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Carrier: Occidental Life Insurance Company of North Carolina (AmAm)
Product: SafeCare Term
Product Types: 10-Year, 15-Year, 20-Year, and 30-Year Level Term
Issue Ages: 18 to 75
Face Amounts: $25,000 to $500,000
Target Market: Clients seeking simplified term coverage, Mortgage protection coverage for applicants with moderate health concerns with immediate underwriting decisions and optional Return of Premium on longer terms
Carrier
Occidental Life Insurance Company of North Carolina (a member of the American-Amicable Group)
Product Overview
SafeCare Term is a simplified issue level term life insurance plan offering 10-, 15-, 20-, and 30-year level premium periods. It is designed for agents with Integrity and offers immediate point-of-sale underwriting decisions. The plan is renewable to age 95, with built-in living benefits and optional supplemental riders. The Return of Premium Death Benefit is available on 20- and 30-year plans only.
Issue Ages and Face Amounts
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Issue Ages
(age nearest birthday):10-Year Level Premium Ages 18 – 75 15-Year Level Premium Ages 18 – 70 20-Year Level Premium Ages 18 – 65 30-Year Level Premium Ages 18 – 55 20-Year with ROP Rider Ages 18 – 60 30-Year with ROP Rider Ages 18 – 50 Minimum Face Amount: $25,000 face amount or $25.00 monthly premium (excluding riders), whichever is greater. Maximum Face Amount: Ages 18 – 75 $500,000 Premium Bands: Band 1 Face amounts $25,000 to $249,999 Band 2 Face amounts $250,000 to $500,000 Underwriting Classes: Preferred Non-Tobacco Standard Non-Tobacco Standard Tobacco Modal Factors: Monthly 0.09 Quarterly 0.265 Semi-Annual 0.52 Policy Fee: $70 (fully commissionable) Underwriting: Simplified issue, underwritten standard through table 4. NOT GUARANTEED ISSUE.
Available Term Durations
- 10-Year Level Term
- 15-Year Level Term
- 20-Year Level Term
- 30-Year Level Term
- 20-Year Level Term (ROP available)
- 30-Year Level Term (ROP available)
Underwriting Guidelines
Simplified underwriting includes a Yes/No application, MIB check, Rx check, Motor Vehicle Report, and build chart analysis. A telephone interview may be required. APS may be ordered. Applicants above Table 4 will be declined.
Build Chart (Updated)
| BUILD CHART | BUILD CHART | BUILD CHART | BUILD CHART |
|---|---|---|---|
| HEIGHT | MINIMUM WEIGHT MUST BE AT LEAST | MAXIMUM WEIGHT WITHIN TABLE 2 | MAXIMUM WEIGHT WITHIN TABLE 4 |
| 4’10” | 86 | 182 | 199 |
| 4’11” | 88 | 188 | 205 |
| 5’ | 90 | 195 | 212 |
| 5’1” | 93 | 201 | 220 |
| 5’2” | 95 | 208 | 227 |
| 5’3” | 99 | 215 | 234 |
| 5’4” | 101 | 221 | 242 |
| 5’5” | 104 | 228 | 249 |
| 5’6” | 106 | 235 | 257 |
| 5’7” | 110 | 243 | 265 |
| 5’8” | 113 | 250 | 273 |
| 5’9” | 117 | 257 | 281 |
| 5’10” | 120 | 265 | 289 |
| 5’11” | 125 | 272 | 298 |
| 6’ | 129 | 280 | 306 |
| 6’1” | 133 | 288 | 315 |
| 6’2” | 136 | 296 | 323 |
| 6’3” | 140 | 304 | 332 |
| 6’4” | 143 | 312 | 341 |
| 6’5” | 146 | 320 | 350 |
| 6’6” | 149 | 329 | 359 |
| 6’7” | 153 | 337 | 368 |
| 6’8” | 157 | 346 | 378 |
| 6’9” | 160 | 355 | 387 |
Medical Impairment Guide
| EASY TERM PRESCRIPTION REFERENCE GUIDE (continued) | EASY TERM PRESCRIPTION REFERENCE GUIDE (continued) | EASY TERM PRESCRIPTION REFERENCE GUIDE (continued) | EASY TERM PRESCRIPTION REFERENCE GUIDE (continued) |
|---|---|---|---|
| Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. |
| MEDICATION | COMMON USE OF CONCERN | RX FILL WITHIN | PLAN ELIGIBILITY |
| Betapace | Heart Arrhythmia | N/A | Decline |
| Betapace | CHF | N/A | Decline |
| Betaseron | Multiple Sclerosis | N/A | Decline |
| Betaxolol HCL | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Betaxolol HCL | CHF | N/A | Decline |
| BiDil | CHF | N/A | Decline |
| Bisoprolol Fumarate | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Bisoprolol Fumarate | CHF | N/A | Decline |
| Bromocriptine Mesylate | Parkinson’s | N/A | Decline |
| Bumetanide | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Bumetanide | CHF | N/A | Decline |
| Bumex | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Bumex | CHF | N/A | Decline |
| Buprenex | Alcohol / Drugs | 4 years | Decline |
| Bystolic | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Bystolic | CHF | N/A | Decline |
| Calan | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Calcium Acetate | Kidney Dialysis | N/A | Decline |
| Calcium Acetate | Renal Insufficiency/Failure | N/A | Decline |
| Calcium Acetate | Diabetic Nephropathy | N/A | Decline |
| Campath | Cancer | 8 years > 8 years | Decline Standard |
| Campral | Alcohol / Drugs | 4 years | Decline |
| Capoten | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Capoten | CHF | N/A | Decline |
| Capozide | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Capozide | CHF | N/A | Decline |
| Captopril | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Captopril | CHF | N/A | Decline |
| Carbamazepine | Seizures | N/A | See Impairment Guide |
| Carbatrol | Seizures | N/A | See Impairment Guide |
| Carbidopa | Parkinson’s | N/A | Decline |
| Cardizem | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Cardura | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Cartia | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Carvedilol | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Carvedilol | CHF | N/A | Decline |
| * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. |
| # Diabetes - If diagnosed, treated, or taken medication prior to age 35, client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. |
Prescription Medication Guide
| Medication | Use | RX Fill Within | Plan Eligibility |
|---|---|---|---|
| Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. |
| MEDICATION | COMMON USE OF CONCERN | RX FILL WITHIN | PLAN ELIGIBILITY |
| Digoxin | Irregular Heartbeat | N/A | Decline |
| Digoxin | CHF | N/A | Decline |
| Dilacor | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Dilantin | Seizures | N/A | See Impairment Guide |
| Dilatrate SR | Angina / CHF | N/A | Decline |
| Dilor | Asthma | N/A | See Impairment Guide |
| Dilor | COPD / Emphysema / Chronic Bronchitis | N/A | Decline |
| Diovan | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Diovan | CHF | N/A | Decline |
| Disulfiram | Alcohol / Drugs | 4 years | Decline |
| Dolophine | Opioid Dependence | 4 years | Decline |
| Donepezil HCL | Alzheimer’s / Dementia | N/A | Decline |
| Duoneb | COPD / Emphysema / Chronic Bronchitis | N/A | Decline |
| Dyazide | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Dyazide | CHF | N/A | Decline |
| Dynacirc | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Dyrenium | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Dyrenium | CHF | N/A | Decline |
| Edecrin | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Edecrin | CHF | N/A | Decline |
| Edurant | AIDS | N/A | Decline |
| Eldepryl | Parkinson’s | N/A | Decline |
| Emtriva | AIDS | N/A | Decline |
| Enalapril Maleate | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Enalapril Maleate | CHF | N/A | Decline |
| Enalaprilat | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Enalaprilat | CHF | N/A | Decline |
| Epitol | Seizures | N/A | See Impairment Guide |
| Epivir | AIDS | N/A | Decline |
| Eplerenone | CHF | N/A | Decline |
| Eskalith | Bi-Polar / Schizophrenia | N/A | Decline |
| Esmolol HCL | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Esmolol HCL | CHF | N/A | Decline |
| Exforge | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Exforge | CHF | N/A | Decline |
| Felodipine | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Femara | Cancer | 8 years > 8 years | Decline Standard |
| * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. |
| # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. |
| Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. |
| MEDICATION | COMMON USE OF CONCERN | RX FILL WITHIN | PLAN ELIGIBILITY |
| Foscavir | AIDS | N/A | Decline |
| Fosinopril Sodium | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Fosinopril Sodium | CHF | N/A | Decline |
| Fosrenol | Kidney Dialysis | N/A | Decline |
| Fosrenol | Renal Insufficiency / Failure | N/A | Decline |
| Fosrenol | Diabetic Nephropathy | N/A | Decline |
| Furosemide | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Furosemide | CHF | N/A | Decline |
| Gabapentin | Seizures | N/A | See Impairment Guide |
| Gabapentin | Restless Leg Syndrome | N/A | Standard |
| Gleevec | Cancer | 8 years > 8 years | Decline Standard |
| Glipizide | Diabetes | N/A | See ‘#’ Below |
| Glucophage | Diabetes | N/A | See ‘#’ Below |
| Glucotrol | Diabetes | N/A | See ‘#’ Below |
| Glyburide | Diabetes | N/A | See ‘#’ Below |
| Glynase | Diabetes | N/A | See ‘#’ Below |
| Haldol | Schizophrenia | N/A | Decline |
| Haloperidol | Schizophrenia | N/A | Decline |
| HCTZ/Triamterene | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| HCTZ/Triamterene | CHF | N/A | Decline |
| Hectoral | Kidney Dialysis | N/A | Decline |
| Hectoral | Renal Insufficiency / Failure | N/A | Decline |
| Hectoral | Diabetic Nephropathy | N/A | Decline |
| Heparin | Blood Clot / Deep Vein Thrombosis | N/A | See Impairment Guide |
| Hepsera | Liver Disorder / Hepatitis | N/A | Decline |
| Hizentra | Immunodeficiency | N/A | Decline |
| Humalog | Diabetes | N/A | Decline |
| Humulin | Diabetes | N/A | Decline |
| Hydralazine HCL | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Hydralazine HCL | CHF | N/A | Decline |
| Hydroxychloroquine | Systemic Lupus (SLE) | N/A | Decline |
| Hydroxychloroquine | Rheumatoid Arthritis | N/A | Decline |
| Hydroxyurea | Cancer | 8 years > 8 years | Decline Standard |
| Hytrin | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Hyzaar | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Hyzaar | CHF | N/A | Decline |
| Imdur | Angina / CHF | N/A | Decline |
| * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. |
| # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. |
| Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. |
| MEDICATION | COMMON USE OF CONCERN | RX FILL WITHIN | PLAN ELIGIBILITY |
| Imuran | Organ / Tissue Transplant | N/A | Decline |
| Imuran | Rheumatoid Arthritis | N/A | Decline |
| Imuran | Systemic Lupus (SLE) | N/A | Decline |
| Inamrinone | CHF | N/A | Decline |
| Inderal | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Inderal | CHF | N/A | Decline |
| Inderide | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Inderide | CHF | N/A | Decline |
| Inspra | CHF | N/A | Decline |
| Insulin | Diabetes | N/A | Decline |
| Intron-A | Cancer | 8 years > 8 years | Decline Standard |
| Intron-A | Hepatitis C | N/A | Decline |
| Invirase | AIDS | N/A | Decline |
| Ipratropium Bromide | Allergies | N/A | Standard |
| Ipratropium Bromide | COPD / Emphysema / Chronic Bronchitis | N/A | Decline |
| Isoptin | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Isordil | Angina / CHF | N/A | Decline |
| Isosorbide Dinitrate/ Mononitrate | Angina / CHF | N/A | Decline |
| Janumet | Diabetes | N/A | See ‘#’ Below |
| Januvia | Diabetes | N/A | See ‘#’ Below |
| Kaletra | AIDS | N/A | Decline |
| Kemadrin | Parkinson’s | N/A | Decline |
| Kerlone | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Kerlone | Glaucoma | N/A | Standard |
| Labetalol | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Labetalol | Angina | N/A | Decline |
| Lamictal | Seizures | N/A | See Impairment Guide |
| Lamictal | Bi-polar / Major depression | N/A | Decline |
| Lamotrigine | Seizures | N/A | See Impairment Guide |
| Lamotrigine | Bi-polar / Major depression | N/A | Decline |
| Lanoxicaps | Irregular Heartbeat | N/A | Decline |
| Lanoxicaps | CHF | N/A | Decline |
| Lanoxin | Irregular Heartbeat | N/A | Decline |
| Lanoxin | CHF | N/A | Decline |
| Lantus | Diabetes | N/A | Decline |
| Larodopa | Parkinson’s | N/A | Decline |
| * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. |
| # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. |
| Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. |
| MEDICATION | COMMON USE OF CONCERN | RX FILL WITHIN | PLAN ELIGIBILITY |
| Lasix | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Lasix | CHF | N/A | Decline |
| Leukeran | Cancer | 8 years > 8 years | Decline Standard |
| Levatol | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Levatol | Angina | N/A | Decline |
| Levemir | Diabetes | N/A | Decline |
| Levocarnitine | Kidney Dialysis | N/A | Decline |
| Levocarnitine | Renal Insufficiency / Failure | N/A | Decline |
| Levocarnitine | Diabetic Nephropathy | N/A | Decline |
| Levodopa | Parkinson’s | N/A | Decline |
| Lexiva | AIDS | N/A | Decline |
| Lipitor | Cholesterol | N/A | Standard |
| Lisinopril | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Lisinopril | CHF | N/A | Decline |
| Lithium | Bi-Polar / Schizophrenia | N/A | Decline |
| Lodosyn | Parkinson’s | N/A | Decline |
| Lopressor | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Losartan | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Losartan | CHF | N/A | Decline |
| Lotensin | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Lotensin | CHF | N/A | Decline |
| Loxapine | Schizophrenia | N/A | Decline |
| Loxitane | Schizophrenia | N/A | Decline |
| Lozol | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Lupron | Cancer | 8 years > 8 years | Decline Standard |
| Lyrica | Seizures | N/A | See Impairment Guide |
| Mavik | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Mavik | CHF | N/A | Decline |
| Maxzide | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Maxzide | CHF | N/A | Decline |
| Mellaril | Schizophrenia | N/A | Decline |
| Metformin | Diabetes | N/A | See ‘#’ Below |
| Methadone | Opioid Dependence | 4 years | Decline |
| Methadose | Opioid Dependence | 4 years | Decline |
| Methotrexate | Cancer | 8 years > 8 years | Decline Standard |
| Methotrexate | Rheumatoid Arthritis | N/A | Decline |
| * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. |
| # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. |
| Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. |
| MEDICATION | COMMON USE OF CONCERN | RX FILL WITHIN | PLAN ELIGIBILITY |
| Metoprolol HCTZ | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Metoprolol HCTZ | CHF | N/A | Decline |
| Metoprolol Tartrate / Succinate | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Metoprolol Tartrate / Succinate | CHF | N/A | Decline |
| Micardis | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Micardis | CHF | N/A | Decline |
| Micronase | Diabetes | N/A | See ‘#’ Below |
| Milrinone | CHF / Cardiomyopathy | N/A | Decline |
| Minipress | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Minitran | Angina / CHF | N/A | Decline |
| Mirapex | Parkinson’s | N/A | Decline |
| Mirapex | Other Use | N/A | Standard |
| Moban | Schizophrenia | N/A | Decline |
| Moduretic | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Moduretic | CHF | N/A | Decline |
| Moexipril HCL | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Moexipril HCL | CHF | N/A | Decline |
| Monoket | Angina / CHF | N/A | Decline |
| Monopril | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Monopril | CHF | N/A | Decline |
| Mysoline | Seizures | N/A | See Impairment Guide |
| Nadolol | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Nadolol | CHF | N/A | Decline |
| Naloxone | Alcohol / Drugs | 4 years | Decline |
| Naltrexone | Alcohol / Drugs | 4 years | Decline |
| Narcan | Alcohol / Drugs | 4 years | Decline |
| Natrecor | CHF | N/A | Decline |
| Navane | Schizophrenia | N/A | Decline |
| Neurontin | Seizures | N/A | See Impairment Guide |
| Nifedipine | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Nimodipine | Stroke / Heart or Circulatory Disease or Disorder | N/A | Decline |
| Nimotop | Stroke / Heart or Circulatory Disease or Disorder | N/A | Decline |
| Nitrek | Angina / CHF | N/A | Decline |
| Nitro-bid | Angina / CHF | N/A | Decline |
| Nitro-dur | Angina / CHF | N/A | Decline |
| Nitroglycerine / Nitrotab / Nitroquick/Nitrostat | Angina / CHF | N/A | Decline |
| Nitrol | Angina / CHF | N/A | Decline |
| * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. |
| # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. |
| Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. |
| MEDICATION | COMMON USE OF CONCERN | RX FILL WITHIN | PLAN ELIGIBILITY |
| Normodyne | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Norpace | Irregular Heartbeat | N/A | Decline |
| Norvir | AIDS | N/A | Decline |
| Novolin | Diabetes | N/A | Decline |
| Novolog | Diabetes | N/A | Decline |
| Pacerone | Irregular Heartbeat | N/A | Decline |
| Pancrease | Chronic Pancreatitis | N/A | Decline |
| Parcopa | Parkinson’s | N/A | Decline |
| Parlodel | Parkinson’s | N/A | Decline |
| Pegasys | Liver Disorder / Hepatitis C / Chronic Hepatitis | N/A | Decline |
| Peg-Intron | Liver Disorder / Hepatitis C / Chronic Hepatitis | N/A | Decline |
| Pentam 300 | AIDS | N/A | Decline |
| Pentamidine Isethionate | AIDS | N/A | Decline |
| Pergolide Mesylate | Parkinson’s | N/A | Decline |
| Permax | Parkinson’s | N/A | Decline |
| Phenobarbital | Seizures | N/A | See Impairment Guide |
| Phoslo | Kidney Dialysis | N/A | Decline |
| Phoslo | Renal Insufficiency / Failure | N/A | Decline |
| Phoslo | Diabetic Nephropathy | N/A | Decline |
| Plaquenil | Systemic Lupus (SLE) | N/A | Decline |
| Plaquenil | Malaria | N/A | Standard |
| Plaquenil | Rheumatoid Arthritis | N/A | Decline |
| Plavix | Stroke / Heart or Circulatory Disease or Disorder | N/A | Decline |
| Plendil | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Prandin | Diabetes | N/A | See ‘#’ Below |
| Prazosin | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Primacor | CHF | N/A | Decline |
| Prinivil | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Prinivil | CHF | N/A | Decline |
| Prinzide | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Prinzide | CHF | N/A | Decline |
| Procardia | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Prograf | Organ / Tissue Transplant | N/A | Decline |
| Proleukin | Cancer | 8 years > 8 years | Decline Standard |
| Prolixin | Schizophrenia | N/A | Decline |
| Propranolol HCL | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Propranolol HCL | CHF | N/A | Decline |
| * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. |
| # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. |
| Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. |
| MEDICATION | COMMON USE OF CONCERN | RX FILL WITHIN | PLAN ELIGIBILITY |
| Proventil | Asthma | N/A | See Impairment Guide |
| Proventil | COPD / Emphysema / Chronic Bronchitis | N/A | Decline |
| Prozac | Depressive Disorder | N/A | Standard |
| Quinapril | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Quinapril | CHF | N/A | Decline |
| Quinaretic | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Quinaretic | CHF | N/A | Decline |
| Ramipril | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Ramipril | CHF | N/A | Decline |
| Ranexa | Angina / CHF | N/A | Decline |
| Rapamune | Organ / Tissue Transplant | N/A | Decline |
| Rebetol | Liver Disorder / Hepatitis C / Chronic Hepatitis | N/A | Decline |
| Rebetron | Liver Disorder / Hepatitis C / Chronic Hepatitis | N/A | Decline |
| Rebif | Multiple Sclerosis | N/A | Decline |
| Renagel | Kidney Dialysis | N/A | Decline |
| Renagel | Renal Insufficiency / Failure | N/A | Decline |
| Renagel | Diabetic Nephropathy | N/A | Decline |
| Renvela | Kidney Dialysis | N/A | Decline |
| Renvela | Renal Insufficiency / Failure | N/A | Decline |
| Renvela | Diabetic Nephropathy | N/A | Decline |
| Requip | Parkinson’s | N/A | Decline |
| Requip | Restless Leg Syndrome | N/A | Standard |
| Ribavirin | Liver Disorder / Hepatitis C / Chronic Hepatitis | N/A | Decline |
| Rilutek | ALS / Motor Neuron Disease | N/A | Decline |
| Risperdal | Bi-Polar / Schizophrenia | N/A | Decline |
| Risperidone | Bi-Polar / Schizophrenia | N/A | Decline |
| Rituxan | Cancer | 8 years > 8 years | Decline Standard |
| Rituxan | Rheumatoid Arthritis | N/A | Decline |
| Ropinirole | Parkinson’s | N/A | Decline |
| Ropinirole | Restless Leg Syndrome | N/A | Standard |
| Rythmol | Irregular Heartbeat | N/A | Decline |
| Serevent | Asthma | N/A | See Impairment Guide |
| Serevent | COPD / Emphysema / Chronic Bronchitis | N/A | Decline |
| Seroquel | Bi-Polar / Schizophrenia | N/A | Decline |
| Sinemet/Sinemet CR | Parkinson’s | N/A | Decline |
| Sodium Edecrin | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Sodium Edecrin | CHF | N/A | Decline |
| * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. |
| # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. |
| Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. |
| MEDICATION | COMMON USE OF CONCERN | RX FILL WITHIN | PLAN ELIGIBILITY |
| Sotalol Hydrochloride | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Sotalol Hydrochloride | CHF | N/A | Decline |
| Sotalol HCL | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Sotalol HCL | CHF | N/A | Decline |
| Spiriva | COPD / Emphysema / Chronic Bronchitis | N/A | Decline |
| Spironolactone | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Spironolactone | CHF | N/A | Decline |
| Sprycel | Cancer | 8 years > 8 years | Decline Standard |
| Stalevo | Parkinson’s | N/A | Decline |
| Starlix | Diabetes | N/A | See ‘#’ Below |
| Suboxone | Alcohol / Drugs | 4 years | Decline |
| Subutex | Alcohol / Drugs | 4 years | Decline |
| Sustiva | AIDS | N/A | Decline |
| Symbicort | Asthma | N/A | Standard |
| Symbicort | COPD / Emphysema / Chronic Bronchitis | N/A | Decline |
| Symmetrel | Parkinson’s | N/A | Decline |
| Tambocor | Irregular Heartbeat | N/A | Decline |
| Tamoxifen | Cancer | 8 years > 8 years | Decline Standard |
| Tarka | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Tarka | CHF | N/A | Decline |
| Tasmar | Parkinson’s | N/A | Decline |
| Tegretol | Seizures | N/A | See Impairment Guide |
| Tenex | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Tenoretic | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Tenoretic | CHF | N/A | Decline |
| Tenormin | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Tenormin | CHF | N/A | Decline |
| Theo-Dur | Asthma | N/A | See Impairment Guide |
| Theo-Dur | COPD / Emphysema / Chronic Bronchitis | N/A | Decline |
| Theophylline | Asthma | N/A | See Impairment Guide |
| Theophylline | COPD / Emphysema / Chronic Bronchitis | N/A | Decline |
| Thioridazine | Schizophrenia | N/A | Decline |
| Thiothixene | Schizophrenia | N/A | Decline |
| Thorazine | Schizophrenia | N/A | Decline |
| Tiazac | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Tolazamide | Diabetes | N/A | See ‘#’ Below |
| * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. |
| # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. |
| Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. |
| MEDICATION | COMMON USE OF CONCERN | RX FILL WITHIN | PLAN ELIGIBILITY |
| Tolbutamide | Diabetes | N/A | See ‘#’ Below |
| Tolinase | Diabetes | N/A | See ‘#’ Below |
| Toprol XL | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Toprol XL | CHF | N/A | Decline |
| Torsemide | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Torsemide | CHF | N/A | Decline |
| Trandate | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Trandate | CHF | N/A | Decline |
| Triamterene | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Triamterene | CHF | N/A | Decline |
| Tribenzor | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Tribenzor | CHF | N/A | Decline |
| Trihexyphenidyl HCL | Parkinson’s | N/A | Decline |
| Tresiba (Insulin) | Diabetes | N/A | Decline |
| Truvada | AIDS | N/A | Decline |
| Tyzeka | Liver Disorder / Hepatitis | N/A | Decline |
| Uniretic | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Uniretic | CHF | N/A | Decline |
| Univasc | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Univasc | CHF | N/A | Decline |
| Valcyte | AIDS | N/A | Decline |
| Valproic Acid | Seizures | N/A | See Impairment Guide |
| Valstar | Cancer | 8 years > 8 years | Decline Standard |
| Valturna | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Valturna | CHF | N/A | Decline |
| Vascor | Angina | N/A | Decline |
| Vaseretic | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Vaseretic | CHF | N/A | Decline |
| Vasotec | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Vasotec | CHF | N/A | Decline |
| Ventolin | Asthma | N/A | See Impairment Guide |
| Ventolin | COPD / Emphysema / Chronic Bronchitis | N/A | Decline |
| Verapamil | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Viaspan | Organ / Tissue Transplant | N/A | Decline |
| Viracept | AIDS | N/A | Decline |
| Viramune | AIDS | N/A | Decline |
| Viread | AIDS | N/A | Decline |
| * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. |
| # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. |
| Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. | Where medications used for more than one condition exist, alternate uses and appropriate levels of coverage are listed below. Suppose the insured had a medication prescribed within a time frame in the ‘RX FILL WITHIN’ column. For those conditions, the time frame impacts the Underwriting decision. If `N/A’ appears in this column, then the Underwriting decision will be the same regardless of when the insured filled the prescription. |
| MEDICATION | COMMON USE OF CONCERN | RX FILL WITHIN | PLAN ELIGIBILITY |
| Visken | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Visken | CHF | N/A | Decline |
| Vivitrol | Alcohol / Drugs | 4 years | Decline |
| Warfarin | Blood Clot / Deep Vein Thrombosis | N/A | See Impairment Guide |
| Warfarin | Stroke / Heart or Circulatory Disease or Disorder / Heart Valve Disease | N/A | Decline |
| Xeloda | Cancer | 8 years > 8 years | Decline Standard |
| Xopenex | Asthma | N/A | See Impairment Guide |
| Xopenex | COPD / Emphysema / Chronic Bronchitis | N/A | Decline |
| Zelapar | Parkinson’s | N/A | Decline |
| Zemplar | Kidney Dialysis | N/A | Decline |
| Zemplar | Renal Insufficiency / Failure | N/A | Decline |
| Zemplar | Diabetic Nephropathy | N/A | Decline |
| Zestoretic | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Zestoretic | CHF | N/A | Decline |
| Zestril | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Zestril | CHF | N/A | Decline |
| Ziac | High Blood Pressure (HTN) | N/A | See ‘*’ Below |
| Ziac | CHF | N/A | Decline |
| Zyprexa | Bi-Polar / Schizophrenia | N/A | Decline |
| * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. | * High Blood Pressure - If controlled with 2 or fewer medications, the client could qualify for the plan. If controlled with 3 or more medications, the client will not be eligible for coverage. |
| # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. | # Diabetes - If diagnosed, treated, or taken medication prior to age 35, the client will not be eligible for coverage. If currently taking insulin shots or tobacco use within the past 12 months, the client will not be eligible for coverage. If combined with overweight, gout, retinopathy, or protein in the urine; the client is not eligible for coverage. |
Included Riders
- Terminal Illness Accelerated Death Benefit Rider
- Chronic Illness Accelerated Death Benefit Rider
- Confined Care Accelerated Benefit Rider
Optional Riders
- Return of Premium Death Benefit (20- & 30-Year only)
- Critical Illness Rider (up to $100,000)
- Total Disability Benefit Rider (up to $1,500/mo)
- Accident-Only Total Disability Rider (up to $2,000/mo)
- Waiver of Premium – Disability
- Waiver of Premium – Unemployment
- Children’s Insurance Agreement
- Accidental Death Benefit Rider
- Level Term Rider (Spouse Only)
Conversion Privilege
Convertible to a permanent plan with no evidence of insurability. Converted amount must meet company minimums and may not exceed the original policy face amount.
Eligibility Requirements
- Applicants must have a valid Social Security Number and U.S. address
- Third-party payors only allowed if spouse, business partner, or parent (under age 30)
- Restricted occupations include professional athletes, casino workers, underground miners, and others
State-Specific Restrictions
- AL, CT, ID, IL, MT, PA, RI, UT require specific forms
- KS and KY do not allow replacement applications
- MA and WA require signed CI disclosure
Application & Forms
- Use Application Form No. 3762
- Disclosures: Terminal Illness, Chronic Illness, Confined Care, CI Rider
- HIPAA Form No. 9526 is required
- Submit via Mobile App, AppDrop, or Fax
