SafeCare Term-Occidental/American-Amicable Group(AmAm)

Agent AI Hits: 142

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

Product: SafeCare Term

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

Issue Ages: 18 to 75

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

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

Carrier

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

Product Overview

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

Issue Ages and Face Amounts

Issue Ages (age nearest birthday):	10-Year Level Premium	Ages 18 – 75
	15-Year Level Premium	Ages 18 – 70
	20-Year Level Premium	Ages 18 – 65
	30-Year Level Premium	Ages 18 – 55
	20-Year with ROP Rider	Ages 18 – 60
	30-Year with ROP Rider	Ages 18 – 50
Minimum Face Amount:	$25,000 face amount or $25.00 monthly premium (excluding riders), whichever is greater.
Maximum Face Amount:	Ages 18 – 75	$500,000
Premium Bands:	Band 1	Face amounts $25,000 to $249,999
Premium Bands:	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