Life Insurance Underwriting Pocket Guide. The Company You Keep. Agent use only

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1 Life Insurance Underwriting Pocket Guide The Company You Keep Agent use only

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3 Table of Contents Page 1 Page 2 Page 3 Page 4 Pages 5-6 Pages 7-8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Introduction New York Life s Underwriting Philosophy Field Underwriter s Responsibility Underwriter s Responsibility The Life Insurance Application Medical Impairment Information Inspection Reports (IR) Telephone Interview Reports (TIR) TIR Preparation Motor Vehicle Reports (MVR) Routine Attending Physician Statements (APS) Cover Letters Chart A Chart C Risk Classification Criteria Senior Risk Classification Criteria Body Mass Index APS Expedite Form Income Replacement Guidelines Reinsurance New York Life Retention Limits Informal Inquiries

4 Introduction This guide has been developed to assist you with the application and underwriting process. The underwriting rules are subject to change and therefore this guide will be refreshed as necessary. Please make sure you have the most up-to-date underwriting charts and guidelines. New York Life s Underwriting Philosophy New York Life s philosophy is to put good business on the books while providing professional and consistent underwriting service in a timely and efficient manner. This philosophy will contribute to New York Life s long term growth, while at the same time protecting its long term financial integrity and our policyholders. Field Underwriter s Responsibility One of the primary responsibilities of an agent is to be an effective field underwriter. A chief responsibility of the field underwriter is to gather and record accurate and thorough information on the life application. The field underwriter is required to ask and record answers to each question on the application. The field underwriter is also responsible for providing the company s Privacy and Information Practices brochures to the client. Underwriter s Responsibility The underwriter s primary responsibility is to provide fair and consistent underwriting decisions that protect the company s financial integrity while accepting prudent risks that serve in the best interest of our policyholders. The underwriter is responsible for evaluating and categorizing each client s risk based on information gathered by the agent on the application and other sources. 1

5 The Life Insurance Application The application is a legal document that represents an agreement between the owner and New York Life Insurance Company. As such, there are rules that must be followed in order to maintain the integrity of the contract. Ask each question as stated on the application and record accurate and thorough information. Incomplete information slows down the process, resulting in delays for both you and your client. White Out or highlighters cannot be used on an application. Correct mistakes by drawing a SINGLE line through the error, write the correct response next to it, and have the proposed insured initial it. Prepare the application with deliberate neatness and cleanliness. For example, a misspelling of a client s name due to sloppy handwriting does not represent the agent or New York Life in a positive manner and can cause a delay. A complete application results in faster processing time. The application should be proofread before being handed in to the General Office (G.O.) staff. Missed questions could result in the agent having to obtain additional information and signatures from the client. Make sure all parties sign the application. Obtain the correct state HIV Notice and Consent and replacement forms. Medical Impairment Information If a proposed insured has a known medical condition and you would like a preliminary assessment from the underwriter, obtain the following information before contacting the underwriter: The specific diagnosis of the impairment; Date of diagnosis or onset; Treatment, including dates and specific medication prescribed; Frequency and duration of episodes; Date of most recent episode; Type of tests completed along with date and results of each test; Date of the last visit to the treating physician, as well as any medication or treatment provided. 2

6 Inspection Reports (IR) Inspection reports (face to face interviews) are obtained on total risk amounts of $15,000,001 and more. Clients should be prepared to complete a face to face interview with a consumer reporting company for New York Life. Telephone Interview Reports (TIR) The Telephone Interview Report (TIR) program is an in-house service provided for total risk amounts of $500,000 to $15,000,000. The program allows us to minimize the degree which your clients are contacted by an outside vendor. For select agents a telephone interview report will be obtained on total risk amounts of $1,000,001 - $15,000,000. For quality assurance purposes, TIRs may also be conducted on cases below $500,000. On certain face amounts, references or outside sources are needed. TIR Preparation These are some very important tips to foster smooth processing of the TIR: Provide the correct phone number and best time to call your client; Inform your client that they will receive a call from a New York Life representative who will ask a range of questions (such as employment, financial, medical history, etc.) that will be similar to questions answered on the application; Advise them that responses are confidential and used only for underwriting purposes; Indicate which language and / or dialect the proposed insured speaks on the application to ensure that an interpreter is on the line if needed. Motor Vehicle Reports (MVR) A Motor Vehicle Report (MVR) will be obtained on all cases with a total risk amount of $100,000 and more, at issue ages 16 and over. This is for all plans except SPUL, SPVUL and EWL. 3

7 Routine Attending Physician Statements (APS) An age and amount APS will be requested under the following circumstances: Age at Application Amount 0-6 months (Note 1) $100,000 and over 7 months - 40 years old $1,000,000 and over years old $500,000 and over years old $250,000 and over years old $200,000 and over years old $50,000 and over 70 years old and over All amounts Note 1 APS is required at age 0 for all amounts if the child is born premature (less than 37 weeks gestation) Cover Letters Cover letters are especially helpful to an underwriter and should be used whenever you feel there is information that may need clarification. This is your opportunity to provide greater detail to help the underwriter better understand the risk presented by your prospective client or by any of the other parties named on the application. Examples of details to include: How well you know the client; How the sale developed, purpose of insurance and determination of face amount; Unusual or extensive medical histories or financial situations; Clarification of an unusual beneficiary or ownership arrangement; Discussions with the underwriter prior to the application submission; If there are other insurers involved or if the case is known to be substandard; Any information that may be unclear on the application. 4

8 CHART C (Select Agents, Single Sum, Multi Amount Ages $1-49,999 50,000-99,999 Oral Fluid # Oral Fluid # Oral Fluid # 100, , , , ,000 Expanded Blood Draw,, Expanded Blood Draw,, Expanded Blood Draw, 500,001-1,000,000 1,000,001-2,500,000 2,500,001 and Over, (URI)* & Blood, + Blood, ECG Blood, + Blood, ECG Blood, + Blood, ECG = APS required at age 0 if child is born prematurely. + = ECG is also required if a cigarette smoker currently or within last 12 months. ^ = X-ray Current cigarette smokers (or within the last 5 years) Individual or Survivorship plans X-ray required at ages 46 and over at $2,000,001 and up. An X-ray should not be obtained on pregnant women. # = Dried Blood Profile and Urinalysis should be done in the state of Vermont. * = Ages 12 and over only. Expanded Blood Draw = Blood profile and physical measurements. URI = Modified urine specimen 7

9 -life Cases and Prior Insureds within 2 years) & Over Oral Fluid # Oral Fluid # (URI) MD Exam ECG, Expanded Blood Draw, Blood, + Blood, ECG, Expanded Blood Draw, Blood, + Blood, +^ Blood, ECG ^**, Expanded Blood Draw, Blood, + Blood, ECG ^** Blood MD Exam Blood ECG MD Exam Blood ECG ^** MD Exam Blood ECG MD Exam Blood ECG ^ ** = Treadmill stress test Non-cigarette user (Individual plans) required at ages at $10,000,001 and up. (Survivorship plans) treadmill required for non-cigarette users ages at $20,000,001 and up. Current cigarette smokers (or within the last 12 months) Individual or Survivorship plans treadmill required at ages at $3,000,001 and up. When a treadmill is required at ages on this chart, CHART A requirements must be used. A treadmill test should not be arranged until it has been determined that none has been completed in the last 2 years and that there is no medical reason why the test should not be done. Only treadmill exercise tests using the Bruce or similar generally accepted protocol will be accepted. The test must be completed in a hospital or similar facility where emergency equipment and personnel trained in CPR are present. 8

10 Nicotine Body Mass Index Risk Classification Criteria Ages 18 through 69 Minimum Face Amount = $100,000 Preferred / Requirements Select Preferred Select Standard No nicotine use of any kind within the last 5 years See BMI Table No nicotine use of any kind within the last 5 years (Nicotine OK for Select Std) See BMI Table Cholesterol Maximum of 250 Maximum of 250 HDL Ratio Maximum of 4.5 Maximum of 6.0 Lab Results All results within normal limits All results within normal limits Family History Blood Pressure Ages Ages Resting Pulse Prescription Drugs Motor Vehicle Record Commercial Pilots No Cardiovascular Disease parent / sibling less than age 60 Maximum of 130/80 Maximum of 140/85 No more than two moving violations in the last 2 years. No DWI or DUI in the last 5 years. No 9 No Cardiovascular Disease parent / sibling less than age 60 Maximum of 135/85 Maximum of 150/ Any combination of the following types of prescription medications: One statin cholesterol lowering medication Hormone replacement (females) Thyroid replacement Osteoporosis/Osteopenia medications Sleep Aids being used periodically as needed Allergy medications GERD medications Nasal Steroid Spray allowed only if used periodically for seasonal allergies A single blood pressure medication AND any combination of the following types of prescription medications: One statin cholesterol lowering medication Hormone replacement (females) Thyroid replacement Osteoporosis/Osteopenia medications Sleep Aids being used periodically as needed Allergy medications GERD medications Nasal Steroid Spray allowed only if used periodically for seasonal allergies No more than two moving violations in the last 2 years. No DWI or DUI in the last 5 years. Yes

11 Senior Risk Classification Criteria Ages 70 and over Requirements Attending Physician Statement Nicotine Body Mass Index Cholesterol HDL Ratio Lab Results Minimum Face Amount = $100,000 Select Preferred Required within 3 years No nicotine use of any kind within the last 5 years See BMI Table Minimum 140 Maximum of 250 Maximum of 4.5 Serum Albumin > 3.6 All results within normal limits Preferred / Select Standard Required within 3 years No nicotine use of any kind within the last 5 years (Nicotine OK for Select Std) See BMI Table Minimum of 140 Maximum of 300 Maximum of 6.0 Serum Albumin > 3.6 All results within normal limits Blood Pressure Resting Pulse Prescription Drugs Motor Vehicle Record Commercial Pilots Maximum of 145/85 Maximum of 155/90 40 Pulse Pulse 100 A single blood pressure Any combination of the medication AND any following types of combination of the prescription following types of medications: prescription One statin cholesterol medications: lowering medication One statin cholesterol Hormone replacement lowering medication (females) Hormone replacement Thyroid replacement (females) Osteoporosis /Osteopenia Thyroid replacement medications Osteoporosis /Osteopenia Sleep Aids being used medications periodically as needed Sleep Aids being used Allergy medications periodically as needed GERD medications Allergy medications Nasal Steroid Spray GERD medications allowed only if used Nasal Steroid Spray periodically for allowed only if used seasonal allergies periodically for seasonal allergies No more than two moving violations in the last 2 years. No DWI or DUI in the last 5 years. No 10 No more than two moving violations in the last 2 years. No DWI or DUI in the last 5 years. Yes

12 Body Mass Index (BMI) BMI is a measurement of body fat based on height and weight that applies to both adult men and women. It is another way to state the height-weight relationship. The following BMI ranges will be used to determine eligibility for Select Preferred and Preferred / Select Standard: Ages 18 through 69 Preferred / Select Standard Select Preferred Preferred / Select Standard To calculate the BMI use the following formula and round to the nearest tenth (weight in pounds, height in inches): BMI = [Weight/(Height x Height)] x 703 Ages 70 and over Select Preferred Preferred / Select Standard Note: Final BMI measurement is automatically calculated in NB21. 11

13 APS Expedite Form (22313) In order to streamline the ordering of Attending Physician Statements, agents can use this optional form to potentially reduce APS turnaround time by several days. The intention is to identify the need for medical records early and get them ordered before the exam Part II is received. This will expedite the APS and can result in substantial time savings for you and your client. The form should be submitted to the General Office along with the application and any other required forms. The form number is Income Replacement Guidelines Income replacement is simply intended to replace the earnings of the insured, should he or she die prematurely. Generally, only earned income should be used in determining the amount of insurance needed. If unearned income stops upon the death of the insured, then it too should be used in determining the replacement income. If the unearned income, such as that from investments, continues upon the death of the insured, then it should not be taken into consideration in determining the amount of insurance. When evaluating a prospective client s financial situation, the underwriter considers many factors such as earned income, unearned income, net worth, occupation, age, and future income potential. The chart below is a guide for income replacement. Income Age Replacement Factors x x x x x x x 66+ 5x 12

14 Reinsurance Life reinsurance involves the transfer of a specified risk between at least two companies. The companies enter an agreement (reinsurance treaty) whereby one company (the reinsurer) for a negotiated price, agrees to indemnify the other company (the ceding company) against all or part of a loss that the ceding company (e.g. New York Life) can incur in conjunction with its insurance contracts. Automatic reinsurance is an agreement between NYL and the reinsurer whereby the act of risk transfer will be done without the reinsurer re-underwriting the case based on the agreements of the treaty. Facultative reinsurance is an agreement by which the application papers must be forwarded to the reinsurer or reinsurers involved who will evaluate the case and either accept the NYL underwriter s assessment, offer a counter proposal or decline to cover the risk. Minimum face amount for facultative consideration is $100,000. New York Life sends cases that are offered at class 5 and higher to facultative reinsurance (except SPUL, SPVUL, EWL, Asset Preserver, and Private Placement VUL). If New York Life makes an offer, we keep the offer on the table and may win the case completely if we provided the best offer. 13

15 New York Life Retention Limits Retention limit is defined as the maximum amount of life insurance, inforce and applied for, that NYL is able to retain without the need for reinsurance. Retention limits are set by the Board of Directors. Single Life Maximum Issue Age Maximum Retention Limit 0-60 $40,000, $25,000,000 $30,000, $12,500,000 $20,000, $10,000, and Over $5,000,000 $7,500,000 Joint Life Second-to-Die Maximum Issue Age of Youngest Insured Maximum Retention Limit 0-60 $50,000, $35,000,000 $40,000, $17,500,000 $30,000, $15,000, and and Over Over $10,000,000 $7,500,000 The Joint Life Second-to-Die Maximum Retention Limits will be reduced by the total amount of insurance coverage on the two insureds already issued by all New York Life companies. 14

16 Informal Inquiries An informal inquiry is used to determine whether or not a policy might be issued on a client, and at which possible classification, before an application is formally taken. We utilize two types of informal inquiries, the pre-trust case and the insurability case. The pre-trust situation is where a formal application is not used because the trust has not yet been finalized. Insurability cases are those where the intention is to determine the likelihood of a client s insurability based upon the information submitted. The agent should fully complete the informal inquiry form (# 22078) and identify whether the inquiry is for insurability or pre-trust. This two-page form includes a special authorization to allow the company to check the MIB and to obtain medical records as needed. Important Note: Deposit premiums and temporary coverage should never be accepted or provided on these cases. For an insurability case, the underwriter will review the history and advise the General Office to order specific medical requirements or Attending Physician Statements as needed from the medical providers indicated on the form to assess the risk. For a pre-trust case, the agent should order the appropriate age and amount requirements. The underwriting department will order any TIRs or MVRs as needed. If an offer can be made, the underwriter will notify the office manager and copy the agent with the offer, the plan, and the amount. If no offer can be made on a client, a letter will be sent to the office manager and the agent to inform them of that decision. A declination letter will not be sent to the client and/or applicant. 15

17 NOTES

18 New York Life Insurance Company New York Life Insurance and Annuity Corporation (A Delaware Corporation) 51 Madison Avenue New York, NY The Company You Keep For internal use only. Not to be used with the general public (05/09) SMRU CV (05/2011)

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