Occidental-American Amicable (AmAm)-Family Choice

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
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Address

Legacy Agent, LLC
41000 Woodward Ave, East Ste #350
Bloomfield Hills, MI 48304
 

Talk to us

+1-888-479-9888
+1-248-461-3360
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