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