Limited Pay Policy (L-222B) - Underwriting Guidelines

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1 Limited Pay Policy (L-222B) - Underwriting Guidelines 1 Addiction/Abuser Drug - Past or Present Presently Recovered - AA for last 2 years 2 Aids 3 Alcoholic Presently Recovered - AA for last 2 years 4 Alzheimer's 5 Anemia Sickle Cell Anemia 6 Aneurysm 7 Arrhythmias 8 Arteriosclerosis Under Age 50 Over Age 50 but under 70 Over Age 70 Any Age Combined w/ Diabetes 9 Artery Bypass Within 4 years Over 4 years 10 Arthritis 11 Asthma 12 Bronchiectasis 13 Bronchitis 1

2 14 Cancer Currently exists in Body Brain Lungs Liver Skin - Recovered 1 or more yrs. Has moved from original site 15 From Recovery or Last treatment 0 through 3 years 4 years and over 16 Cerebral Palsy 17 Chronic Obstructive Pulmonary With oxygen 18 Cirrhosis 19 Congestive Heart Failure diagnosed within last 4 years diagnosed over 4 years ago 20 Confinement Wheelchair Bed 21 Coronary Artery Disease 22 Coronary Thrombosis diagnosed within last 2 years diagnosed within last 2 years 23 Crohn's Disease Recovery less than 5 years Recovery more than 5 years 24 Cystic Fibrosis Lung Disorder 25 Diabetes Onset Age

3 Onset Age 40 and Diet controlled Onset Age 40 & 60 units or less Over 60 units per day - any age Duration over 15 years 26 Diabetes Combined with the following: High Blood Pressure Heart disease Hardening of the Arteries Extreme Overweight Other Impairments 27 Dialysis Kidney - Currently receiving Kidney - Previously received 28 Disabled Physically Mentally 29 Diverticulitis 30 Down Syndrome 31 Drug Addiction Drug - Past or Present 32 Drug Rehab Currently residing 33 Emphysema 34 Hardening of Arteries With oxygen Under Age 50 Over Age 50 but under 70 Over Age 70 Any Age Combined w/ Diabetes 35 Heart Attack diagnosed within last 2 years 3

4 36 Heart Disease diagnosed within last 2 years 37 Heart Enlargement diagnosed within last 4 years diagnosed over 4 years ago 38 Hepatitis 39 Hernia 40 High Blood Pressure Controlled with medication Combined with Diabetes Combined with heart Disease Combined with Kidney Disease 42 Hospital Patient Currently residing in Hospital 43 Impaired Severely or markedly 44 Incontinent Loss of bladder and bowel 45 Kidney Disease Chronic On Dialysis Renal Failure nephritis Kidney Stones nephrectomy Pancreas 46 Leukemia Currently exists in Body From Recovery or Last treatment 0 through 3 years 4 years and over 47 Life Support Currently being sustained 4

5 Previously sustained 48 Lung Disorder Cancer Chronic Obstructive Pulmonary COPD + Oxygen Cystic fibrosis Silicosis 49 Lupus Joint disease with Kidney failure 50 Nervous/Mental Disorders Alzheimer's Down's Syndrome Paranoid Parkinson's Disease Psychotics Psychoneurosis Retardation Schizophrenia 51 Mental Institution Currently residing in Institution 52 Myocardial Infarction diagnosed within last 2 years 53 Nursing Home Currently residing in Institution 54 Osteoporosis 55 Pacemaker Within 4 years Over 4 years 56 Paranoid 57 Parkinson's Disease 58 Psychotics 5

6 59 Psychoneurosis 60 Resident of the following 61 Respiratory Disorders Drug/Alcohol Rehabilitation Hospital mental Institution nursing Home Veterans Hospital Asthma Bronchiectasis Bronchitis 62 Retardation Mental Disorder 63 Silicosis Lung Disorder 64 Suicide within last 5 years 6 years or more 65 Schizophrenia Mental Disorder 66 Stroke within 1 year Over 1 year 67 Terminally Ill Any disease 68 Tuberculosis 69 Tumor Benign Malignant Currently exists in Body From Recovery or Last treatment 0 through 3 years 4 years and over 6

7 70 Ulcers 71 Ulcerative Colitis 7

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