Hepatitis	2  years	Return of Premium Graded
Benazepril HCL	Hypertension CHF	N/A N/A	Immediate No Coverage
Benicar	Hypertension CHF	N/A N/A	Immediate No Coverage
Benlysta	Systemic Lupus	nan	Return of Premium
Benztropine Mesylate	Parkinson’s Other Use	N/A N/A	Graded Immediate
Betapace	Arrhythmia CHF	N/A N/A	Immediate No Coverage
Betaseron	Multiple Sclerosis	nan	Graded
Betaxolol HCL	Hypertension CHF	N/A N/A	Immediate No Coverage
BiDil	CHF	nan	No Coverage
Bisoprolol Fumarate	Hypertension CHF	N/A N/A	Immediate No Coverage
Bromocriptine Mesylate	Parkinson’s	nan	Graded
Bumetanide	Hypertension CHF	N/A N/A	Immediate No Coverage
Bumex	Hypertension CHF	N/A N/A	Immediate No Coverage
Buprenex	Alcohol / Drugs	2 years	Return of Premium
Bystolic	Hypertension CHF	N/A N/A	Immediate No Coverage
Calcium Acetate	Kidney Dialysis	N/A N/A N/A	No Coverage Return of Premium Return of Premium
Campath	Cancer	2 years	Return of Premium Graded
Campral	Alcohol / Drugs	2 years	Return of Premium
Capoten	Hypertension CHF	N/A N/A	Immediate No Coverage
Capozide	Hypertension CHF	N/A N/A	Immediate No Coverage
Captopril	Hypertension CHF	N/A N/A	Immediate No Coverage
Carbamazepine	Seizures	3 years N/A	Graded
Carbatrol	Seizures	3 years N/A	Graded
Carbidopa	Parkinson’s	nan	Graded
Carvedilol	Hypertension CHF	N/A N/A	Immediate No Coverage
Casodex	Cancer	2 years	Return of Premium Graded
Celebrex	Arthritis	nan	Immediate
Cellcept	Organ / Tissue Transplant	nan	No Coverage
Clopidogrel	Stroke / TIA / Heart Attack Stroke / Heart Attack Stroke / Heart Attack	First Fill 2 years First Fill 3 years First Fill > 3 years	Return of Premium Graded
Cogentin	Parkinson’s Other Use	N/A N/A	Graded Immediate
Cognex	Alzheimer’s / Dementia	nan	No Coverage
Combivent	COPD	2  years	Return of Premium Graded
Combivir	AIDS	nan	No Coverage
Complera	AIDS	nan	No Coverage
Copaxone	Multiple Sclerosis	nan	Graded
Copegus	Liver Disorder / Hepatitis C	2  years	Return of Premium Graded
Cordarone	Arrhythmia	nan	Immediate
Coreg	Hypertension CHF	N/A N/A	Immediate No Coverage
Corgard	Hypertension CHF	N/A N/A	Immediate No Coverage
Corzide	Hypertension CHF	N/A N/A	Immediate No Coverage
Coumadin	Pulmonary Embolism Thrombosis	N/A N/A	Immediate Immediate
Cozaar	Hypertension CHF	N/A N/A	Immediate No Coverage
Cyclosporine	Organ / Tissue Transplant	nan	No Coverage
Cyclosporine Modified	Organ / Tissue Transplant	nan	No Coverage
Cytoxan	Cancer	2  years	Return of Premium Graded
Demadex	Hypertension CHF	N/A N/A	Immediate No Coverage
Depacon	Seizures	3 years N/A	Graded
Depade	Alcohol / Drugs	2 years	Return of Premium
Depakene	Seizures	3 years N/A	Graded
Depakote	Seizure Disorder	3 years	Graded
Diabeta	Diabetes *	nan	Immediate
Diabinese	Diabetes *	nan	Immediate
Digitek	Atrial Fibrillation CHF	N/A N/A	Immediate No Coverage
Digoxin	Atrial Fibrillation CHF	N/A N/A	Immediate No Coverage
Dilantin	Seizure Disorder	nan	Graded
Dilatrate SR	Angina	2 years	Return of Premium Graded
Dilor	Asthma	nan	Immediate
Diovan	Hypertension CHF	N/A N/A	Immediate No Coverage
Disulfiram	Alcohol / Drugs	2 years	Return of Premium
Dolophine	Opioid Dependence	2 years	Return of Premium
Donepezil HCL	Alzheimer’s / Dementia	nan	No Coverage
Duoneb	COPD	2 years	Return of Premium Graded
Dyazide	Hypertension CHF	N/A N/A	Immediate No Coverage
Dynacirc	Hypertension	nan	Immediate
Dyrenium	Hypertension CHF	N/A N/A	Immediate No Coverage
Edecrin	Hypertension CHF	N/A N/A	Immediate No Coverage
Edurant	AIDS	nan	No Coverage
Eldepryl	Parkinson’s	nan	Graded
Emtriva	AIDS	nan	No Coverage
Enalapril Maleate	Hypertension CHF	N/A N/A	Immediate No Coverage
Enalaprilat	Hypertension CHF	N/A N/A	Immediate No Coverage
Epitol	Seizures	3 years N/A	Graded
Epivir	AIDS	nan	No Coverage
Eskalith	Bipolar Disorder	nan	Immediate
Esmolol HCL	Hypertension CHF	N/A N/A	Immediate No Coverage
Exelon	Alzheimer’s / Dementia	nan	No Coverage
Exforge	Hypertension CHF	N/A N/A	Immediate No Coverage
Femara	Cancer	2  years	Return of Premium Graded
Foscavir	AIDS	nan	No Coverage
Fosinopril Sodium	Hypertension CHF	N/A N/A	Immediate No Coverage
Fosrenol	Kidney Dialysis	N/A N/A N/A	No Coverage Return of Premium Return of Premium
Furosemide	Hypertension CHF	N/A N/A	Immediate No Coverage
Gabapentin	Seizures	3 years N/A N/A	Graded
Galantamine	Alzheimer’s / Dementia	nan	No Coverage
Gleevec	Cancer	2 years	Return of Premium Graded
Glipizide	Diabetes *	nan	Immediate
Glucophage	Diabetes *	nan	Immediate
Glucotrol	Diabetes *	nan	Immediate
Glyburide	Diabetes *	nan	Immediate
Glynase	Diabetes *	nan	Immediate
Haldol	Psychotic Disorder	nan	Immediate
Haloperidol	Psychotic Disorder	nan	Immediate
HCTZ	Hypertension	nan	Immediate
HCTZ / Triamterene	Hypertension CHF	N/A N/A	Immediate No Coverage
Hectoral	Kidney Dialysis	N/A N/A N/A	No Coverage Return of Premium Return of Premium
Heparin	Pulmonary Embolism Thrombosis	N/A N/A	Immediate Immediate
Hepsera	Liver Disorder / Hepatitis	2  years	Return of Premium Graded
Hizentra	Immunodeficiency	nan	Decline
Humalog	Diabetes *	nan	Immediate
Humulin	Diabetes *	nan	Immediate
Hydralazine HCL	Hypertension CHF	N/A N/A	Immediate No Coverage
Hydroxyurea	Cancer	2  years	Return of Premium Graded
Hydergine	Alzheimer’s / Dementia	nan	No Coverage
Hydroxychloroquine	Systemic Lupus Malaria	N/A N/A N/A	Return of Premium Immediate Immediate
Hyzaar	Hypertension CHF	N/A N/A	Immediate No Coverage
Imdur	Angina	2  years	Return of Premium Graded
Imuran	Organ / Tissue Transplant Rheumatoid Arthritis Systemic Lupus	N/A N/A N/A	No Coverage Immediate
Inamrinone	CHF	nan	No Coverage
Inderal	Hypertension CHF	N/A N/A	Immediate No Coverage
Inderide	Hypertension CHF	N/A N/A	Immediate No Coverage
Innopran XL	Hypertension CHF	N/A N/A	Immediate No Coverage
Inspra	CHF	nan	No Coverage
Insulin	Diabetes *	nan	Immediate
Intron-A	Cancer	2  years	Return of Premium Graded
Invirase	AIDS	nan	No Coverage
Ipratropium Bromide	Allergies	nan	Immediate
Isordil	Angina	2  years	Return of Premium Graded
Isosorbide Dinitrate / Mononitrate	Angina	2  years	Return of Premium Graded
Janumet	Diabetes *	nan	Immediate
Januvia	Diabetes *	nan	Immediate
Kaletra	AIDS	nan	No Coverage
Kemadrin	Parkinson’s Other Use	N/A N/A	Graded Immediate
Kerlone	Hypertension CHF	N/A N/A	Immediate No Coverage
Labetalol	Hypertension CHF	N/A N/A	Immediate No Coverage
Lamictal	Seizures	3 years N/A	Graded
Lamotrigine	Seizures	3 years N/A	Graded
Lanoxicaps	Atrial Fibrillation CHF	N/A N/A	Immediate No Coverage
Lanoxin	Atrial Fibrillation CHF	N/A N/A	Immediate No Coverage
Lantus	Diabetes *	nan	Immediate
Larodopa	Parkinson’s	nan	Graded
Lasix	Hypertension CHF	N/A N/A	Immediate No Coverage
Leukeran	Cancer	2 years	Return of Premium Graded
Levatol	Hypertension CHF	N/A N/A	Immediate No Coverage
Levemir	Diabetes *	nan	Immediate
Levocarnitine	Kidney Dialysis	N/A N/A N/A	No Coverage Return of Premium Return of Premium
Levodopa	Parkinson’s	nan	Graded
Lexiva	AIDS	nan	No Coverage
Lexxel	Hypertension CHF	N/A N/A	Immediate No Coverage
Lipitor	Cholesterol	nan	Immediate
Lisinopril	Hypertension CHF	N/A N/A	Immediate No Coverage
Lithium	Bipolar Disorder	nan	Immediate
Lodosyn	Parkinson’s	nan	Graded
Losartan Potassium	Hypertension CHF	N/A N/A	Immediate No Coverage
Lotensin	Hypertension CHF	N/A N/A	Immediate No Coverage
Loxapine	Psychotic Disorder	nan	Immediate
Loxitane	Psychotic Disorder	nan	Immediate
Lupron	Cancer	2  years	Return of Premium Graded
Lyrica	Seizures	3 years N/A	Graded
Mavik	Hypertension CHF	N/A N/A	Immediate No Coverage
Maxzide	Hypertension CHF	N/A N/A	Immediate No Coverage
Mellaril	Psychotic Disorder	nan	Immediate
Mepron	AIDS	nan	No Coverage
Metformin	Diabetes *	nan	Immediate
Methadone	Opioid Dependence	2 years	Return of Premium
Methadose	Opioid Dependence	2 years	Return of Premium
Methotrexate	Cancer	2 years	Return of Premium Graded
Metolazone	Hypertension CHF	N/A N/A	Immediate No Coverage
Metoprolol HCTZ	Hypertension CHF	N/A N/A	Immediate No Coverage
Metoprolol Tartrate / Succinate	Hypertension CHF	N/A N/A	Immediate No Coverage
Micardis	Hypertension CHF	N/A N/A	Immediate No Coverage
Micronase	Diabetes *	nan	Immediate
Midamor	Hypertension CHF	N/A N/A	Immediate No Coverage
Milrinone	CHF	nan	No Coverage
Minitran	Angina	2  years	Return of Premium Graded
Mirapex	Parkinson’s Other Use	N/A N/A	Graded Immediate
Moban	Psychotic Disorder	nan	Immediate
Moduretic	Hypertension CHF	N/A N/A	Immediate No Coverage
Moexipril HCL	Hypertension CHF	N/A N/A	Immediate No Coverage
Monoket	Angina	2  years	Return of Premium Graded
Monopril	Hypertension CHF	N/A N/A	Immediate No Coverage
Mykrok	Hypertension CHF	N/A N/A	Immediate No Coverage
Mysoline	Seizure Disorder	nan	Graded
Nadolol	Hypertension CHF	N/A N/A	Immediate No Coverage
Naloxone	Alcohol / Drugs	2 years	Return of Premium
Naltrexone	Alcohol / Drugs	2 years	Return of Premium
Namenda	Alzheimer’s / Dementia	nan	No Coverage
Narcan	Alcohol / Drugs	2 years	Return of Premium
Natrecor	CHF	nan	No Coverage
Navane	Psychotic Disorder	nan	Immediate
Neurontin	Seizures	3 years N/A	Graded
Nimodipine	Stroke / TIA / Heart Attack Stroke / Heart Attack Stroke / Heart Attack	First Fill 2 years First Fill 3 years First Fill > 3 years	Return of Premium Graded
Nimotop	Stroke / TIA / Heart Attack Stroke / Heart Attack Stroke / Heart Attack	First Fill 2 years First Fill 3 years First Fill > 3 years	Return of Premium Graded
Nitrek	Angina	2 years	Return of Premium Graded
Nitro-bid	Angina	2  years	Return of Premium Graded
Nitro-dur	Angina	2  years	Return of Premium Graded
Nitroglycerine / Nitrotab / Nitroquick / Nitrostat	Angina	2  years	Return of Premium Graded
Nitrol	Angina	2  years	Return of Premium Graded
Nitromist	Angina	2  years	Return of Premium Graded
Normodyne	Hypertension CHF	N/A N/A	Immediate No Coverage
Norpace	Arrhythmia	nan	Immediate
Norvir	AIDS	nan	No Coverage
Novolin	Diabetes *	nan	Immediate
Novolog	Diabetes *	nan	Immediate
Pacerone	Arrhythmia	nan	Immediate
Parcopa	Parkinson’s	nan	Graded
Parlodel	Parkinson’s	nan	Graded
Paxil	Depressive Disorder	nan	Immediate
Pegasys	Liver Disorder / Hepatitis C	2  years	Return of Premium Graded
Peg-Intron	Liver Disorder / Hepatitis C	2  years	Return of Premium Graded
Pentam 300	AIDS	nan	No Coverage
Pentamidine Isethionate	AIDS	nan	No Coverage
Pepcid	Stomach Disorder	nan	Immediate
Pergolide Mesylate	Parkinson’s	nan	Graded
Perindopril Erbumine	Hypertension CHF	N/A N/A	Immediate No Coverage
Permax	Parkinson’s	nan	Graded
Phenobarbital	Seizures	3 Years	Graded
Phoslo	Kidney Dialysis	N/A N/A N/A	No Coverage Return of Premium Return of Premium
Pindolol	Hypertension CHF	N/A N/A	Immediate No Coverage
Plaquenil	Systemic Lupus Malaria	N/A N/A N/A	Return of Premium Immediate Immediate
Plavix	Stroke / TIA / Heart Attack Stroke / Heart Attack Stroke / Heart Attack	First Fill 2 years First Fill 3 years First Fill > 3 years	Return of Premium Graded
Prandin	Diabetes *	nan	Immediate
Primacor	CHF	nan	No Coverage
Prinivil	Hypertension CHF	N/A N/A	Immediate No Coverage
Prinzide	Hypertension CHF	N/A N/A	Immediate No Coverage
Prograf	Organ / Tissue Transplant	nan	No Coverage
Proleukin	Cancer	2 years	Return of Premium Graded
Prolixin	Psychotic Disorder	nan	Immediate
Propranolol HCL	Hypertension CHF	N/A N/A	Immediate No Coverage
Proventil	Asthma	nan	Immediate
Prozac	Depressive Disorder	nan	Immediate
Quinapril	Hypertension CHF	N/A N/A	Immediate No Coverage
Quinaretic	Hypertension CHF	N/A N/A	Immediate No Coverage
Ramipril	Hypertension CHF	N/A N/A	Immediate No Coverage
Rapamune	Organ / Tissue Transplant	nan	No Coverage
Razadyne	Alzheimer’s / Dementia	nan	No Coverage
Rebetol	Liver Disorder / Hepatitis C	2  years	Return of Premium Graded
Rebetron	Liver Disorder / Hepatitis C	2  years	Return of Premium Graded
Rebif	Multiple Sclerosis	nan	Graded
Reminyl	Alzheimer’s / Dementia	nan	No Coverage
Renagel	Kidney Dialysis	N/A N/A N/A	No Coverage Return of Premium Return of Premium
Renvela	Kidney Dialysis	N/A N/A N/A	No Coverage Return of Premium Return of Premium
Requip	Parkinson’s Other Use	N/A N/A	Graded Immediate
Ribavirin	Liver Disorder / Hepatitis C	2  years	Return of Premium Graded
Rilutek	ALS (Lou Gehrig's Disease)	nan	No Coverage
Risperdal	Psychotic Disorder	nan	Immediate
Risperidone	Psychotic Disorder	nan	Immediate
Rituxan	Cancer	2  years	Return of Premium Graded
Rivastigmine Tartrate	Alzheimer’s / Dementia	nan	No Coverage
Ropinirole	Parkinson’s	nan	Graded
Rythmol	Arrhythmia	nan	Immediate
Sectral	Hypertension CHF	N/A N/A	Immediate No Coverage
Serevent	Asthma	nan	Immediate
Seroquel	Psychotic Disorder	nan	Immediate
Sinemet / Sinemet CR	Parkinson’s	nan	Graded
Sodium Edecrin	Hypertension CHF	N/A N/A	Immediate No Coverage
Sotalol Hydrochloride	Hypertension CHF	N/A N/A	Immediate No Coverage
Sotalol HCL	Hypertension CHF	N/A N/A	Immediate No Coverage
Spiriva	COPD	2  years	Return of Premium Graded
Spironolactone	Hypertension CHF	N/A N/A	Immediate No Coverage
Sprycel	Cancer	2  years	Return of Premium Graded
Stalevo	Parkinson’s	nan	Graded
Starlix	Diabetes *	nan	Immediate
Suboxone	Alcohol / Drugs	2 years	Return of Premium
Subutex	Alcohol / Drugs	2 years	Return of Premium
Sustiva	AIDS	nan	No Coverage
Symbicort	Asthma	nan	Immediate
Symmetrel	Parkinson’s	nan	Graded
Tambocor	Arrhythmia	nan	Immediate
Tamoxifen	Cancer	2  years	Return of Premium Graded
Tarka	Hypertension CHF	N/A N/A	Immediate No Coverage
Tasmar	Parkinson’s	nan	Graded
Tegretol	Seizures	3 years N/A	Graded
Tenoretic	Hypertension CHF	N/A N/A	Immediate No Coverage
Tenormin	Hypertension CHF	N/A N/A	Immediate No Coverage
Teveten	Hypertension CHF	N/A N/A	Immediate No Coverage
Theo-Dur	Asthma	nan	Immediate
Theophylline	Asthma	nan	Immediate
Thioridazine	Psychotic Disorder	nan	Immediate
Thiothixene	Psychotic Disorder	nan	Immediate
Thorazine	Psychotic Disorder	nan	Immediate
Tolazamide	Diabetes *	nan	Immediate
Tolbutamide	Diabetes *	nan	Immediate
Tolinase	Diabetes *	nan	Immediate
Toprol XL	Hypertension CHF	N/A N/A	Immediate No Coverage
Torsemide	Hypertension CHF	N/A N/A	Immediate No Coverage
Trandate	Hypertension CHF	N/A N/A	Immediate No Coverage
Trandolapril	Hypertension CHF	N/A N/A	Immediate No Coverage
Tresiba (Insulin)	Diabetes*	nan	Immediate
Triamterene	Hypertension CHF	N/A N/A	Immediate No Coverage
Triamterene / HCTZ	Hypertension CHF	N/A N/A	Immediate No Coverage
Tribenzor	Hypertension CHF	N/A N/A	Immediate No Coverage
Trihexyphenidyl HCL	Parkinson’s Other Use	N/A N/A	Graded Immediate
Truvada	AIDS	nan	No Coverage
Twynsta	Hypertension CHF	N/A N/A	Immediate No Coverage
Tyzeka	Liver Disorder / Hepatitis	2  years	Return of Premium Graded
Uniretic	Hypertension CHF	N/A N/A	Immediate No Coverage
Univasc	Hypertension CHF	N/A N/A	Immediate No Coverage
Valcyte	AIDS	nan	No Coverage
Valproic Acid	Seizures	3 years N/A	Graded
Valstar	Cancer	2 years	Return of Premium Graded
Valturna	Hypertension CHF	N/A N/A	Immediate No Coverage
Vascor	Angina	2  years	Return of Premium Graded
Vaseretic	Hypertension CHF	N/A N/A	Immediate No Coverage
Vasotec	Hypertension CHF	N/A N/A	Immediate No Coverage
Ventolin	Asthma	nan	Immediate
Viaspan	Organ / Tissue Transplant	nan	No Coverage
Viracept	AIDS	nan	No Coverage
Viramune	AIDS	nan	No Coverage
Viread	AIDS	nan	No Coverage
Visken	Hypertension CHF	N/A N/A	Immediate No Coverage
Vivitrol	Alcohol / Drugs	2 years	Return of Premium
Warfarin	Pulmonary Embolism Thrombosis	N/A N/A	Immediate Immediate
Xeloda	Cancer	2 years	Return of Premium Graded
Xopenex	Asthma	nan	Immediate
Zantac	Stomach Disorder	nan	Immediate
Zaroxolyn	Hypertension CHF	N/A N/A	Immediate No Coverage
Zebeta	Hypertension CHF	N/A N/A	Immediate No Coverage
Zelapar	Parkinson’s	nan	Graded
Zemplar	Kidney Dialysis	N/A N/A N/A	No Coverage Return of Premium Return of Premium
Zestoretic	Hypertension CHF	N/A N/A	Immediate No Coverage
Zestril	Hypertension CHF	N/A N/A	Immediate No Coverage
Ziac	Hypertension CHF	N/A N/A	Immediate No Coverage
Zocor	Cholesterol	nan	Immediate
Zoloft	Depressive Disorder	nan	Immediate
Zyprexa	Psychotic Disorder	nan	Immediate
NOTE: Proposed insureds taking both a medication marked with an asterisk (*) representing ‘diabetes’ and a number sign (#) representing ‘retinopathy, nephropathy, neuropathy’ should answer question # 4 on the application as 'Yes' (Return of Premium Death Benefit plan section). Question #4 asks – “Have you ever been medically diagnosed or treated for complications of diabetes, including insulin shock, diabetic coma, retinopathy (eye), nephropathy (kidney), neuropathy (nerve damage/pain), or used insulin prior to age 50?”	nan	nan	nan

Included Riders

• Terminal Illness Accelerated Benefit Rider

Optional Riders

• Accidental Death Benefit Rider
• Children’s Insurance Agreement
• Grandchild Rider
• Waiver of Premium for Disability

Conversion Options

This is a permanent product and not convertible. No term plans are available.

Other Eligibility Requirements

• Applicant must reside in the United States and have a valid Social Security Number
• Third-party premium payors must be disclosed; spouse and parent are typically accepted
• Product may not be available in all states; refer to the approved state list

Application Submission

• Use the state-specific Senior Choice application
• Submit via mobile app, AppDrop, or fax
• Point-of-sale decisions may include instant approval, referral, or decline

Carrier: American-Amicable Life Insurance Company of Texas

Product: Family Choice

Product Types: Immediate Death Benefit, Return of Premium (ROP)

Issue Ages: 0–49 (Immediate), 18–49 (ROP)

Face Amounts: $10,000–$35,000 (Immediate), $10,000–$20,000 (ROP)

Target Market: Final Expense (younger market), simplified whole life

Carrier

American-Amicable Life Insurance Company of Texas (Family Choice Series)

Product Overview

The Family Choice Final Expense product provides permanent life insurance with simplified issue underwriting. Two plan types are available: Immediate Death Benefit, Return of Premium (ROP). All plans include a terminal illness rider and optional living benefits. The product is ideal for individuals seeking affordable, guaranteed coverage with living benefit options.

Issue Ages and Face Amounts

• Immediate Plan: 0–49
• Return of Premium (ROP) Plan: 18-49
• Minimum Face Amount: $10,000
• Maximum Immediate Face Amounts: $35,000
• Maximum Return of Premium Face Amount: $20,000

Plan Types

• Immediate Death Benefit
• Return of Premium (ROP)

Underwriting Guidelines

Simplified issue underwriting includes a Yes/No application, MIB and RX checks, build chart validation, and potential telephone interview. No labs or exams are required. APS may be requested. Eligibility is assigned based on application responses and prescription match.

Adult Build Chart

Height	Immediate Max	ROP Max	Immediate Min	ROP Min
HT.	MAXIMUM WEIGHT FOR PLAN	MAXIMUM WEIGHT FOR PLAN	MINIMUM WEIGHT FOR PLAN	MINIMUM WEIGHT FOR PLAN
HT.	IMMEDIATE	RETURN OF PREMIUM*	IMMEDIATE	RETURN OF PREMIUM**
4’10"	211	212 - 230	92	87 - 91
4’11”	218	219 - 238	94	89 - 93
5’	225	226 - 246	96	91 - 95
5’1”	233	234 - 254	99	94 - 98
5’2”	241	242 - 262	101	96 - 100
5’3”	248	249 - 271	105	100 - 104
5’4”	256	257 - 280	107	102 - 106
5’5”	264	265 - 288	110	105 - 109
5’6”	273	274 - 297	112	107 - 111
5’7”	281	282 - 306	116	111 - 115
5’8”	289	290 - 316	119	114 - 118
5’9”	298	299 - 325	123	118 - 122
5’10”	307	308 - 335	126	121 - 125
5’11”	315	316 - 344	131	126 - 130
6’	324	325 - 354	135	130 - 134
6’1”	334	335 - 364	139	134 - 138
6’2”	343	344 - 374	142	137 - 141
6’3”	352	353 - 384	146	141 - 145
6’4”	361	362 - 394	149	144 - 148
* Above the weight on the high end of this range is a decline. ** Below the weight on low end of this range is a decline.	* Above the weight on the high end of this range is a decline. ** Below the weight on low end of this range is a decline.	* Above the weight on the high end of this range is a decline. ** Below the weight on low end of this range is a decline.	* Above the weight on the high end of this range is a decline. ** Below the weight on low end of this range is a decline.	* Above the weight on the high end of this range is a decline. ** Below the weight on low end of this range is a decline.

Juvenile Build Chart

Height	Minimum	Maximum
24″	8	23
26″	10	26
28″	13	31
30″	15	36
32″	18	40
34″	21	42
36″	23	45
38″	26	48
30″	18	40
34″	22	44
38″	26	54
42″	32	64
46″	38	78
50″	46	94
54″	56	111
58″	66	128
48″	44	92
52″	54	108
56″	63	126
60″	74	144
64″	87	166
68″	100	186
72″	113	206
76″	126	228

Medical Impairment Guide

Condition / Concern	Criteria	Plan to Apply For	Question on App
AIDS / ARC	Medically treated or diagnosed by a medical professional as having	No Coverage	1
Alcoholism / Alcohol Abuse	Within the past 24 months, abused alcohol or had, or been recommended to have, treatment or counseling for alcohol use	No Coverage	2
Amputation	Has ever had an amputation caused by disease	No Coverage	6b
Aneurysm	Medically diagnosed, treated, or taken medication for within the past 3 years	Return of Premium	9
Bi-Polar Disorder	Medically diagnosed, treated, or taken medication for	No Coverage	6b
Blood Clot	Medically diagnosed, treated, or taken medication for within the past 3 years	Return of Premium	9
Cancer	Medically diagnosed, treated, or taken medication for internal cancer, lymphoma, melanoma or Hodgkin's Disease or history of metastatic cancer within the past 5 years	No Coverage	4
Cardiomyopathy	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Cerebral Palsy	Medically diagnosed, treated, or taken medication for	Return of Premium	7b
Chronic Bronchitis	Medically diagnosed, treated, or taken medication for within the past 3 years	Return of Premium	9
Chronic Hepatitis	Medically diagnosed, treated, or taken medication for	Return of Premium	7b
Chronic Pancreatitis	Medically diagnosed, treated, or taken medication for	Return of Premium	7b
Chronic Obstructive Pulmonary Disease (COPD)	Medically diagnosed, treated, or taken medication for within the past 3 years	Return of Premium	9
Circulatory Disease	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Congestive Heart Failure (CHF)	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Connective Tissue	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Criminal Background	Convicted of any felony within the past 24 months	No Coverage	2
Crohn's Disease	Medically diagnosed, treated, or taken medication for	Return of Premium	7b
Cystic Fibrosis	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Decline for Insurance	Declined for life insurance coverage within the past 12 months	Return of Premium	8
Diabetes	Medically diagnosed, treated, or taken medication for prior to age 21	No Coverage	5
Diagnostic Testing, Surgery, or Hospitalization	Recommended within the past 12 months by a medical professional which has not been completed or for which the results have not been received	Return of Premium	8
Disability	Prohibited from actively working full-time (30 hours or more per week) at your regular occupation due to any illness, injury, or health related problem within the past 12 months	No Coverage	3
Down Syndrome	Medically diagnosed, treated, or taken medication for	No Coverage	6b
Driving Record	Driver's license suspended or revoked, or convicted of an alcohol/drug related infraction within the past 24 months	No Coverage	2
Drug Abuse / Addiction	Used illegal drugs or abused drugs or recommended to have treatment or counseling for drug abuse within the	No Coverage	2
Emphysema	Medically diagnosed, treated, or taken medication for within the past 3 years	Return of Premium	9
Heart Disease/Disorder	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Heart Valve Disease	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Hemophilia	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Hepatitis C	Medically diagnosed, treated, or taken medication for	Return of Premium	7b
High Blood Pressure	Medically diagnosed, treated, or taken medication for prior to age 30	Return of Premium	7a
HIV	Tested positive for	No Coverage	1
Huntington's Disease	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Immune Deficiency Related Disorder	Medically treated or diagnosed by a medical professional as having	No Coverage	1
Irregular Heartbeat	Medically diagnosed, treated, or taken medication for within the past 3 years	Return of Premium	9
Kidney Dialysis	Medically diagnosed, treated, or taken medication for	No Coverage	6b
Kidney Failure	Medically diagnosed, treated, or taken medication for	No Coverage	6b
Leukemia	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Liver Disease	Medically diagnosed, treated or taken medication for	Return of Premium	7b
Liver Failure	Medically diagnosed, treated, or taken medication for liver failure	No Coverage	6b
Marfan Syndrome	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Mental Retardation	Medically diagnosed, treated, or taken medication for	No Coverage	6b
Motor Neuron Disease	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Multiple Sclerosis (MS)	Medically diagnosed, treated, or taken medication for	Return of Premium	7b
Muscular Dystrophy	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Neuro-Muscular Dis- ease	Medically diagnosed, treated, or taken medication for (including, but not limited to cerebral palsy, multiple sclerosis, or Parkin- son's disease)	Return of Premium	7b
Obesity	Has surgical treatment for morbid obesity within the past 12 months	Return of Premium	8
Organ Transplant	Has ever had or medically advised to have	No Coverage	6b
Paralysis	Medically diagnosed, treated, or taken medication for paralysis of 2 or more extremities	Return of Premium	7b
Renal Insufficiency	Medically diagnosed, treated, or taken medication for	No Coverage	6b
Rheumatoid Arthritis	Medically diagnosed, treated, or taken medication for	Return of Premium	7b
Schizophrenia	Medically diagnosed, treated, or taken medication for	No Coverage	6b
Seizures	Medically diagnosed, treated, or taken medication for within the past 3 years	Return of Premium	9
Sickle Cell Anemia	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Stroke	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Systemic Lupus (SLE)	Medically diagnosed, treated, or taken medication for	No Coverage	6a
Ulcerative Colitis	Medically diagnosed, treated, or taken medication for	Return of Premium	7b

Prescription Medication Guide

Medication	Common Use	RX Fill Within	Plan Eligibility
Plan Eligibility	Abilify	Abilify	Abilify
Accupril	Accupril	Accupril	High Blood Pressure (HTN)
Accupril	CHF	CHF	N/A
High Blood Pressure (HTN)	N/A	N/A	See '*' Below
N/A	No Coverage	No Coverage	No Coverage
See '*' Below	See '*' Below	No Coverage	No Coverage
Aceon	Aceon	Aceon	Aceon
Aceon	Aceon	CHF	CHF
Diabetes	Diabetes	N/A	N/A
N/A	N/A	See '#' Below	See '#' Below
Immediate	Immediate	Immediate	See '#' Below
Return of Premium	Aggrenox	Aggrenox	Aggrenox
Return of Premium	Aggrenox	Aggrenox	Stroke / Heart or Circulatory Disease or Disorder
Albuterol	Asthma	Asthma	N/A
COPD / Chronic Bronchitis / Emphysema	3 years	3 years	Return of Premium
N/A	See '*' Below	See '*' Below	See '*' Below
No Coverage	No Coverage	Aldactone	Aldactone
No Coverage	No Coverage	Aldactone	Aldactone
Allopurinol	Allopurinol	Gout	Gout
High Blood Pressure (HTN)	High Blood Pressure (HTN)	N/A	N/A
N/A	N/A	No Coverage	No Coverage
Return of Premium	Return of Premium	Return of Premium	Amaryl
See '#' Below	Ambisome	Ambisome	Ambisome
Amiloride HCL	Amiloride HCL	Amiloride HCL	High Blood Pressure (HTN)
Amiloride HCL	CHF	CHF	N/A
High Blood Pressure (HTN)	N/A	N/A	See '*' Below
N/A	No Coverage	No Coverage	No Coverage
No Coverage	No Coverage	Antabuse	Antabuse
Apokyn	Apokyn	Apokyn	Apokyn
* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Medication	Medication	Medication
Apresoline	Apresoline	High Blood Pressure (HTN)	High Blood Pressure (HTN)
CHF	CHF	CHF	CHF
AIDS	AIDS	N/A	N/A
N/A N/A N/A	N/A N/A N/A	No Coverage No Coverage No Coverage	No Coverage No Coverage No Coverage
No Coverage Immediate	No Coverage Immediate	Atacand	Atacand
No Coverage Immediate	No Coverage Immediate	Atacand	CHF
Atamet	Parkinson’s	Parkinson’s	Parkinson’s
High Blood Pressure (HTN)	High Blood Pressure (HTN)	High Blood Pressure (HTN)	N/A
CHF	N/A	N/A	No Coverage
N/A	No Coverage	No Coverage	Atripla
No Coverage	Atrovent/Atrovent HFA Atrovent (Nasal)	Atrovent/Atrovent HFA Atrovent (Nasal)	Atrovent/Atrovent HFA Atrovent (Nasal)
No Coverage	Atrovent/Atrovent HFA Atrovent (Nasal)	COPD / Chronic Bronchitis / Emphysema	COPD / Chronic Bronchitis / Emphysema
High Blood Pressure (HTN)	High Blood Pressure (HTN)	High Blood Pressure (HTN)	High Blood Pressure (HTN)
CHF	CHF	N/A	N/A
N/A	N/A	See '#' Below	See '#' Below
See '*' Below	See '*' Below	See '#' Below	See '#' Below
Avonex	Avonex	Avonex	Multiple Sclerosis
Azasan	Organ / Tissue Transplant Rheumatoid Arthritis Systemic Lupus (SLE)	Organ / Tissue Transplant Rheumatoid Arthritis Systemic Lupus (SLE)	Organ / Tissue Transplant Rheumatoid Arthritis Systemic Lupus (SLE)
Organ / Tissue Transplant Rheumatoid Arthritis Systemic Lupus (SLE)	Organ / Tissue Transplant Rheumatoid Arthritis Systemic Lupus (SLE)	Organ / Tissue Transplant Rheumatoid Arthritis Systemic Lupus (SLE)	N/A N/A N/A
Parkinson’s	N/A	N/A	Return of Premium
N/A	Immediate	Immediate	Return of Premium
Return of Premium	Azor	Azor	Azor
Return of Premium	Azor	CHF	CHF
Multiple Sclerosis	Multiple Sclerosis	Multiple Sclerosis	Multiple Sclerosis
Liver Disorder / Hepatitis Liver Failure	Liver Disorder / Hepatitis Liver Failure	N/A N/A	N/A N/A
* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.
Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
Medication	Common Uses	Common Uses	RX Fill Within
High Blood Pressure (HTN)	N/A	N/A	See '*' Below
N/A	No Coverage	No Coverage	Benicar
See '*' Below	No Coverage	No Coverage	Benicar
Benlysta	Benlysta	Benlysta	Benlysta
Benztropine Mesylate	Benztropine Mesylate	Parkinson’s Other Use	Parkinson’s Other Use
Irregular Heartbeat CHF	Irregular Heartbeat CHF	3 years N/A	3 years N/A
N/A	N/A	Return of Premium	Return of Premium
See '*' Below	See '*' Below	Return of Premium	Return of Premium
BiDil	BiDil	BiDil	BiDil
Bisoprolol Fumarate	Bisoprolol Fumarate	Bisoprolol Fumarate	High Blood Pressure (HTN)
Bisoprolol Fumarate	CHF	CHF	N/A
Parkinson’s	N/A	N/A	Return of Premium
N/A	See '*' Below	See '*' Below	Return of Premium
No Coverage	Bumex	Bumex	Bumex
No Coverage	Bumex	Bumex	Bumex
Buprenex	Buprenex	Alcohol / Drugs	Alcohol / Drugs
High Blood Pressure (HTN)	High Blood Pressure (HTN)	N/A	N/A
N/A	N/A	No Coverage	No Coverage
See '*' Below	See '*' Below	Calcium Acetate	Calcium Acetate
Campath	Campath	Campath	Campath
Campral	Campral	Campral	Alcohol / Drugs
Capoten	High Blood Pressure (HTN)	High Blood Pressure (HTN)	N/A
CHF	N/A	N/A	No Coverage
N/A	See '*' Below	See '*' Below	No Coverage
No Coverage	Captopril	Captopril	Captopril
No Coverage	Captopril	Captopril	Captopril
Carbamazepine	Carbamazepine	Seizures Diabetic Neuropathy	Seizures Diabetic Neuropathy
* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.
Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
Medication	Common Uses	Common Uses	Common Uses
Seizures Diabetic Neuropathy	Seizures Diabetic Neuropathy	Seizures Diabetic Neuropathy	3 years N/A
Parkinson’s	N/A	N/A	Return of Premium
N/A	See '*' Below	See '*' Below	Cardura
See '*' Below	Cartia	Cartia	Cartia
Carvedilol	Carvedilol	High Blood Pressure (HTN)	High Blood Pressure (HTN)
CHF	CHF	CHF	CHF
Cancer	Cancer	5 years > 5 years	5 years > 5 years
N/A	N/A	See '*' Below	See '*' Below
No Coverage	No Coverage	Chlorpromazine	Chlorpromazine
Clopidogrel	Clopidogrel	Clopidogrel	Stroke / Heart or Circulatory Disease or Disorder
Cogentin	Parkinson’s Other Use	Parkinson’s Other Use	Parkinson’s Other Use
COPD / Chronic Bronchitis / Emphysema	COPD / Chronic Bronchitis / Emphysema	COPD / Chronic Bronchitis / Emphysema	3 years
AIDS	N/A	N/A	No Coverage
N/A	No Coverage	No Coverage	Copaxone
Return of Premium	Copegus	Copegus	Copegus
Cordarone	Cordarone	Irregular Heartbeat	Irregular Heartbeat
High Blood Pressure (HTN)	High Blood Pressure (HTN)	High Blood Pressure (HTN)	High Blood Pressure (HTN)
CHF	CHF	N/A	N/A
N/A	N/A	See '*' Below	See '*' Below
No Coverage	No Coverage	Corzide	Corzide
No Coverage	No Coverage	Corzide	CHF
Coumadin	Blood Clot	Blood Clot	Blood Clot
Stroke / Heart or Circulatory Disease or Disorder	Stroke / Heart or Circulatory Disease or Disorder	Stroke / Heart or Circulatory Disease or Disorder	N/A
High Blood Pressure (HTN)	N/A	N/A	See '*' Below
N/A	No Coverage	No Coverage	Creon
Return of Premium	Cyclosporine	Cyclosporine	Cyclosporine
Cyclosporine Modified	Cyclosporine Modified	Organ / Tissue Transplant	Organ / Tissue Transplant
* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
Medication	Medication	Medication	Medication
Cytoxan	Cytoxan	Cytoxan	Cancer
Daliresp	COPD / Chronic Bronchitis / Emphysema	COPD / Chronic Bronchitis / Emphysema	3 years
High Blood Pressure (HTN)	N/A	N/A	See '*' Below
N/A	No Coverage	No Coverage	Depacon
Return of Premium No Coverage	Depade	Depade	Depade
Depakene	Depakene	Depakene	Depakene
Depakote	Depakote	Seizures	Seizures
Diabetes	Diabetes	N/A	N/A
N/A	N/A	See '#' Below	See '#' Below
Return of Premium No Coverage	Return of Premium No Coverage	Digoxin	Digoxin
Dilacor	Dilacor	Dilacor	Dilacor
Dilantin	Dilantin	Dilantin	Seizures
Dilatrate SR	Angina / CHF	Angina / CHF	N/A
Asthma	N/A	N/A	Immediate
3 years	Return of Premium	Return of Premium	Diovan
See '*' Below	Return of Premium	Return of Premium	Diovan
Disulfiram	Disulfiram	Disulfiram	Disulfiram
Dolophine	Dolophine	Opioid Dependence	Opioid Dependence
COPD / Chronic Bronchitis / Emphysema	COPD / Chronic Bronchitis / Emphysema	3 years	3 years
N/A	N/A	See '*' Below	See '*' Below
No Coverage	No Coverage	Dynacirc	Dynacirc
Dyrenium	Dyrenium	Dyrenium	Dyrenium
Dyrenium	Dyrenium	Dyrenium	CHF
Edecrin	High Blood Pressure (HTN)	High Blood Pressure (HTN)	N/A
CHF	N/A	N/A	No Coverage
N/A	No Coverage	No Coverage	Eldepryl
Return of Premium	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.
Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
Plan Eligibility	Plan Eligibility	Emtriva	Emtriva
Enalapril Maleate	Enalapril Maleate	Enalapril Maleate	Enalapril Maleate
Enalapril Maleate	Enalapril Maleate	Enalapril Maleate	CHF
Enalaprilat	High Blood Pressure (HTN)	High Blood Pressure (HTN)	N/A
CHF	N/A	N/A	No Coverage
3 years N/A	Return of Premium No Coverage	Return of Premium No Coverage	Epivir
No Coverage	Eplerenone	Eplerenone	Eplerenone
Eskalith	Eskalith	Eskalith	Eskalith
Esmolol HCL	Esmolol HCL	High Blood Pressure (HTN)	High Blood Pressure (HTN)
CHF	CHF	N/A	N/A
N/A	N/A	No Coverage	No Coverage
No Coverage	No Coverage	Felodipine	Felodipine
Femara	Femara	Femara	Femara
Foscavir	Foscavir	Foscavir	AIDS
Fosinopril Sodium	High Blood Pressure (HTN)	High Blood Pressure (HTN)	N/A
CHF	N/A	N/A	No Coverage
N/A N/A N/A	No Coverage No Coverage No Coverage	No Coverage No Coverage No Coverage	Furosemide
See '*' Below	No Coverage No Coverage No Coverage	No Coverage No Coverage No Coverage	Furosemide
Gabapentin	Gabapentin	Gabapentin	Gabapentin
Gleevec	Gleevec	Cancer	Cancer
Diabetes	Diabetes	N/A	N/A
N/A	N/A	See '#' Below	See '#' Below
See '#' Below	See '#' Below	Glyburide	Glyburide
Glynase	Glynase	Glynase	Glynase
Haldol	Haldol	Haldol	Schizophrenia
Haloperidol	Schizophrenia	Schizophrenia	N/A
High Blood Pressure (HTN)	N/A	N/A	See '*' Below
N/A	No Coverage	No Coverage	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.
Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
RX Fill Within	RX Fill Within	Plan Eligibility	Plan Eligibility
No Coverage No Coverage No Coverage	No Coverage No Coverage No Coverage	Heparin	Heparin
Hepsera	Hepsera	Hepsera	Hepsera
Humalog (Insulin)	Humalog (Insulin)	Humalog (Insulin)	Diabetes
Humulin (Insulin)	Diabetes	Diabetes	N/A
High Blood Pressure (HTN)	N/A	N/A	See '*' Below
N/A	No Coverage	No Coverage	Hydroxyurea
No Coverage Immediate	Hydroxychloroquine	Hydroxychloroquine	Hydroxychloroquine
Hytrin	Hytrin	Hytrin	Hytrin
Hyzaar	Hyzaar	High Blood Pressure (HTN)	High Blood Pressure (HTN)
CHF	CHF	N/A	N/A
N/A	N/A	No Coverage	No Coverage
No Coverage Return of Premium No Coverage	No Coverage Return of Premium No Coverage	Inamrinone	Inamrinone
Inderide	Inderide	Inderide	Inderide
Inderide	Inderide	Inderide	CHF
Inspra	CHF	CHF	N/A
Diabetes	N/A	N/A	No Coverage
5 years > 5 years	No Coverage Immediate	No Coverage Immediate	No Coverage
Return of Premium	Invirase	Invirase	Invirase
Ipratropium Bromide	Ipratropium Bromide	Ipratropium Bromide	Ipratropium Bromide
Ipratropium Bromide	Ipratropium Bromide	COPD / Chronic Bronchitis / Emphysema	COPD / Chronic Bronchitis / Emphysema
High Blood Pressure (HTN)	High Blood Pressure (HTN)	N/A	N/A
N/A	N/A	No Coverage	No Coverage
No Coverage	No Coverage	Janumet	Janumet
Januvia	Januvia	Januvia	Januvia
Kaletra	Kaletra	Kaletra	AIDS
* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
Medication	Medication	Medication	Medication
Hectoral	Hectoral	Kidney Dialysis Renal Insufficiency/Failure Diabetic Nephropathy	Kidney Dialysis Renal Insufficiency/Failure Diabetic Nephropathy
Blood Clot	Blood Clot	3 years	3 years
N/A	N/A	Return of Premium	Return of Premium
No Coverage	No Coverage	Humulin (Insulin)	Humulin (Insulin)
Hydralazine HCL	Hydralazine HCL	Hydralazine HCL	Hydralazine HCL
Hydralazine HCL	Hydralazine HCL	Hydralazine HCL	CHF
Hydroxyurea	Cancer	Cancer	5 years > 5 years
Systemic Lupus (SLE) Rheumatoid Arthritis	N/A N/A	N/A N/A	No Coverage Return of Premium
N/A	See '*' Below	See '*' Below	Hyzaar
See '*' Below	See '*' Below	See '*' Below	Hyzaar
Imdur	Imdur	Imdur	Imdur
Imuran	Imuran	Organ / Tissue Transplant Rheumatoid Arthritis Systemic Lupus (SLE)	Organ / Tissue Transplant Rheumatoid Arthritis Systemic Lupus (SLE)
CHF	CHF	N/A	N/A
N/A	N/A	See '*' Below	See '*' Below
No Coverage	No Coverage	Inspra	Inspra
Insulin	Insulin	Insulin	Insulin
Intron-A	Intron-A	Intron-A	Cancer
Intron-A	Hepatitis C	Hepatitis C	N/A
AIDS	N/A	N/A	No Coverage
N/A	Immediate	Immediate	No Coverage
Return of Premium	Isoptin	Isoptin	Isoptin
Isordil	Isordil	Isordil	Isordil
Isosorbide Dinitrate/ Mononitrate	Isosorbide Dinitrate/ Mononitrate	Angina / CHF	Angina / CHF
Diabetes	Diabetes	N/A	N/A
N/A	N/A	See '#' Below	See '#' Below
No Coverage	No Coverage	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.
Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
RX Fill Within	Plan Eligibility	Plan Eligibility	Hectoral
No Coverage No Coverage No Coverage	Heparin	Heparin	Heparin
Hepsera	Hepsera	Hepsera	Hepsera
Humalog (Insulin)	Humalog (Insulin)	Diabetes	Diabetes
Diabetes	Diabetes	N/A	N/A
N/A	N/A	See '*' Below	See '*' Below
No Coverage	No Coverage	Hydroxyurea	Hydroxyurea
Hydroxychloroquine	Hydroxychloroquine	Hydroxychloroquine	Hydroxychloroquine
Hytrin	Hytrin	Hytrin	High Blood Pressure (HTN)
Hyzaar	High Blood Pressure (HTN)	High Blood Pressure (HTN)	N/A
CHF	N/A	N/A	No Coverage
N/A	No Coverage	No Coverage	Imuran
No Coverage Return of Premium No Coverage	Inamrinone	Inamrinone	Inamrinone
Inderide	Inderide	Inderide	Inderide
Inderide	Inderide	CHF	CHF
CHF	CHF	N/A	N/A
N/A	N/A	No Coverage	No Coverage
No Coverage Immediate	No Coverage Immediate	No Coverage	No Coverage
Invirase	Invirase	Invirase	Invirase
Ipratropium Bromide	Ipratropium Bromide	Ipratropium Bromide	Allergies
Ipratropium Bromide	COPD / Chronic Bronchitis / Emphysema	COPD / Chronic Bronchitis / Emphysema	3 years
High Blood Pressure (HTN)	N/A	N/A	See '*' Below
N/A	No Coverage	No Coverage	Isosorbide Dinitrate/ Mononitrate
No Coverage	Janumet	Janumet	Janumet
Januvia	Januvia	Januvia	Januvia
Kaletra	Kaletra	AIDS	AIDS
* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.
Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
Medication	Medication	Medication	Common Uses
Nadolol	High Blood Pressure (HTN)	High Blood Pressure (HTN)	N/A
CHF	N/A	N/A	No Coverage
2 years	No Coverage	No Coverage	Naltrexone
No Coverage	Narcan	Narcan	Narcan
Natrecor	Natrecor	Natrecor	Natrecor
Navane	Navane	Schizophrenia	Schizophrenia
Seizures Diabetic Neuropathy	Seizures Diabetic Neuropathy	3 years N/A	3 years N/A
N/A	N/A	See '*' Below	See '*' Below
No Coverage	No Coverage	Nimotop	Nimotop
Nitrek	Nitrek	Nitrek	Nitrek
Nitro-bid	Nitro-bid	Nitro-bid	Angina / CHF
Nitro-dur	Angina / CHF	Angina / CHF	N/A
Angina / CHF	N/A	N/A	No Coverage
N/A	No Coverage	No Coverage	Normodyne
See '*' Below	Norpace	Norpace	Norpace
Norvir	Norvir	Norvir	Norvir
Novolin (Insulin)	Novolin (Insulin)	Diabetes	Diabetes
Diabetes	Diabetes	N/A	N/A
3 years	3 years	Return of Premium	Return of Premium
Return of Premium	Return of Premium	Parcopa	Parcopa
Parlodel	Parlodel	Parlodel	Parlodel
Pegasys	Pegasys	Pegasys	Liver Disorder / Hepatitis C / Chron- ic Hepatitis
Peg-Intron	Liver Disorder / Hepatitis C / Chron- ic Hepatitis	Liver Disorder / Hepatitis C / Chron- ic Hepatitis	N/A
AIDS	N/A	N/A	No Coverage
N/A	No Coverage	No Coverage	Pergolide Mesylate
Return of Premium	Permax	Permax	Permax
Phenobarbital	Phenobarbital	Phenobarbital	Phenobarbital
* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
Medication	Medication	Medication	Medication
Phoslo	Phoslo	Phoslo	Kidney Dialysis Renal Insufficiency/Failure Diabetic Nephropathy
Plaquenil	Systemic Lupus (SLE) Malaria Rheumatoid Arthritis	Systemic Lupus (SLE) Malaria Rheumatoid Arthritis	N/A N/A N/A
Stroke / Heart or Circulatory Disease or Disorder	N/A	N/A	No Coverage
N/A	See '*' Below	See '*' Below	Prandin
See '#' Below	Prazosin	Prazosin	Prazosin
Primacor	Primacor	Primacor	Primacor
Prinivil	Prinivil	High Blood Pressure (HTN)	High Blood Pressure (HTN)
CHF	CHF	N/A	N/A
N/A	N/A	See '*' Below	See '*' Below
No Coverage	No Coverage	Procardia	Procardia
Prograf	Prograf	Prograf	Prograf
Proleukin	Proleukin	Proleukin	Cancer
Prolixin	Schizophrenia	Schizophrenia	N/A
High Blood Pressure (HTN)	N/A	N/A	See '*' Below
N/A	No Coverage	No Coverage	Proventil
Immediate	No Coverage	No Coverage	Proventil
Prozac	Prozac	Prozac	Prozac
Quinapril	Quinapril	High Blood Pressure (HTN)	High Blood Pressure (HTN)
CHF	CHF	N/A	N/A
N/A	N/A	See '*' Below	See '*' Below
No Coverage	No Coverage	Ramipril	Ramipril
No Coverage	No Coverage	Ramipril	Ramipril
Ranexa	Ranexa	Ranexa	Angina / CHF
Rapamune	Organ / Tissue Transplant	Organ / Tissue Transplant	N/A
Liver Disorder / Hepatitis C / Chron- ic Hepatitis	N/A	N/A	Return of Premium
N/A	Return of Premium	Return of Premium	Rebif
Return of Premium	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.
Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
Plan Eligibility	Plan Eligibility	Renagel	Renagel
Renvela	Renvela	Renvela	Renvela
Requip	Requip	Requip	Parkinson’s Restless Leg Syndrome
Ribavirin	Liver Disorder / Hepatitis C / Chron- ic Hepatitis	Liver Disorder / Hepatitis C / Chron- ic Hepatitis	N/A
ALS / Motor Neuron Disease	N/A	N/A	No Coverage
N/A	No Coverage	No Coverage	Risperidone
No Coverage	Rituxan	Rituxan	Rituxan
No Coverage	Rituxan	Rituxan	Rituxan
Ropinirole	Ropinirole	Parkinson’s Other Use	Parkinson’s Other Use
Irregular Heartbeat	Irregular Heartbeat	3 years	3 years
N/A	N/A	Immediate	Immediate
Return of Premium	Return of Premium	Seroquel	Seroquel
Sinemet/Sinemet CR	Sinemet/Sinemet CR	Sinemet/Sinemet CR	Sinemet/Sinemet CR
Sodium Edecrin	Sodium Edecrin	Sodium Edecrin	High Blood Pressure (HTN)
Sodium Edecrin	CHF	CHF	N/A
High Blood Pressure (HTN)	N/A	N/A	See '*' Below
N/A	No Coverage	No Coverage	Sotalol HCL
See '*' Below	No Coverage	No Coverage	Sotalol HCL
Spiriva	Spiriva	Spiriva	Spiriva
Spironolactone	Spironolactone	High Blood Pressure (HTN)	High Blood Pressure (HTN)
CHF	CHF	N/A	N/A
5 years > 5 years	5 years > 5 years	No Coverage Immediate	No Coverage Immediate
Return of Premium	Return of Premium	Starlix	Starlix
Suboxone	Suboxone	Suboxone	Suboxone
Subutex	Subutex	Subutex	Alcohol / Drugs
* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
Medication	Medication	Medication	Medication
Sustiva	Sustiva	AIDS	AIDS
Asthma	Asthma	N/A	N/A
3 years	3 years	Return of Premium	Return of Premium
Return of Premium	Return of Premium	Tambocor	Tambocor
Tamoxifen	Tamoxifen	Tamoxifen	Tamoxifen
Tarka	Tarka	Tarka	High Blood Pressure (HTN)
Tarka	CHF	CHF	N/A
Parkinson’s	N/A	N/A	Return of Premium
3 years N/A	Return of Premium No Coverage	Return of Premium No Coverage	Tenex
See '*' Below	Tenoretic	Tenoretic	Tenoretic
See '*' Below	Tenoretic	Tenoretic	Tenoretic
Tenormin	Tenormin	High Blood Pressure (HTN)	High Blood Pressure (HTN)
CHF	CHF	N/A	N/A
N/A	N/A	Immediate	Immediate
Return of Premium	Return of Premium	Theophylline	Theophylline
Return of Premium	Return of Premium	Theophylline	Theophylline
Thioridazine	Thioridazine	Thioridazine	Schizophrenia
Thiothixene	Schizophrenia	Schizophrenia	N/A
Schizophrenia	N/A	N/A	No Coverage
N/A	See '*' Below	See '*' Below	Tolazamide
See '#' Below	Tolbutamide	Tolbutamide	Tolbutamide
Tolinase	Tolinase	Tolinase	Tolinase
Toprol XL	Toprol XL	High Blood Pressure (HTN)	High Blood Pressure (HTN)
CHF	CHF	N/A	N/A
N/A	N/A	See '*' Below	See '*' Below
No Coverage	No Coverage	Trandate	Trandate
No Coverage	No Coverage	Trandate	Trandate
Triameterene	Triameterene	Triameterene	High Blood Pressure (HTN)
Triameterene	CHF	CHF	N/A
* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.
Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
Medication	Medication	Common Uses	Common Uses
High Blood Pressure (HTN)	High Blood Pressure (HTN)	N/A	N/A
N/A	N/A	No Coverage	No Coverage
Return of Premium Immediate	Return of Premium Immediate	Truvada	Truvada
Tyzeka	Tyzeka	Tyzeka	Tyzeka
Uniretic	Uniretic	Uniretic	High Blood Pressure (HTN)
Uniretic	CHF	CHF	N/A
High Blood Pressure (HTN)	N/A	N/A	See '*' Below
N/A	No Coverage	No Coverage	Valcyte
No Coverage	Valproic Acid	Valproic Acid	Valproic Acid
Valstar	Valstar	Valstar	Valstar
Valturna	Valturna	High Blood Pressure (HTN)	High Blood Pressure (HTN)
CHF	CHF	N/A	N/A
N/A	N/A	No Coverage	No Coverage
See '*' Below	See '*' Below	No Coverage	No Coverage
Vasotec	Vasotec	Vasotec	Vasotec
Vasotec	Vasotec	Vasotec	CHF
Ventolin	Asthma	Asthma	N/A
COPD / Chronic Bronchitis / Emphysema	3 years	3 years	Return of Premium
N/A	See '*' Below	See '*' Below	Viaspan
No Coverage	Viracept	Viracept	Viracept
Viramune	Viramune	Viramune	Viramune
Viread	Viread	AIDS	AIDS
High Blood Pressure (HTN)	High Blood Pressure (HTN)	N/A	N/A
N/A	N/A	No Coverage	No Coverage
No Coverage	No Coverage	Warfarin	Warfarin
No Coverage	No Coverage	Warfarin	Warfarin
Xeloda	Xeloda	Xeloda	Cancer
* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.
FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	FAMILY CHOICE PRESCRIPTION REFERENCE GUIDE (cont.)	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If ‘N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
Medication	Medication	Medication	Medication
Xopenex	Xopenex	Asthma	Asthma
COPD / Chronic Bronchitis / Emphysema	COPD / Chronic Bronchitis / Emphysema	3 years	3 years
N/A	N/A	Return of Premium	Return of Premium
No Coverage No Coverage No Coverage	No Coverage No Coverage No Coverage	Zestoretic	Zestoretic
No Coverage No Coverage No Coverage	No Coverage No Coverage No Coverage	Zestoretic	Zestoretic
Zestril	Zestril	Zestril	High Blood Pressure (HTN)
Zestril	CHF	CHF	N/A
High Blood Pressure (HTN)	N/A	N/A	See '*' Below
N/A	No Coverage	No Coverage	Zyprexa
No Coverage	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.	* High Blood Pressure - If diagnosed, treated, or taken medication for prior to age 30 or if taking 3 or more medications for the condition, client should apply for the Return of Premium Death Benefit Plan. Otherwise, client should apply for the Immediate Death Benefit Plan.
# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.	# Diabetes - Refer to the 'Diabetes' impairment section of the Medical Impairment Guide.

Included Riders

• Terminal Illness Accelerated Benefit Rider (included on all plans)

Optional Riders

• Accidental Death Benefit
• Children's Insurance Agreement
• Grandchild Rider
• Waiver of Premium for Disability

Conversion Options

This is a permanent final expense product. There is no conversion option available as the coverage is already lifetime-guaranteed.

Other Eligibility Requirements

• Applicants must reside in the U.S. and have a valid Social Security Number
• Third-party payors (other than spouse or parent) may be restricted
• State-specific disclosures and replacement forms may be required

Application Notes

• Use state-approved Family Choice application packet
• Submit via mobile app, AppDrop, or fax
• Point-of-sale decisions typically delivered instantly

Carrier: Occidental Life Insurance Company of North Carolina (AmAm)

Product: SafeCare Term

Product Types: 10-Year, 15-Year, 20-Year, and 30-Year Level Term

Issue Ages: 18 to 75

Face Amounts: $25,000 to $500,000

Target Market: Clients seeking simplified term coverage, Mortgage protection coverage for applicants with moderate health concerns with immediate underwriting decisions and optional Return of Premium on longer terms

Carrier

Occidental Life Insurance Company of North Carolina (a member of the American-Amicable Group)

Product Overview

SafeCare Term is a simplified issue level term life insurance plan offering 10-, 15-, 20-, and 30-year level premium periods. It is designed for agents with Integrity and offers immediate point-of-sale underwriting decisions. The plan is renewable to age 95, with built-in living benefits and optional supplemental riders. The Return of Premium Death Benefit is available on 20- and 30-year plans only.

Issue Ages and Face Amounts

• Issue Ages (age nearest birthday):	10-Year Level Premium	Ages 18 – 75
  	15-Year Level Premium	Ages 18 – 70
  	20-Year Level Premium	Ages 18 – 65
  	30-Year Level Premium	Ages 18 – 55
  	20-Year with ROP Rider	Ages 18 – 60
  	30-Year with ROP Rider	Ages 18 – 50
  Minimum Face Amount:	$25,000 face amount or $25.00 monthly premium (excluding riders), whichever is greater.
  Maximum Face Amount:	Ages 18 – 75	$500,000
  Premium Bands:	Band 1	Face amounts $25,000 to $249,999
  	Band 2	Face amounts $250,000 to $500,000
  Underwriting Classes:	Preferred Non-Tobacco
  	Standard Non-Tobacco
  	Standard Tobacco
  Modal Factors:	Monthly	0.09
  	Quarterly	0.265
  	Semi-Annual	0.52
  Policy Fee:	$70 (fully commissionable)
  Underwriting:	Simplified issue, underwritten standard through table 4. NOT GUARANTEED ISSUE.

Available Term Durations

• 10-Year Level Term
• 15-Year Level Term
• 20-Year Level Term
• 30-Year Level Term
• 20-Year Level Term (ROP available)
• 30-Year Level Term (ROP available)

Underwriting Guidelines

Simplified underwriting includes a Yes/No application, MIB check, Rx check, Motor Vehicle Report, and build chart analysis. A telephone interview may be required. APS may be ordered. Applicants above Table 4 will be declined.

Build Chart (Updated)

BUILD CHART	BUILD CHART	BUILD CHART	BUILD CHART
HEIGHT	MINIMUM WEIGHT MUST BE AT LEAST	MAXIMUM WEIGHT WITHIN TABLE 2	MAXIMUM WEIGHT WITHIN TABLE 4
4’10”	86	182	199
4’11”	88	188	205
5’	90	195	212
5’1”	93	201	220
5’2”	95	208	227
5’3”	99	215	234
5’4”	101	221	242
5’5”	104	228	249
5’6”	106	235	257
5’7”	110	243	265
5’8”	113	250	273
5’9”	117	257	281
5’10”	120	265	289
5’11”	125	272	298
6’	129	280	306
6’1”	133	288	315
6’2”	136	296	323
6’3”	140	304	332
6’4”	143	312	341
6’5”	146	320	350
6’6”	149	329	359
6’7”	153	337	368
6’8”	157	346	378
6’9”	160	355	387

Medical Impairment Guide

EASY TERM PRESCRIPTION REFERENCE GUIDE (continued)	EASY TERM PRESCRIPTION REFERENCE GUIDE (continued)	EASY TERM PRESCRIPTION REFERENCE GUIDE (continued)	EASY TERM PRESCRIPTION REFERENCE GUIDE (continued)
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
MEDICATION	COMMON USE OF CONCERN	RX FILL WITHIN	PLAN ELIGIBILITY
Betapace	Heart Arrhythmia	N/A	Decline
Betapace	CHF	N/A	Decline
Betaseron	Multiple Sclerosis	N/A	Decline
Betaxolol HCL	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Betaxolol HCL	CHF	N/A	Decline
BiDil	CHF	N/A	Decline
Bisoprolol Fumarate	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Bisoprolol Fumarate	CHF	N/A	Decline
Bromocriptine Mesylate	Parkinson’s	N/A	Decline
Bumetanide	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Bumetanide	CHF	N/A	Decline
Bumex	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Bumex	CHF	N/A	Decline
Buprenex	Alcohol / Drugs	4 years	Decline
Bystolic	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Bystolic	CHF	N/A	Decline
Calan	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Calcium Acetate	Kidney Dialysis	N/A	Decline
Calcium Acetate	Renal Insufficiency/Failure	N/A	Decline
Calcium Acetate	Diabetic Nephropathy	N/A	Decline
Campath	Cancer	8 years > 8 years	Decline Standard
Campral	Alcohol / Drugs	4 years	Decline
Capoten	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Capoten	CHF	N/A	Decline
Capozide	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Capozide	CHF	N/A	Decline
Captopril	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Captopril	CHF	N/A	Decline
Carbamazepine	Seizures	N/A	See Impairment Guide
Carbatrol	Seizures	N/A	See Impairment Guide
Carbidopa	Parkinson’s	N/A	Decline
Cardizem	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Cardura	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Cartia	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Carvedilol	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Carvedilol	CHF	N/A	Decline
* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.
# Diabetes - If diagnosed, treated, or taken medication prior to age 35, client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.

Prescription Medication Guide

Medication	Use	RX Fill Within	Plan Eligibility
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
MEDICATION	COMMON USE OF CONCERN	RX FILL WITHIN	PLAN ELIGIBILITY
Digoxin	Irregular Heartbeat	N/A	Decline
Digoxin	CHF	N/A	Decline
Dilacor	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Dilantin	Seizures	N/A	See Impairment Guide
Dilatrate SR	Angina / CHF	N/A	Decline
Dilor	Asthma	N/A	See Impairment Guide
Dilor	COPD / Emphysema / Chronic Bronchitis	N/A	Decline
Diovan	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Diovan	CHF	N/A	Decline
Disulfiram	Alcohol / Drugs	4 years	Decline
Dolophine	Opioid Dependence	4 years	Decline
Donepezil HCL	Alzheimer’s / Dementia	N/A	Decline
Duoneb	COPD / Emphysema / Chronic Bronchitis	N/A	Decline
Dyazide	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Dyazide	CHF	N/A	Decline
Dynacirc	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Dyrenium	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Dyrenium	CHF	N/A	Decline
Edecrin	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Edecrin	CHF	N/A	Decline
Edurant	AIDS	N/A	Decline
Eldepryl	Parkinson’s	N/A	Decline
Emtriva	AIDS	N/A	Decline
Enalapril Maleate	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Enalapril Maleate	CHF	N/A	Decline
Enalaprilat	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Enalaprilat	CHF	N/A	Decline
Epitol	Seizures	N/A	See Impairment Guide
Epivir	AIDS	N/A	Decline
Eplerenone	CHF	N/A	Decline
Eskalith	Bi-Polar / Schizophrenia	N/A	Decline
Esmolol HCL	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Esmolol HCL	CHF	N/A	Decline
Exforge	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Exforge	CHF	N/A	Decline
Felodipine	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Femara	Cancer	8 years > 8 years	Decline Standard
* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.
# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
MEDICATION	COMMON USE OF CONCERN	RX FILL WITHIN	PLAN ELIGIBILITY
Foscavir	AIDS	N/A	Decline
Fosinopril Sodium	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Fosinopril Sodium	CHF	N/A	Decline
Fosrenol	Kidney Dialysis	N/A	Decline
Fosrenol	Renal Insufficiency / Failure	N/A	Decline
Fosrenol	Diabetic Nephropathy	N/A	Decline
Furosemide	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Furosemide	CHF	N/A	Decline
Gabapentin	Seizures	N/A	See Impairment Guide
Gabapentin	Restless Leg Syndrome	N/A	Standard
Gleevec	Cancer	8 years > 8 years	Decline Standard
Glipizide	Diabetes	N/A	See ‘#’ Below
Glucophage	Diabetes	N/A	See ‘#’ Below
Glucotrol	Diabetes	N/A	See ‘#’ Below
Glyburide	Diabetes	N/A	See ‘#’ Below
Glynase	Diabetes	N/A	See ‘#’ Below
Haldol	Schizophrenia	N/A	Decline
Haloperidol	Schizophrenia	N/A	Decline
HCTZ/Triamterene	High Blood Pressure (HTN)	N/A	See ‘*’ Below
HCTZ/Triamterene	CHF	N/A	Decline
Hectoral	Kidney Dialysis	N/A	Decline
Hectoral	Renal Insufficiency / Failure	N/A	Decline
Hectoral	Diabetic Nephropathy	N/A	Decline
Heparin	Blood Clot / Deep Vein Thrombosis	N/A	See Impairment Guide
Hepsera	Liver Disorder / Hepatitis	N/A	Decline
Hizentra	Immunodeficiency	N/A	Decline
Humalog	Diabetes	N/A	Decline
Humulin	Diabetes	N/A	Decline
Hydralazine HCL	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Hydralazine HCL	CHF	N/A	Decline
Hydroxychloroquine	Systemic Lupus (SLE)	N/A	Decline
Hydroxychloroquine	Rheumatoid Arthritis	N/A	Decline
Hydroxyurea	Cancer	8 years > 8 years	Decline Standard
Hytrin	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Hyzaar	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Hyzaar	CHF	N/A	Decline
Imdur	Angina / CHF	N/A	Decline
* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.
# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
MEDICATION	COMMON USE OF CONCERN	RX FILL WITHIN	PLAN ELIGIBILITY
Imuran	Organ / Tissue Transplant	N/A	Decline
Imuran	Rheumatoid Arthritis	N/A	Decline
Imuran	Systemic Lupus (SLE)	N/A	Decline
Inamrinone	CHF	N/A	Decline
Inderal	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Inderal	CHF	N/A	Decline
Inderide	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Inderide	CHF	N/A	Decline
Inspra	CHF	N/A	Decline
Insulin	Diabetes	N/A	Decline
Intron-A	Cancer	8 years > 8 years	Decline Standard
Intron-A	Hepatitis C	N/A	Decline
Invirase	AIDS	N/A	Decline
Ipratropium Bromide	Allergies	N/A	Standard
Ipratropium Bromide	COPD / Emphysema / Chronic Bronchitis	N/A	Decline
Isoptin	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Isordil	Angina / CHF	N/A	Decline
Isosorbide Dinitrate/ Mononitrate	Angina / CHF	N/A	Decline
Janumet	Diabetes	N/A	See ‘#’ Below
Januvia	Diabetes	N/A	See ‘#’ Below
Kaletra	AIDS	N/A	Decline
Kemadrin	Parkinson’s	N/A	Decline
Kerlone	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Kerlone	Glaucoma	N/A	Standard
Labetalol	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Labetalol	Angina	N/A	Decline
Lamictal	Seizures	N/A	See Impairment Guide
Lamictal	Bi-polar / Major depression	N/A	Decline
Lamotrigine	Seizures	N/A	See Impairment Guide
Lamotrigine	Bi-polar / Major depression	N/A	Decline
Lanoxicaps	Irregular Heartbeat	N/A	Decline
Lanoxicaps	CHF	N/A	Decline
Lanoxin	Irregular Heartbeat	N/A	Decline
Lanoxin	CHF	N/A	Decline
Lantus	Diabetes	N/A	Decline
Larodopa	Parkinson’s	N/A	Decline
* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.
# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
MEDICATION	COMMON USE OF CONCERN	RX FILL WITHIN	PLAN ELIGIBILITY
Lasix	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Lasix	CHF	N/A	Decline
Leukeran	Cancer	8 years > 8 years	Decline Standard
Levatol	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Levatol	Angina	N/A	Decline
Levemir	Diabetes	N/A	Decline
Levocarnitine	Kidney Dialysis	N/A	Decline
Levocarnitine	Renal Insufficiency / Failure	N/A	Decline
Levocarnitine	Diabetic Nephropathy	N/A	Decline
Levodopa	Parkinson’s	N/A	Decline
Lexiva	AIDS	N/A	Decline
Lipitor	Cholesterol	N/A	Standard
Lisinopril	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Lisinopril	CHF	N/A	Decline
Lithium	Bi-Polar / Schizophrenia	N/A	Decline
Lodosyn	Parkinson’s	N/A	Decline
Lopressor	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Losartan	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Losartan	CHF	N/A	Decline
Lotensin	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Lotensin	CHF	N/A	Decline
Loxapine	Schizophrenia	N/A	Decline
Loxitane	Schizophrenia	N/A	Decline
Lozol	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Lupron	Cancer	8 years > 8 years	Decline Standard
Lyrica	Seizures	N/A	See Impairment Guide
Mavik	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Mavik	CHF	N/A	Decline
Maxzide	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Maxzide	CHF	N/A	Decline
Mellaril	Schizophrenia	N/A	Decline
Metformin	Diabetes	N/A	See ‘#’ Below
Methadone	Opioid Dependence	4 years	Decline
Methadose	Opioid Dependence	4 years	Decline
Methotrexate	Cancer	8 years > 8 years	Decline Standard
Methotrexate	Rheumatoid Arthritis	N/A	Decline
* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.
# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
MEDICATION	COMMON USE OF CONCERN	RX FILL WITHIN	PLAN ELIGIBILITY
Metoprolol HCTZ	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Metoprolol HCTZ	CHF	N/A	Decline
Metoprolol Tartrate / Succinate	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Metoprolol Tartrate / Succinate	CHF	N/A	Decline
Micardis	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Micardis	CHF	N/A	Decline
Micronase	Diabetes	N/A	See ‘#’ Below
Milrinone	CHF / Cardiomyopathy	N/A	Decline
Minipress	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Minitran	Angina / CHF	N/A	Decline
Mirapex	Parkinson’s	N/A	Decline
Mirapex	Other Use	N/A	Standard
Moban	Schizophrenia	N/A	Decline
Moduretic	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Moduretic	CHF	N/A	Decline
Moexipril HCL	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Moexipril HCL	CHF	N/A	Decline
Monoket	Angina / CHF	N/A	Decline
Monopril	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Monopril	CHF	N/A	Decline
Mysoline	Seizures	N/A	See Impairment Guide
Nadolol	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Nadolol	CHF	N/A	Decline
Naloxone	Alcohol / Drugs	4 years	Decline
Naltrexone	Alcohol / Drugs	4 years	Decline
Narcan	Alcohol / Drugs	4 years	Decline
Natrecor	CHF	N/A	Decline
Navane	Schizophrenia	N/A	Decline
Neurontin	Seizures	N/A	See Impairment Guide
Nifedipine	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Nimodipine	Stroke / Heart or Circulatory Disease or Disorder	N/A	Decline
Nimotop	Stroke / Heart or Circulatory Disease or Disorder	N/A	Decline
Nitrek	Angina / CHF	N/A	Decline
Nitro-bid	Angina / CHF	N/A	Decline
Nitro-dur	Angina / CHF	N/A	Decline
Nitroglycerine / Nitrotab / Nitroquick/Nitrostat	Angina / CHF	N/A	Decline
Nitrol	Angina / CHF	N/A	Decline
* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.
# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
MEDICATION	COMMON USE OF CONCERN	RX FILL WITHIN	PLAN ELIGIBILITY
Normodyne	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Norpace	Irregular Heartbeat	N/A	Decline
Norvir	AIDS	N/A	Decline
Novolin	Diabetes	N/A	Decline
Novolog	Diabetes	N/A	Decline
Pacerone	Irregular Heartbeat	N/A	Decline
Pancrease	Chronic Pancreatitis	N/A	Decline
Parcopa	Parkinson’s	N/A	Decline
Parlodel	Parkinson’s	N/A	Decline
Pegasys	Liver Disorder / Hepatitis C / Chronic Hepatitis	N/A	Decline
Peg-Intron	Liver Disorder / Hepatitis C / Chronic Hepatitis	N/A	Decline
Pentam 300	AIDS	N/A	Decline
Pentamidine Isethionate	AIDS	N/A	Decline
Pergolide Mesylate	Parkinson’s	N/A	Decline
Permax	Parkinson’s	N/A	Decline
Phenobarbital	Seizures	N/A	See Impairment Guide
Phoslo	Kidney Dialysis	N/A	Decline
Phoslo	Renal Insufficiency / Failure	N/A	Decline
Phoslo	Diabetic Nephropathy	N/A	Decline
Plaquenil	Systemic Lupus (SLE)	N/A	Decline
Plaquenil	Malaria	N/A	Standard
Plaquenil	Rheumatoid Arthritis	N/A	Decline
Plavix	Stroke / Heart or Circulatory Disease or Disorder	N/A	Decline
Plendil	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Prandin	Diabetes	N/A	See ‘#’ Below
Prazosin	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Primacor	CHF	N/A	Decline
Prinivil	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Prinivil	CHF	N/A	Decline
Prinzide	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Prinzide	CHF	N/A	Decline
Procardia	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Prograf	Organ / Tissue Transplant	N/A	Decline
Proleukin	Cancer	8 years > 8 years	Decline Standard
Prolixin	Schizophrenia	N/A	Decline
Propranolol HCL	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Propranolol HCL	CHF	N/A	Decline
* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.
# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
MEDICATION	COMMON USE OF CONCERN	RX FILL WITHIN	PLAN ELIGIBILITY
Proventil	Asthma	N/A	See Impairment Guide
Proventil	COPD / Emphysema / Chronic Bronchitis	N/A	Decline
Prozac	Depressive Disorder	N/A	Standard
Quinapril	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Quinapril	CHF	N/A	Decline
Quinaretic	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Quinaretic	CHF	N/A	Decline
Ramipril	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Ramipril	CHF	N/A	Decline
Ranexa	Angina / CHF	N/A	Decline
Rapamune	Organ / Tissue Transplant	N/A	Decline
Rebetol	Liver Disorder / Hepatitis C / Chronic Hepatitis	N/A	Decline
Rebetron	Liver Disorder / Hepatitis C / Chronic Hepatitis	N/A	Decline
Rebif	Multiple Sclerosis	N/A	Decline
Renagel	Kidney Dialysis	N/A	Decline
Renagel	Renal Insufficiency / Failure	N/A	Decline
Renagel	Diabetic Nephropathy	N/A	Decline
Renvela	Kidney Dialysis	N/A	Decline
Renvela	Renal Insufficiency / Failure	N/A	Decline
Renvela	Diabetic Nephropathy	N/A	Decline
Requip	Parkinson’s	N/A	Decline
Requip	Restless Leg Syndrome	N/A	Standard
Ribavirin	Liver Disorder / Hepatitis C / Chronic Hepatitis	N/A	Decline
Rilutek	ALS / Motor Neuron Disease	N/A	Decline
Risperdal	Bi-Polar / Schizophrenia	N/A	Decline
Risperidone	Bi-Polar / Schizophrenia	N/A	Decline
Rituxan	Cancer	8 years > 8 years	Decline Standard
Rituxan	Rheumatoid Arthritis	N/A	Decline
Ropinirole	Parkinson’s	N/A	Decline
Ropinirole	Restless Leg Syndrome	N/A	Standard
Rythmol	Irregular Heartbeat	N/A	Decline
Serevent	Asthma	N/A	See Impairment Guide
Serevent	COPD / Emphysema / Chronic Bronchitis	N/A	Decline
Seroquel	Bi-Polar / Schizophrenia	N/A	Decline
Sinemet/Sinemet CR	Parkinson’s	N/A	Decline
Sodium Edecrin	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Sodium Edecrin	CHF	N/A	Decline
* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.
# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
MEDICATION	COMMON USE OF CONCERN	RX FILL WITHIN	PLAN ELIGIBILITY
Sotalol Hydrochloride	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Sotalol Hydrochloride	CHF	N/A	Decline
Sotalol HCL	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Sotalol HCL	CHF	N/A	Decline
Spiriva	COPD / Emphysema / Chronic Bronchitis	N/A	Decline
Spironolactone	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Spironolactone	CHF	N/A	Decline
Sprycel	Cancer	8 years > 8 years	Decline Standard
Stalevo	Parkinson’s	N/A	Decline
Starlix	Diabetes	N/A	See ‘#’ Below
Suboxone	Alcohol / Drugs	4 years	Decline
Subutex	Alcohol / Drugs	4 years	Decline
Sustiva	AIDS	N/A	Decline
Symbicort	Asthma	N/A	Standard
Symbicort	COPD / Emphysema / Chronic Bronchitis	N/A	Decline
Symmetrel	Parkinson’s	N/A	Decline
Tambocor	Irregular Heartbeat	N/A	Decline
Tamoxifen	Cancer	8 years > 8 years	Decline Standard
Tarka	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Tarka	CHF	N/A	Decline
Tasmar	Parkinson’s	N/A	Decline
Tegretol	Seizures	N/A	See Impairment Guide
Tenex	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Tenoretic	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Tenoretic	CHF	N/A	Decline
Tenormin	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Tenormin	CHF	N/A	Decline
Theo-Dur	Asthma	N/A	See Impairment Guide
Theo-Dur	COPD / Emphysema / Chronic Bronchitis	N/A	Decline
Theophylline	Asthma	N/A	See Impairment Guide
Theophylline	COPD / Emphysema / Chronic Bronchitis	N/A	Decline
Thioridazine	Schizophrenia	N/A	Decline
Thiothixene	Schizophrenia	N/A	Decline
Thorazine	Schizophrenia	N/A	Decline
Tiazac	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Tolazamide	Diabetes	N/A	See ‘#’ Below
* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.
# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
MEDICATION	COMMON USE OF CONCERN	RX FILL WITHIN	PLAN ELIGIBILITY
Tolbutamide	Diabetes	N/A	See ‘#’ Below
Tolinase	Diabetes	N/A	See ‘#’ Below
Toprol XL	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Toprol XL	CHF	N/A	Decline
Torsemide	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Torsemide	CHF	N/A	Decline
Trandate	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Trandate	CHF	N/A	Decline
Triamterene	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Triamterene	CHF	N/A	Decline
Tribenzor	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Tribenzor	CHF	N/A	Decline
Trihexyphenidyl HCL	Parkinson’s	N/A	Decline
Tresiba (Insulin)	Diabetes	N/A	Decline
Truvada	AIDS	N/A	Decline
Tyzeka	Liver Disorder / Hepatitis	N/A	Decline
Uniretic	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Uniretic	CHF	N/A	Decline
Univasc	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Univasc	CHF	N/A	Decline
Valcyte	AIDS	N/A	Decline
Valproic Acid	Seizures	N/A	See Impairment Guide
Valstar	Cancer	8 years > 8 years	Decline Standard
Valturna	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Valturna	CHF	N/A	Decline
Vascor	Angina	N/A	Decline
Vaseretic	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Vaseretic	CHF	N/A	Decline
Vasotec	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Vasotec	CHF	N/A	Decline
Ventolin	Asthma	N/A	See Impairment Guide
Ventolin	COPD / Emphysema / Chronic Bronchitis	N/A	Decline
Verapamil	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Viaspan	Organ / Tissue Transplant	N/A	Decline
Viracept	AIDS	N/A	Decline
Viramune	AIDS	N/A	Decline
Viread	AIDS	N/A	Decline
* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.
# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.
Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.	Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription.
MEDICATION	COMMON USE OF CONCERN	RX FILL WITHIN	PLAN ELIGIBILITY
Visken	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Visken	CHF	N/A	Decline
Vivitrol	Alcohol / Drugs	4 years	Decline
Warfarin	Blood Clot / Deep Vein Thrombosis	N/A	See Impairment Guide
Warfarin	Stroke / Heart or Circulatory Disease or Disorder / Heart Valve Disease	N/A	Decline
Xeloda	Cancer	8 years > 8 years	Decline Standard
Xopenex	Asthma	N/A	See Impairment Guide
Xopenex	COPD / Emphysema / Chronic Bronchitis	N/A	Decline
Zelapar	Parkinson’s	N/A	Decline
Zemplar	Kidney Dialysis	N/A	Decline
Zemplar	Renal Insufficiency / Failure	N/A	Decline
Zemplar	Diabetic Nephropathy	N/A	Decline
Zestoretic	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Zestoretic	CHF	N/A	Decline
Zestril	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Zestril	CHF	N/A	Decline
Ziac	High Blood Pressure (HTN)	N/A	See ‘*’ Below
Ziac	CHF	N/A	Decline
Zyprexa	Bi-Polar / Schizophrenia	N/A	Decline
* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.	* High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage.
# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.	# Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage.

Included Riders

• Terminal Illness Accelerated Death Benefit Rider
• Chronic Illness Accelerated Death Benefit Rider
• Confined Care Accelerated Benefit Rider

Optional Riders

• Return of Premium Death Benefit (20- & 30-Year only)
• Critical Illness Rider (up to $100,000)
• Total Disability Benefit Rider (up to $1,500/mo)
• Accident-Only Total Disability Rider (up to $2,000/mo)
• Waiver of Premium – Disability
• Waiver of Premium – Unemployment
• Children’s Insurance Agreement
• Accidental Death Benefit Rider
• Level Term Rider (Spouse Only)

Conversion Privilege

Convertible to a permanent plan with no evidence of insurability. Converted amount must meet company minimums and may not exceed the original policy face amount.

Eligibility Requirements

• Applicants must have a valid Social Security Number and U.S. address
• Third-party payors only allowed if spouse, business partner, or parent (under age 30)
• Restricted occupations include professional athletes, casino workers, underground miners, and others

State-Specific Restrictions

• AL, CT, ID, IL, MT, PA, RI, UT require specific forms
• KS and KY do not allow replacement applications
• MA and WA require signed CI disclosure

Application & Forms

• Use Application Form No. 3762
• Disclosures: Terminal Illness, Chronic Illness, Confined Care, CI Rider
• HIPAA Form No. 9526 is required
• Submit via Mobile App, AppDrop, or Fax