Life Insurance Field Underwriting Guide

Transcription

1 Life Insurance Field Underwriting Guide National Life Insurance Company Life Insurance Company of the Southwest 30 % MK2312(0311) TC61418(0311) For Agent Use Only - Not For Use With the Public

2 Table of Contents Helpful Hints Expedite your applications! Insurance and General Medical Testing Guidelines Paramedical Facilities/Laboratory Testing Services Harbor, Foundation and Provider Requirements Horizon, Advantage 79, SecurePlus Paragon and IncomeBuilder Requirements LSW Term Requirements National Life Product Requirements Rate Classes/Table Ratings Elite Preferred and Preferred Risk Guidelines Table of Height and Weight Financial Underwriting Guidelines Tentative Quotes Trial Application Informal Inquiry Field Underwriting Disability Income Rider DIR Ineligible Occupation Listing Foreign National Guidelines Common Medical Impairments Medical Questionnaires - Help avoid APS! Diabetes Tentative Rating Charts APS Guidelines Uninsurable Risks and Extremely Problematic Risks Life Coverage/Disability Income Rider Probable Action Long-Term Care Rider Probable Action After Issue Contract Changes For Agent Use Only Not For Use With The Public

3 Helpful Hints for Efficient Processing New Business 1. Fully complete the application and related forms; obtain required signatures. 2. Print legibly. 3. Obtain complete details to all answers on application. 4. Use the appropriate state-approved application kits(state of execution). 5. Submit Illustration. 6. The Agent s Report must be fully completed to ensure all applications include fi nancial information, sales materials and any replacement. In addition, a completed ESI New Business Form ES0060 must be completed for every variable product application. Underwriting Tips 1. Pre-qualify the client during the telephone interview process. See listing of problematic and uninsurable risks in this guide. Contact your underwriter for a tentative quote if needed. 2. Fully complete the application and provide details to all answers. 3. Use medical questionnaires to help avoid the need for medical records. Expedite Applications; Use Oral Fluid OF Testing If ease of application and minimal testing are what your clients want we can help! In lieu of comprehensive medical testing, certain clients may qualify for oral swab testing completed at the time of the application (agent administered). This quick testing process can put you on the Fast Track for approval! Please see availability by product, age and face amount on the following pages, and look for this symbol OF where oral swab testing may be an option. Insurance & General Medical Testing Guidelines Underwriting Amount The underwriting amount is the total of the base policy(s) being applied for plus any Term Riders/APB (Additional Protection Benefi t). GIR/AIO If applying for the Guaranteed Insurability Rider or Additional Insurance Option, add one option of GIR/AIO to the underwriting amount if the proposed insured is over age 22. Refer to the Company/Product & Class Specifi c Guidelines provided. The company reserves the right to request any other evidence of insurability as it may deem necessary. 4. Collect oral fluid testing at the time of the application if required. Mail promptly. Include a copy of the lab slip with the application. 5. If a paramedical exam, blood/urine or EKG is required, schedule immediately. See listing of company-approved exam providers on page Consult Height & Weight Chart before quoting rate class. 7. Contact your underwriter with any questions. For Agent Use Only Not For Use With The Public 3

4 Inspection Reports/Personal History Interview (Ordered by Home Office) Please provide the proposed insured s phone numbers on every application regardless of the amount applied for and inform the applicant of the possibility of contact. Routine Inspection $5,000,001 and over: Inspection Required Foreign Nationals: Inspection Required Routine PHI (Phone Interview) Through $2,000,000: Underwriter Discretion $2,000,001 - $5,000,000 (all ages): Required PHI Ages 70 & over for $500,000 and over: Required PHI PHI may also be required for certain riders applied for Motor Vehicle Report (Ordered by Home Office) Ages 14 30: All applications Ages 31 40: Requested for $250,000 and over Ages 41 69: Requested for $500,000 and over Ages 70+: Requested for $100,000 and over An MVR may also be requested at the underwriter s discretion, based on the application and history. Paramedical Facilities (Ordered by Agent) Laboratory Testing Services Clinical Reference Lab is the approved testing service for oral fluid/saliva, blood profi les and urinalyses. (Use of our approved lab assures the timely transmission of test results.) Blood Profiles/Urinalysis/Oral Fluid OF Blood or oral fluid testing is required for all applicants age 15 and older. Agent administered oral fluid testing is available for certain rate classes and certain products. A full blood profi le and urinalysis is always required for Preferred and Elite Preferred consideration. A urinalysis is required whenever blood testing is needed. Please refer to the product-specifi c charts in this guide for additional information. HIV consent forms must be submitted in those states where required, for all proposed insureds age 15 and older. Completion of these forms is the agent s responsibility. Medical Testing by Other Companies We will consider a paramedical exam, EKG, treadmill and/or labs that have been completed within the last six months for another carrier if copies are made available to us. We reserve the right to request current testing. American Para Professional Systems/APPS: Exam One: Portamedic/Hooper Holmes: Examination Management Service/EMSI: We do not authorize medical testing to be collected via a personal physician. 4 For Agent Use Only Not For Use With The Public

5 Life Underwriting Requirements Harbor, Foundation and Provider Underwriting Amount Issue Age Through $50,000 A OF C OF C OF C OF D OF D OF D D D $50,001 - $100,000 A OF C OF C OF D OF D D D D D $100,001 - $150,000 A OF C OF C OF D D D D D D $150,001 - $200,000 A OF C OF D OF D E E E E E $200,001 - $250,000 A C D D E E E E E $250,001 - $300,000 A C D D E E E E E $300,001 - $500,000 A D D E E E E E E $500,001 - $1,000,000 B D E E E E E E E $1,000,001 - $3,000,000 B D E E E E E E E $3,000,001 - $5,000,000 B D E E F F F F F $5,000,001 - $10,000,000 B F F F F F F F F $10,000,001 and up B F F F F F F F F Category OF A B C D E F Medical Requirements Application and Oral Fluid Only! (for VSNT, ESNT or Standard Tobacco) Application Application and APS Application, Blood Profi le and Urine Application, Paramedical, Blood Profi le, Urine Application, Paramedical, Blood Profi le, Urine and EKG Application, MD Exam, Blood Profi le, Urine and EKG (Ages need Stress Test in lieu of EKG for $10,000,001+) Rate Classes Harbor 1 Foundation 2 Provider 2 Elite Preferred NT ages Preferred NT ages ages ages Verifi ed Standard NT 3 ages 0-85 ages 0-85 ages 0-85 Express Standard NT 4 ages 0-85 ages 0-85 ages 0-85 Preferred Tobacco ages ages ages Standard Tobacco 5 ages ages ages Please note that ABR3 is not available on rated Harbor, Provider, Horizon, Advantage 79, IncomeBuilder or Paragon products and/or any reinsured policies. 1 Issue age nearest birthday 2 Issue age last birthday 3 Verifi ed Standard NT used at ages Express standard class not available in PA/NJ 5 200% rating added to Standard NT rates for tobacco users up to age 19(NA in PA) For Agent Use Only Not For Use With The Public 5

6 Life Underwriting Requirements Horizon, Advantage 79, SecurePlus Paragon and IncomeBuilder Issue Age Underwriting Amount Through $50,000 A C C C D D D D D $50,001 - $100,000 A C C D D D D D D $100,001 - $150,000 A C C D D D D D D $150,001 - $200,000 A C D D E E E E E $200,001 - $250,000 A C D D E E E E E $250,001 - $300,000 A C D D E E E E E $300,001 - $500,000 A D D E E E E E E $500,001 - $1,000,000 B D E E E E E E E $1,000,001 - $3,000,000 B D E E E E E E E $3,000,001 - $5,000,000 B D E E F F F F F $5,000,001 - $10,000,000 B F F F F F F F F $10,000,001 and up B F F F F F F F F Category A B C D E F Medical Requirements Application Application and APS Application, Blood Profi le and Urine Application, Paramedical, Blood Profi le, Urine Application, Paramedical, Blood Profi le, Urine and EKG Application, MD Exam, Blood Profi le, Urine and EKG (Ages need Stress Test in lieu of EKG for $10,000,001+) Note: Oral Fluid testing is not available with Horizon, Advantage 79, SecurePlus Paragon, and IncomeBuilder products Rate Classes Horizon 1 Advantage 79 1 Paragon 1 IncomeBuilder 1 Elite Preferred NT ages ages ages ages Preferred NT ages ages ages ages Standard/Verifi ed Standard NT ages 0-85 ages ages 0-85 ages 0-85 Preferred Tobacco ages ages ages ages Standard Tobacco 2 ages ages ages ages Please note that ABR3 is not available on rated Harbor, Provider, Horizon, Advantage 79, IncomeBuilder or Paragon products and/or any reinsured policies. 1 Issue age nearest birthday 2 200% rating added to Standard NT rates for tobacco users up to age 19(NA in PA) 6 For Agent Use Only Not For Use With The Public

7 Life Underwriting Requirements LSW Term Underwriting Amount Issue Age Through $50,000 A OF C OF C OF C OF D OF D OF D D $50,001 - $100,000 A OF C OF C OF D OF D D D D $100,001 - $150,000 A OF C OF C OF D D D D D $150,001 - $200,000 A OF C OF D OF D E E E E $200,001 - $250,000 A C D D E E E E $250,001 - $300,000 A C D D E E E E $300,001 - $500,000 A D D E E E E E $500,001 - $1,000,000 B D E E E E E E $1,000,001 - $3,000,000 B D E E E E E E $3,000,001 - $5,000,000 B D E E F F F F $5,000,001 - $10,000,000 B F F F F F F F $10,000,001 and up B F F F F F F F Category OF A B C D E F Medical Requirements Application and Oral Fluid Only!(for VSNT, ESNT or Standard Tobacco) Application Application and APS Application, Blood Profi le and Urine Application, Paramedical, Blood Profi le, Urine Application, Paramedical, Blood Profi le, Urine and EKG Application, MD Exam, Blood Profi le, Urine and EKG (Ages need Stress Test in lieu of EKG for $10,000,001+) Issue Ages 1 Rate Classes Available Level Term 10-G ages Elite Preferred NT Level Term 15-G & 15-NG ages Preferred NT Level Term 20-G & 20-NG ages Verifi ed Standard NT Level Term 30-G & 30-NG ages Express Standard NT 2 (for face amounts up to $249,999 only) Preferred Tobacco Standard Tobacco 1 Issue age last birthday 2 Express Standard class not available in PA/NJ For Agent Use Only Not For Use With The Public 7

8 Underwriting Requirements National Life Products Issue Age 1 Underwriting Amount through 50,000 A C C C D D D 50, ,000 A C C D D D D 150, ,000 A C D D E E E 300, ,000 A D D E E E E 500,001-1,000,000 B D E E E E E 1,000,001-3,000,000 B D E E E E E 3,000,001-5,000,000 B D E E F F F 5,000,001-10,000,000 B F F F F F F 10,000,001 and up F F F F F F F Category A B C D E F Medical Requirements Non-medical (Ages 15-17, urinalysis required) Non-medical, APS (Ages 15-17, urinalysis required) Nonmedical, Blood Profi le, Urine Paramedical, Blood Profi le, Urine Paramedical, Blood Profi le, Urine, EKG MD Exam, Blood Profi le, Urine, EKG ( Ages 0-14, MD Exam + EKG only Ages 15-17, MD Exam, Urine, EKG only Ages Need Stress Test in lieu of EKG for $10,000,001+) 1 Issue age nearest birthday. Proposed insureds with cardiovascular conditions should check with their physician before performing a Stress Test. Please note that ABR Critical Illness is not available on rated and/or reinsured policies. 8 For Agent Use Only Not For Use With The Public

9 LSW Product Underwriting Classes 1 OF Verified Standard/Standard NT Offers competitive rates for applicants who are fully underwritten, who are standard risks, and who do not use tobacco. OF Express Standard 2 NT Available to applicants who do not use products containing tobacco or nicotine who qualify as standard under quick underwriting, and to those with ratings of four tables or less, who would otherwise be substandard. Preferred Tobacco Available to applicants who use products containing tobacco or nicotine who meet all preferred guidelines (see page 10). A blood profi le and urinalysis are required for all Preferred Tobacco applicants. OF Standard Tobacco Applicants who use tobacco and who do not otherwise meet the preferred guidelines will fall into this rate class. Table Ratings converted to Percent Ratings Table Table B % Table Table C % Table Table D % Table Table E % Table Table F % Table Table H % Table Table J % Table Table L % Table Table P % Ratings are illustrated using standard or Verifi ed Standard class as the platform for Non-Smoker clients or using Standard Tobacco class as the platform for tobacco users. 1 See product-specifi c tables on pages 5-7 for rate classes available 2 Please refer to the product-specifi c charts for classes available. For Agent Use Only Not For Use With The Public 9

10 Elite Preferred Non-Tobacco and Preferred Criteria 1 Elite Preferred Non-Tobacco Preferred Citizenship U.S. Resident. U.S. Resident. Tobacco or Nicotine Products 2, 3 Health Alcohol/Drugs Aviation/Avocation Family History No use of tobacco or nicotine containing products of any kind within the last 24 months. Current lab testing negative for nicotine. Standard risks with no current borderline medical problems. No medical history which would have been ratable in the past. No drug or alcohol abuse or treatment within the last 10 years. No aviation, hazardous avocation or occupation. This does not include major commercial airline pilots or holiday scuba diving. No parental family history of death from cardiovascular disease or cancer prior to age 60. No use of tobacco or nicotine-containing products 4 of any kind within the past 12 months. Current lab testing negative for nicotine. Standard risk with no current borderline medical problems. No medical history which would have been ratable in the past. No drug or alcohol abuse or treatment within the last 10 years. No aviation, hazardous avocation or occupation. This does not include major commercial airline pilots or holiday scuba diving. No parental family history of death from cardiovascular disease or cancer prior to age 60. Build See Height and Weight Chart on page 11. See Height and Weight Chart on page 11. Blood Pressure Cholesterol Driving History Current untreated blood pressure with a 12-month average reading of 135/85 or better. Current untreated cholesterol of 200mg/dl or less and a Chol/HDL ratio of 4.0 or less. No alcohol related moving violations within fi ve years and no more than two moving violations within the last two years. Current blood pressure with a 12-month average reading of 140/90 or better. Cholesterol of 240mg with ratio of 8.0 or less; or total cholesterol of with a ratio of 6.0 or less. No alcohol related moving violations within fi ve years. No ratable driving record. 1 Please refer to the National Life and LSW product-specifi c charts for classes available. 2 Not applicable for Preferred Tobacco class. 3 Products such as cigarettes, cigars, chewing tobacco, pipe, nicotine gum products, nicotine patch, etc. 4 Individual consideration will be given for infrequent cigar use. 10 For Agent Use Only Not For Use With The Public

11 Table of Height and Weight This chart is used as a guideline to identify the weights that are usually acceptable for standard premium rates within the rate classes shown, and to show the acceptable weight to qualify for the disability income rider. Other factors, including age or disproportion in body measurements (girth of chest and abdomen), may impact the fi nal decision. Verifi ed Standard NT Preferred NT Express & Standard & Preferred Elite Feet Inches Standard NT Tobacco Tobacco Preferred NT DIR For Agent Use Only Not For Use With The Public 11

12 Financial Underwriting Guidelines Cover Letter The writing producer is an important source of information. Through a cover letter, he/she can provide an explanation of the purpose, need, and method used to establish the requested face amount and total line of coverage as well as any unusual aspects of the case, and competitive situations. Copies of the needs analysis and fi nancial statement should accompany applications with large face amounts. Personal Insurance While each application is underwritten based on its own merits, the following are general guidelines for personal insurance to cover income replacement and survivorship. Coverage for non-working spouses would be considered for reasonable amounts based on the working spouse s income as well as net worth and purpose of the coverage. We welcome discussions on individual situations. Issue Ages Factor 0-17 See juvenile insurance guidelines x annual earned income x annual earned income x annual earned income 61+ 5x annual earned income Bankruptcy We will not offer coverage to an individual with a history of Chapter 7 bankruptcy until the bankruptcy proceedings have been discharged, the client is currently working full-time, and demonstrates a fi nancial need for a reasonable amount of coverage. All applicants will be underwritten on their own merit, taking into consideration stable employment, annual income, net worth, purpose and need for coverage, as well as any emotional, anxiety and other medical concerns. Juvenile Applications Generally, we will consider a face amount of coverage on a minor applicant equal to the face amount of coverage on the parents(or legal guardian); unless state insurance law dictates otherwise. Acceptable ownership and premium payers for minors include parents/legal guardians or grandparents only. If multiple applications are submitted for the same family, a cover letter (include a copy with each application), or note on the Agent s Report, with details on the sale will help to provide more efficient processing. Please include the amount of coverage in force and applied for on the parents and any siblings. All children should be similarly insured. Larger face amounts applied for on children should include a detailed outline of the family/household income, net worth, premium funding source and other supporting information. A HIPAA form is needed for each child. The child s signature is required at age 15 and over. A HIV consent form is required at age 15 and over. Please contact your Underwriting Team with special situations. We will consider coverage for applicants currently in Chapter 11 or 13 once the applicant is making regular debt payments and they are not subject to any court imposed restrictions. 12 For Agent Use Only Not For Use With The Public

13 Tentative Quotes Introduction Certain medical or non-medical impairments may require pre-qualifying a proposed client for insurance coverage. The Tentative Quote process is designed to provide detailed information to the underwriter to determine possible insurability before an application is taken. The listing of Uninsurable and Problematic Risks provided in this guide should be reviewed prior to submitting a request. All quotes are tentative, non-binding and subject to change after a full underwriting work up and company retention limits. Requirements Requirements needed for a Tentative Quote: Tentative Rating Request (sample on following pages or available on website) or message with details to include: age, sex, height/weight, amount of insurance to be considered, riders requested, medical diagnosis, date diagnosed, treatment and medications, restrictions, prognosis and all other pertinent information for each medical impairment. The questionnaires provided in this guide may be helpful in obtaining critical information needed. Submission to Home Office Requests can be faxed or ed to National Life Group as follows or obtained via phone directly to your underwriting team: Fax forms to [email protected] with completed form attached. Please allow 48 hours for reply and send a copy of quote obtained if an application is submitted. For Agent Use Only Not For Use With The Public 13

14 Tentative Rating Request Fax to or Agent: Appt. Date: Client Last Name: Client Age (DOB): Sex: M F Height: Weight: Smoker: N Y Plan: Amt. of Insurance: Riders Requested: Diagnosis: Date Diagnosed: Treatments Received and Medications: Restrictions: Prognosis: Comments: Please allow 48 hours for a reply. 14 For Agent Use Only Not For Use With The Public

15 Trial Application Introduction A Trial Application may be submitted for an abbreviated review of a proposed insured s health, fi nancial, or other pertinent history to determine potential underwriting action prior to the formal application process. Any application received will be assigned a policy number and an MIB record is ordered. After initial review we will advise the agent/agency of any requirements such as an attending physicians statement (APS). Upon completion of the underwriting process, the agent/agency will be notifi ed of a tentative offer which will be subject to any necessary requirements needed for age and amount. Any tentative offer other than standard will require an adverse action letter to be sent when required by statute. Requirements Requirements needed for a Trial Application are: New Business Checklist with Trial Application clearly indicated, Fully completed Form 8121 Application for Life Insurance, and Form 8164 HIPPA Compliant Authorization. Important: No medical testing should be ordered or money collected. Submission Forms can be faxed or ed to National Life Group as follows: Fax forms to forms to [email protected] Important: Forms must be password protected if ing. For Agent Use Only Not For Use With The Public 15

16 Informal Inquiry Introduction Requirements An Informal Inquiry will provide a preliminary review for insurability. A policy number will be assigned. We will advise the agent/agency of any requirements such as an attending physicians statement (APS). Upon completion of the underwriting process, the agent/agency will be notifi ed of a tentative offer which will be subject to a formal application and any necessary requirements needed for age and amount. All quotes are tentative, non-binding and subject to change after a full underwriting work up and company retention limits. Requirements needed for an Informal Inquiry are: Form 1386 Informal Inquiry And Authorization Pursuant to Life Insurance, or a cover letter including identifying information. And Form 8164 HIPPA Compliant Authorization, or a blanket authorization form approved by National Life. Important: Authorization must be dated within last 6 months. Identifying Information Submission When using a cover letter instead of Form 1386 the following identifying information should be included. Agent Name & Number Client s Name & Address Social Security Number Date of Birth Sex Smoker Status Face Amount Policy Funding Total Life Insurance currently in force Identify Companies Dates and details of medical conditions of concern Physician Information including name, address, phone number Financial Information of concern Desired Premium Class Are there any competitive offers pending? Forms can be faxed or ed to National Life Group as follows: Fax forms to forms: [email protected] Important: Forms must be password protected if ing. 16 For Agent Use Only Not For Use With The Public

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19 Field Underwriting LSW s Disability Income Rider The primary concerns in underwriting DIR include qualification for: Build Medical History Maximum Amount Eligible based on income / face amount of life coverage Occupation Build Refer to the Height and Weight chart on page 11. There is no flexibility in the maximum weight listed. Medical History Certain medical impairments will prohibit approval of DIR. A general listing of medical conditions is listed on pages including our probable action relating to DIR. Basically, any medical impairment that may generate a substandard premium rate would not be eligible for DIR. Whenever possible, the Underwriter will consider excluding an impairment or body part from the DIR rather than denying the rider. Any injury or impairment within two years of the application will likely be excluded from the DIR depending on severity. If a prospect is currently disabled for any reason, we are unable to consider for DIR. It is crucial that the agent obtain accurate and detailed medical information when DIR is being requested so that the Underwriter may make a fair assessment. If few details are provided, additional requirements will be requested that will delay approval. Whenever possible, an underwriter will use a questionnaire in lieu of an Attending Physician Statement (APS.) Maximum Amount Available The maximum monthly benefi t available from LSW is $2,000/month, subject to underwriting and state limitations. The monthly amount cannot exceed 66% of gross monthly income (40% in California; except for 1099 employees); or $20 per $1,000 of the LSW face amount life insurance applied. (For example, a $2,000 DIR must be attached to a base policy of at least $100,000.) All in force Disability coverage with all companies will be taken into consideration when calculating the total amount eligible based on income (the 66% or 40% whichever applies). Short-term or long-term disability coverage is included in these calculations based on the scale below: Less than six months won t count towards maximum available; Six months up to but not including one year count at 50%; One year or more count at 100% Occupations Part-time employees (less than 30 hours per week) and certain occupations are not eligible for DIR coverage. See listing on next page. Ineligible occupations may be due to hazards, persistency of business, seasonal/ migrant work, or based on claims experience within the industry or company. This list is periodically updated. Self Employed persons are considered on an individual basis by the underwriter. Does the client work from his/her own home? If so, what is the percent of time spent out of the home office? Does he/she travel to meet with clients? Could they do the job without leaving the home at all? Is their occupation otherwise eligible for DIR if not for the self employment? Self employed consultants, graphic designers, (and other occupations who don t need to leave their home office to do their work) and working from their own home are not eligible for DIR. Federal and Municipal employees are eligible for DIR, but only up to the amount of their home mortgage payment or $2,000/month, whichever is less. We would require a copy of their mortgage statement to consider. Please feel free to contact your underwriter with questions. For Agent Use Only Not For Use With The Public 19

20 Disability Income Riders (DIR) 1 Two different DIRs are available on LSW Term, UL and IUL policies, providing coverage for disabilities due to either sickness or accident. Please see the Agent Guides for detailed information on the DIR. These riders are not approved in all states or for all products; see the National Life website for availability. Part-time employees (less than 30 hours per week) and certain occupations shown below are not eligible for DIR coverage: Actor/Actress Air Traffic Controller Amusement Park Employee Armed Forces or Coast Guard Artist/Musician Asbestos Worker Athletic Coach or Instructor Auto Body Repair Blaster Bowling Alley Employee Bridge or Dam Worker Bus Boy Bus Driver Cab Driver Carpet/Floor Installer Casino Employee Chauffeur/Limo Driver Circus Employee Delivery Person Dishwasher Diver Domestic Servant (Maid, Butler, etc.) Drivers (local delivery or long-distance) Exotic Dancer FBI Agent Federal or Municipal Employee 2 Fire Fighter Fisherman/Seaman Flight Attendant Forest Ranger Game Warden Golf Pro Housewife Immigration Officer Life Guard Logging Employee Longshoreman Migrant Worker Mine Worker Movie Industry Employee Nature/Adventure Guide Nurse Peddler Piano Mover/Safe Mover Pilot Police Officer Prison/Corrections Employee Professional Athlete Racing Employee (dog or horse) Rodeo Rider or Clown Roofer School Teacher 3 (public or private) Security Guard (armed) Self-Employed (call with specifi c info) Skating Rink Employee Steeplejack (Billboard Worker) Structural Iron Worker Subway or Tunnel Construction Worker Theater Industry Employee Truck Driver Vending Machine Worker 1 In South Carolina, Disability is defi ned as the insured s inability to perform the duties of his or her own occupation during the fi rst year of disability and has the inability to perform the duties of any occupation for which he or she is suited thereafter. 2 May purchase DIR up to monthly home mortgage amount. 3 Only DIR5 available. 20 For Agent Use Only Not For Use With The Public

21 Foreign National Guidelines Contents: Section 1. Defi nition of Foreign Nationals Section 2. Foreign Nationals Living Inside of the United States Section 2.1: Green Card Holders Section 2.2: Visa s Section 3. Foreign Nationals Living Outside of the United States Section 1: Defi nition: For purposes of an insurance application with National Life (NL) & Life Insurance Company of the Southwest (LSW), a foreign national is a citizen of a foreign country. A foreign national may travel to the U.S. as a non immigrant or reside in the U.S. on a permanent basis as an immigrant. Section 2: Foreign Nationals Living Inside of the United States Section 2-1: Green Card Holders: If an alien holds a Green Card permanent residency and is, therefore, able to provide an Alien Registration number on the application, we will treat the same as if they are a U.S. Citizen for insurance purposes. Please provide the Green Card/Alien Registration number on the application. Section 2-2: Visa s: If an alien does not have a Green Card and therefore cannot provide an alien registration number, we must obtain a copy of their Visa. A foreign national questionnaire (form 8327, catalog #50038) is required. Any offer will depend upon the country of origin, the connection to the U.S., and the need for insurance. An H1 Visa is typically the only accepted Visa, and that is on a case-by-case basis. Basis for Underwriting Decisions: Country of Origin Refer to the U.S. Department of State travel warnings list for problematic countries (available via internet) Reason in the U.S. Future plans Employment Property ownership/verifi able business interests Connection to the state of execution is required Company Guidelines: Face amount limit $1,000,000 per life Minimum face amount $100,000 Permanent plan of insurance only (no term) No riders (all riders are unavailable, including ABR, unemployment, etc) Standard class, at best. No preferred or elite available Minimum age is 18 (no children under age 18 will be considered) Employed full-time Residents of Colombia, Cuba or Haiti are not insurable on any basis Foreign travel guidelines will apply. Underwriting requirements: Copy of visa Foreign national questionnaire (Form 8327) Proof of property ownership (example: copy of mortgage statement or deed) Any medical testing required must be completed in the U.S. Important: If an alien is in the U.S. Illegally, no offer can be made For Agent Use Only Not For Use With The Public 21

22 Section 3: Foreign Nationals Living Outside of the United States Marketing Objectives: An agent must sell insurance primarily to individuals who are citizens or permanent residents of the U.S. Applications on clients who live outside of the U.S. should be a small ratio of the agent s total business. An agent cannot solicit business outside of the U.S. An agent must have a primary residence in the U.S. The client must be affluent, wealthy individuals (not blue collar workers). The client must meet category I or II criteria for Foreign Nationals. Categories of Foreign National Business: Category I The Company will consider applications on Foreign Nationals if the proposed insured demonstrates (and it is verifi able by the Company) that the proposed insured: 1. Owns a U.S. residence, substantial other properties or verifi able substantial business interests in the U.S.; 2. Is a key person in a U.S. Corporation and is frequently in the U.S. on business; or; 3. Is a key person in a foreign domiciled corporation that is admitted to do business and has offices in the U.S. and who is frequently in the U.S. on business (four or more times per year). Requirements for Category I: Essentially treated as U.S. Nationals All transactions and interactions with NL & LSW must be in English No U.S. Trust required U.S. address required for billing/administration purposes at time of issue Premiums must be paid in U.S. dollars. Category II If not in category I, the Company will consider applications on Foreign Nationals if the proposed insured is a professional or business person who can demonstrate (and it is verifiable by the Company) that he/she conducts business (i.e. banking) in the U.S. and/or travels to the U.S. on a frequent and regular basis (four or more times per year). Requirements for Category II: All transactions and interactions with NL & LSW must be in English Does require a U.S. Institutional Trust (bank or trust company) with a U.S. sitused trustee (via an endorsement) An irrevocable trust is not necessary, however, a U.S. sitused trust must remain in existence for the life of the policy for purposes of: Establishing jurisdiction in the U.S. for policy issuance and any potential future litigation; Maintaining a U.S. address for purposes of billing/ administration; and Having a U.S. Trustee for collection of death proceeds. Foreign address or ownership changes will not be permitted Trust must meet requirements of state where established Premiums paid in U.S. dollars. 22 For Agent Use Only Not For Use With The Public

23 Category III The Company will not consider applications on all other Foreign Nationals (i.e. those with no contact with the U.S. or infrequent contact). Basis for Underwriting Decisions: Country of origin refer to the U.S. Department of State travel warnings list for problematic countries (available via internet) Reason in the U.S. Future plans Employment Property ownership/verifi able business interests Connection to the state of execution is required Company Guidelines: Face amount limit $1,000,000 per life. Minimum face amount is $100,000 Permanent plan of insurance only (no term) No riders (all riders are unavailable, including ABR, unemployment, etc) Best class available is standard. No preferred or elite available. Minimum age is 18 (no children under age 18 will be considered) Category II Foreign Nationals require a special endorsement Foreign travel guidelines will apply Residents of Colombia, Cuba or Haiti are not insurable on any basis. Underwriting Requirements: Foreign national questionnaire (form 8327) Proof of property ownership (example: copy of mortgage statement or deed) Full medical testing is required and must be completed in the U.S. Request for exceptions for testing to be completed outside of the U.S. must be approved by the underwriter and must be completed by a U.S. Consulate physician. International inspection report required for all face amounts applied for Medical records will be requested. The proposed insured, benefi ciary or countries of residence/citizenship must not be on the restricted list published by the U.S. Department of Treasury, Office of Foreign Assets Control ( see: ) * Category II Endorsement (will be part of every policy issued in this category): For as long as this policy remains in force, ownership of the policy must be maintained by an institutional trust located in the United States. An institutional trust is a recognized fi nancial institution or trust company. The trustee shall be the United States fi nancial institution or trust company. Dealings on behalf of the trust must be executed by an offi cer of the fi nancial institution or trust company as trustee. All policy premiums are to be paid by the trustee/trust in United States dollars and all billing and administration for this policy will be through the trustee/trust. Any and all benefi ts or other distributions payable pursuant to this policy shall be paid to the institutional trust/trustee. Company Reservation: The Company reserves the right to reject or restrict any application submitted on any foreign national. Please contact your underwriter with any questions. For Agent Use Only Not For Use With The Public 23

24 Common Medical Impairments The following medical impairments may be commonly encountered during the application process. While Medical Questionnaires are available to help you obtain information needed for the application, we hope you fi nd this information informative and helpful. Heart Disease Heart Attack, Angina/Chest Pain, Angioplasty/Stent Placement, Bypass Surgery. Heart disease occurs when the arteries that supply blood and oxygen to the heart become blocked and unable to keep the heart pumping normally. Heart disease can be caused by: A progressive build up of plaque that causes narrowing arteries; A clot caused by the rupture of plaque in the artery; or A vasospasm of the artery. Angina/cardiac chest pain is caused when the heart does not receive enough oxygen. A heart attack or myocardial infarction occurs when there is a profound lack of oxygen to the heart muscle, which can lead to tissue death. Heart disease may be a progressive condition that can be treated but not cured. The most common ways to treat heart disease are medication, modification of risk factors, angioplasty/stent placement, and bypass surgery. Risk factors for heart disease include: Family history Elevated cholesterol Obesity Diabetes Smoking High blood pressure/hypertension A combination of heart disease and the following conditions will usually result in a Decline: Continued smoking Stroke or TIA Diabetes Peripheral Vascular Disease Age at onset under 45 Please complete a Cardiac Questionnaire, Form Cerebrovascular Disease (Stroke/TIA) A stroke or CVA (cerebrovascular accident) occurs when there is an inadequate oxygen supply to the brain. This can be caused by a clot that blocks an artery or a rupture or an artery (aneurysm) in the brain. A major stroke can lead to irreversible brain damage or death. A TIA (transient ischemic attack) is a brief disruption of blood flow to the brain and the symptoms are usually reversible. Sometimes a TIA is a precursor to a full blown stroke, so close monitoring is necessary. Risk factors for stroke include: Uncontrolled high blood pressure/hypertension Smoking Diabetes Other vascular disease (I.e. heart disease, peripheral vascular disease) A combination of any of the above risk factors and a history of stroke/tia will usually result in a Decline. Please complete a Stroke/Transient Ischemic Attack (TIA) Questionnaire, Form For Agent Use Only Not For Use With The Public

25 High Blood Pressure/Hypertension High blood pressure or hypertension is a persistent elevation in blood pressure above what is considered normal for one s age and gender. Untreated high blood pressure can lead to heart enlargement and kidney damage as well as an increased risk of stroke and heart disease. The usual treatment for high blood pressure is medication and diet modifi cation. When individuals are compliant with treatment and blood pressure readings are within the normal range, no rating is necessary. Please complete a Blood Pressure Questionnaire, Form Diabetes Diabetes is a disease in which the body is either unable to produce a sufficient amount of insulin or it cannot use the insulin that is produced. This results in high levels of glucose in the blood stream. Type I (insulin dependent diabetes), also known as Juvenile Onset Diabetes requires regular insulin injections to control blood sugars. Type II (non insulin dependent diabetes), also known as Adult Onset Diabetes is usually diagnosed later in life and can be controlled with close diet monitoring and/or oral medication. In some cases a Type II diabetic may require insulin injections in addition to diet and oral medication. Obesity and family history of diabetes are common risk factors for the development of this type of diabetes. Routine follow up with a physician, close monitoring of blood sugars and modifi cation of diet are key factors in the successful control of diabetes. Hemoglobin A1C is a test commonly used to determine long term control of blood sugars. The type of diabetes, age of onset, level of control, and presence of any complications are used to determine the underwriting rate class. Please complete a Diabetes Questionnaire, Form Tumors/Cancer Cancer or malignant tumors are characterized by abnormal cell growth that invades healthy tissue and causes breakdown of normal tissue function. Once a tumor invades the surrounding tissue, it can then move into the blood and lymph system and eventually spread to other organs in the body. Major risk factors for cancer are family history, tobacco use, excessive exposer to sunlight, exposure to environmental toxins, and inflammatory conditions (i.e. ulcerative colitis, hepatitis). The prognosis is highly variable with Underwriting risk classifi cation focusing on type/location of cancer, extent of invasion and time since treatment was completed. Please complete Tumor Questionnaire, Form Uncontrolled diabetes can lead to vision loss, kidney failure, circulatory problems, neuropathy and diabetic coma. Diabetes is also a major risk factor for heart disease and stroke. For Agent Use Only Not For Use With The Public 25

26 Chronic Respiratory Conditions Asthma, COPD/Emphysema, Chronic Bronchitis Asthma is reversible obstruction of the airways in the lungs. Common symptoms are shortness of breath, wheezing and coughing. Lung function between attacks is usually normal. Treatment focuses on prevention of attacks and may employ oral as well as inhaled medications. Risk classifi cation is determined by factors such as frequency and severity of attacks, type of treatment required and smoking status. COPD (Chronic Obstructive Pulmonary Disease) is a general term used to describe a variety of diseases that cause chronic airway obstruction. Two of the most common forms of COPD are chronic bronchitis and emphysema. The symptoms vary and include difficulty breathing, fatigue, chronic cough, weight loss, diminished levels of oxygen in the blood. The development of COPD is strongly associated with smoking. Treatment may include oral or inhaled medications and in severe cases, the use of oxygen. Risk classifi cation is determined by factors such as degree of respiratory impairment, continued smoking, and type of treatment required. The current use of oxygen would result in a Decline. Alcohol and Drug Abuse A history of substance abuse (alcohol, illegal drugs, or street drugs) poses multiple concerns for life insurance. In addition to being a higher risk due to accidents, homicide, suicide, and overdose, long-term substance abuse can lead to serious health problems involving the brain, heart, liver, GI tract, circulatory system and major infections (i.e. hepatitis and HIV). Any current substance abuse is uninsurable. In most cases, an applicant must be 3 years out from the last use before we consider him/her for life insurance, with complete abstinence. Some factors that are more favorable when considering applications for life insurance include participation in a support group, family and job stability, and a favorable MVR. Factors that would have a negative impact on underwriting these individuals are a history of multi-substance abuse (for example, drugs, and alcohol), mental illness in addition to substance abuse, history of relapse, and participation in hazardous avocations. Occasional marijuana use (1-2 times a month) may be considered at standard tobacco rates. Heavier marijuana use could lead to sub-standard ratings or a decline. Please complete an Alcohol Questionnaire, Form 9270, and/or Drug Questionnaire, Form Please complete a Respiratory Questionnaire, Form See complete listing of available questionnaires. > 26 For Agent Use Only Not For Use With The Public

27 Medical Questionnaires Obtaining detailed medical information is critical for an underwriter s assessment of the mortality and/or morbidity risk. The following questionnaires are available to assist in gathering detailed information from the client and may be accessed via the Forms Section on the web site. In many instances a thoroughly completed questionnaire with all medications and details can assist in avoiding the need for medical records. Questionnaire: Catalog # When needed: Alcohol Usage Questionnaire Arthritis Questionnaire OF Avocation, Aviation & Foreign Travel OF Back Pain Questionnaire OF Blood Pressure Questionnaire OF Cardiac Questionnaire Confi dential Financial Questionnaire Depression / Anxiety / Psychiatric Questionnaire OF Diabetes Questionnaire Drug Questionnaire Foreign National Questionnaire Gastro-Intestinal Questionnaire OF Genitourinary Questionnaire OF Migraine Questionnaire OF Respiratory Questionnaire OF Seizure Questionnaire OF Stroke / TIA Questionnaire OF Tumor Questionnaire OF Catalog # Form # 9270 Catalog # Form # 9275 Catalog # Form # 1480 Catalog # Form # 9277 Catalog # Form # 8625 Catalog # Form # 9274 Catalog # Form # 1392 Catalog # Form # 9437 Catalog # Form # 9594 Catalog # Form # 9269 Catalog # Form # 8327 Catalog # Form # 9276 Catalog # Form # 9267 Catalog # Form # 9271 Catalog # Form # 9268 Catalog # Form # 9272 Catalog # Form # 8624 Catalog # Form # 9279 Any DUI (driving while intoxicated) history History of alcohol treatment within ten years History of abnormal liver function testing or current abnormal lab testing Non-rheumatoid, non-steroid treated arthritis (i.e., osteoarthritis, gout) Any participation in racing, parachuting, sky diving, underwater diving, aviation or foreign travel History of, or current treatment for, musculoskeletal back pain when requesting Waiver of Premium or Disability Income Rider History of, or current treatment for high blood pressure History of cardiac chest pain and other cardiac impairments As needed to provide client or business fi nances History of, or current treatment for, depression, anxiety or other psychiatric issues. History of, or current treatment for diabetes History of drug treatment or drug use within the past ten years Must be submitted with all foreign national applications History of, or current treatment for, acid reflux, gastritis, gastric or duodenal ulcers History of, or current treatment for urethritis, prostatitis, BPH (hypertrophy of the prostate), kidney stones or other benign kidney disorders History of, or current treatment for, stress, migraine, or cluster headaches History of, or current treatment for, non-steroid asthma, bronchitis, emphysema, pneumonia, tuberculosis History of, or current treatment for seizures. History of stroke or transient ischemic attack within ten years. History of benign (non-cancerous) tumors or cysts (I.e., fi broid, basal cell) For Agent Use Only Not For Use With The Public 27

30 Avocation, Aviation & Foreign Travel Supplemental Application National Life Insurance Company Home / Administrative Office: One National Life Drive, Montpelier, VT Life Insurance Company of the Southwest Administrative Office: One National Life Drive, Montpelier, VT Home Office: 1300 West Mockingbird Lane, Dallas, TX Full Name of Proposed Insured: All questions refer to Proposed Insured Part A - Aviation Questionnaire (For pilots and crew members.) 1. What type of Pilot Certificate do you hold? Student Private Commercial Airline Transport Rating (ATR) Instrument Flight Rating (IFGR) 2. Are you a member of a Military Reserve or National Guard unit on flying status? No If "", check one? Active Inactive 3. What type of aircraft do you fly? 4. Was your certificate granted subject to physical waiver? Crew position No 5. Have you ever been grounded or restricted for violation of Civil Air Regulations? (If "", give details in Remarks) 6. Has your Federal Pilot Certificate ever been cancelled? (If "", give details in Remarks) No No 7. Date of last flight as a Pilot: 8. Is it your intention to fly in the future as a: Pilot Crew member: No Crew member No 9. Total flying hours (Give details in Remarks.) Student Pilot in Command Other capacity Describe your annual flying activity in the chart below. Type of Flying Next 12 mos. hours Past 12 mos. hours 1 to 2 years ago hours Employer-owned Charter flying or instructing Non-commercial pilot or student Military Other (Give details in Remarks) 10. Do you fly only within the United States? (If "No", give details in Remarks) No 11. If full coverage at standard rates is not available, do you desire: Full coverage with extra premium, if available? Restricted aviation coverage without extra premium, if available? Part B - Foreign Travel Questionnaire 1. To what foreign country (or countries) do you intend to travel? 2. How long do you plan to remain? 3. For what purpose is the trip made? 4. Will you be located in one or more of the larger cities, or will you travel about the country? 5. Have you traveled abroad before? No 6. If so, when and to what countries? ICC (1109) National Life Group is a trade name of National Life Insurance Company, Life Insurance Company of the Southwest 30 For Agent Use Only Not For Use With The Public and their affiliates. Each company is solely responsible for its own financial condition and contractual obligations. Page 1 of 3 Cat. No

31 Part C - Avocation Questionnaire C.1. Automobile, motorcycle or motorboat racing a. Are you a member of any of the following racing organizations? If so, name of organization? Automobile Motorcycle Motorboat b. Describe the car or cycle you drive or the boat you race Make/Type: Model or Class: Size: Horsepower: c. Is your vehicle equipped for racing? (If "", give details in Remarks) No d. Describe racing: Type of course: Location: Length of course: Maximum speed attained: Duration of races: e. Describe your status and experience: Number of races: Professional Last 12 months: Amateur Anticipated next 12 months: C.2. Parachuting and Sky Diving a. Are you a member of the United States Parachute Association? b. Do you hold a parachutist license? (If "", class) c. Describe your experience in parachuting or sky diving Total jumps to date: Total jumps last 12 months: Do you perform sky diving or delay jumps? (If "", give details in Remarks) Total anticipated next 12 months: No No No Number of delay jumps: Maximum seconds delay: Do you participate in baton passing or other stunts? (If "", give details in Remarks) Do you participate in local or national competition? (If "", give details in Remarks) d. Location of jump areas: C.3. Underwater Diving a. Are you a member of a skin or scuba diving organization? (If "", name of organization) b. Describe diving activity Location: Purpose: (Recreation, research, rescue team - describe) Equipment used: Maximum time submerged: Maximum depth attained: Average depth current diving: No No No c. Describe your status and experience: Number of yrs diving experience: Professional Amateur Number of dives last 12 months: Number of dives anticipated next 12 months: C.4. Other Hazardous Sports or Avocations Provide full details in Remarks describing participation in competition sports, skin or scuba diving, hang gliding, BASE jumping or bungee cord jumping, big game hunting, mountain climbing, cave exploring, rodeos or snowmobiling. BASE is an acronym for building, antenna tower, span (usually bridge), and earth formation (usually cliff). ICC (1109) For Agent Use Only Not For Use With The Public Part C - Avocation Questionnaire 31 Page 2 of 3

32 Part D - Remarks Part E - Please Read and Sign Any person who knowingly presents a false statement in an application for insurance may be guilty of criminal offense and subject to penalties under state law. The statements and answers are, to the best knowledge and belief of the Proposed Insured, complete and true. They, together with the statements and answers on the application to which this is a supplement, shall be a part of the contract if one is issued. The Applicant, if someone other than the Proposed Insured, agrees to be bound by all statements and answers in this supplement. Signed at (City & State) this day of (mm/dd/yyyy) Applicant (Sign name in full) Proposed Insured (If other than the Applicant, sign name in full) Agent (Sign name in full) 32 ICC (1109) For Agent Use Only Not For Use With The Public Page 3 of 3

49 Diabetes Tentative Rating Charts Which diabetes tentative rating chart to use: Chart 1 - Oral Medication/Diet Controlled; Non-Tobacco Users Chart 2 - Insulin Dependent; Non-Tobacco Users (page 50) Chart 3 - Oral Medication/Diet Controlled Tobacco Users (page 50) Chart 4 - Insulin-Dependent; Tobacco Users (page 50) The following tables are based on an applicant who has good control (glycohemoglobin A1C of 8.0% or less) of his/her diabetes and has no other impairments or complications. Add % for diabetes under fair control. If poor control or non-compliant with diet/ medication - decline. Chart 1: Oral Medication/Diet Controlled Diabetics; Non- Tobacco Users Onset 150% = Table 2 175% = Table 3 200% = Table 4 Through Table 4 may be LSW Express Standard (non tobacco users) 9 225% = Table 5 250% = Table 6 300% = Table 8 Years on Medication/Diet 0-5 yrs yrs Under 20 Decline Decline Decline % 300% 300% % 225% 225% % 200% 225% % 175% 200% % 150% 175% % 150% 175% Express Standard * 9 When products allows. For Agent Use Only Not For Use With The Public 49

50 Chart 2: Insulin-Dependent Diabetics; Non-Tobacco Users Onset Years on Insulin 0-5 yrs yrs Under 20 Decline Decline Decline % 300% 350% % 250% 300% % 250% 250% % 225% 250% % 150% 175% % 150% 150% Chart 3: Oral Medication/Diet Controlled Diabetics; Tobacco/Nicotine Users Onset Years on Medication/Diet 0-5 yrs yrs Under 20 Decline Decline Decline % 350% 350% % 300% 300% % 250% 300% % 225% 250% % 200% 225% % 200% 200% Express Standard * 150% = Table 2 175% = Table 3 200% = Table 4 Through Table 4 may be LSW Express Standard (non tobacco users) 9 225% = Table 5 250% = Table 6 300% = Table 8 350% = Table 10 Chart 4: Insulin-Dependent Diabetics; Tobacco Users Onset Years on Medication/Diet 0-5 yrs yrs Under 20 Decline Decline Decline % 350% 400% % 300% 350% % 300% 300% % 300% 300% % 225% 250% % 200% 225% 9 When products allows. 50 For Agent Use Only Not For Use With The Public

51 Attending Physician Statement (APS) Guidelines The following guidelines are not meant to be all-inclusive. Requests for medical records may also be at the Underwriter s discretion due to MIB information, abnormal laboratory results, etc as well as at larger face amounts and/or older ages. We will always require medical records for applicants age 70 and above. An APS is required, regardless of the amount, if the proposed insured has consulted a physician or has had any history of the following: Within the past 10 years: Alcohol/Drug abuse and/or treatment Cardiovascular or Coronary Artery Disease such as bypass, angioplasty, heart attack, myocardial infarct, angina, arrhythmias, abnormal EKGs, valve replacement or repair, septal defects, carotid artery disease or surgery, aneurysm Cancer (except for basal cell skin cancers) Diabetes treated by insulin, with tobacco use, or any face amounts over $100,000 Emphysema, COPD, Chronic Bronchitis Heart Murmur Hepatitis Kidney/Renal Disease Lupus Within the past 3 years Asthma requiring oral steroid use Disabled for non-musculoskeletal impairment or if taking certain pain medications Falls and injuries, over age 65 Gastric Bypass Mental disorders requiring multiple or psychotic medications Rheumatoid Arthritis if disabling, requiring steroid or immunosuppresent use (prednisone, methotrexate, etc) or multiple medications Seizures, epilepsy, convulsions Sleep apnea Ulcerative Colitis or Crohn s Disease Multiple Sclerosis, not disabling Parkinson s Disease, not disabling Peripheral Vascular Disease Stroke, TIA, CVA, Cerebral Hemorrhage Routine (APS) Guidelines Ages 0-15 $500,000 and over Underwriter discretion Underwriter discretion through $1,000,000; required over $1,000, Underwriter discretion through $500,000; required over $500, All applications For Agent Use Only Not For Use With The Public 51

52 Uninsurable and Problematic Risks Applications should not be written on persons with the following impairments/issues. This list is not intended to be all-inclusive. If your applicant has a serious condition not listed here, please contact your Underwriting Team for a tentative quote. If declined by another carrier within the last year, contact your Underwriting Team for a tentative quote. Abdominal aortic aneurysm, present or surgically corrected within the past six months. Alcohol treatment within the last two years. Angioplasty/bypass, or MI/heart attack in the last six months; or in combination with history of diabetes, stroke, and/or continued tobacco use. Alzheimer s disease, dementia or cognitive impairment. Bankruptcy, Chapter 7, that has not been discharged. Cancer treatment, current; or certain internal organ cancer diagnosed within the past three to fi ve years contact underwriter with specifi c details. Cirrhosis of liver. COPD/emphysema, severe (on oxygen or disabling) or with current tobacco use or in combination with sleep apnea. CVA (stroke) within one year; or with history of diabetes or cardiac history. Disabled for most non-muscosketal related impairments (i.e. on SSDI or DI due to depression, PTSD, or other medical issues). Diabetes if uncontrolled (glycohemoglobin A1C 10.0 and above) or if complications present (amputation, retinopathy, kidney or vascular disease) or in combination with cardiac, stroke or morbid obesity. Juvenile onset diabetes (diagnosed prior to age 20). Drug use within the last three years or daily marijuana use. DUI within last year, or two or more within the past fi ve years. Felony or misdemeanor, not released from probation or parole or charge pending; all felony convictions are otherwise individual consideration. Gastric/intestinal bypass within six months. Heart surgery within six months or in combination with diabetes or stroke history. Heart valve surgery within one year. HIV positive/aids. IOLI/SOLI Investor owned or Stranger Owned Life Insurance. Kidney dialysis or chronic renal failure. Mental disorder/ptsd requiring hospitalization or disability in last year. Multiple sclerosis if disabling or progressive. Organ transplant, awaiting or recipient. Parkinson s disease if disabling. Parole or probation (see felony or misdemeanor above). Pregnancy with current gestational diabetes, toxemia, eclampsia, pre-eclampsia. Would reconsider at six weeks post partum. Sleep Apnea in combination with COPD. Surgery(major) pending. Suicide attempt in last year; or more than one attempt within two years. Valve replacement within last year. Epilepsy/seizures diagnosed within one year. 52 For Agent Use Only Not For Use With The Public

53 Medical Condition Probable Action LIFE DIR Abscess No rating Standard Adhesions, post-op, abdominal No rating Standard AIDS Decline Decline Alcoholism (recovered - total abstinence - 5 years) Temp. extra Decline Allergy/allergies (not asthma) No rating Standard Allergic reaction (not asthma) No rating Standard ALS (Lou Gehrig s Disease) Decline Decline Alzheimer s disease Decline Decline Amputations, if not due to peripheral vascular disease.... No rating ER or Decline Anemia Rate for cause Decline Aneurysm, abdominal present Usually decline Decline history (with surgical repair) Moderate rating ER or decline Aneurysm, cerebral, stable after full recovery No rating to moderate rating. Decline Angina pectoris Table 3 plus flat extra to decline Decline Anxiety, mild No rating Standard or ER Aortic insufficiency murmur Table 4 to decline Decline Appendectomy; appendicitis; appendix No rating Standard Atrial fi brillation (depends on frequency and cause) No rating to moderate rating. Decline Arthritis, osteo No rating ER or decline Arthritis, rheumatoid (depends on severity) No rating to decline Decline Arthroscopic knee surgery within one year No rating Exclusion Rider after one year - full recovery No rating Standard or ER Asthma (depends on age, attacks, medications) No rating to decline ER or decline Back disorder No rating ER or decline Bartholin cyst No rating Standard Bell s palsy fully recovered No rating Standard present No rating ER or decline Blindness (depends on cause) No rating Exclusion Rider The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. For Agent Use Only Not For Use With The Public 53

54 Medical Condition Probable Action Bone or joint disorder No rating Exclusion Rider Bone spur present No rating Exclusion Rider surgically corrected No rating Standard Breast cancer, (after 3 years) LIFE No rating to decline, (full details including pathology report) possible flat extra ER to decline Breast disorders, not cancer No rating Standard Broken bone fully recovered No rating Standard or ER not recovered or pins/plates inserted No rating ER or decline Bronchiectesis (depends on severity) No rating to decline ER or decline Bronchitis (acute) No rating Standard Bronchitis (chronic) No rating to decline ER or decline Bundle branch block, right/incomplete No rating Standard Bundle branch block, right/complete No rating to Table Standard or decline Bundle branch block, left (full details) No rating to Table Decline Bursitis No rating ER or decline Cancer, internal (full details including pathology report). No rating to decline Standard or decline prognosis highly variable, call for tentative quote Cancer, skin, not melanoma (removed - recovered) Probably no rating Exclusion Rider Cancer, skin, melanoma Flat extra to decline Decline Cardiomyopathy present or chronic Decline Decline resolved >3 years Table 4 to decline Decline Cartilage - torn present No rating Exclusion Rider fully recovered No rating Standard or ER Cataracts no surgery or surgery on one eye No rating Exclusion Rider bilateral surgery No rating Standard Cerebral palsy (full details) No rating to decline Decline Cerebral vascular accident (CVA), stroke - full recovery... Table 3 to decline Decline Cervicitis No rating Standard Chronic fatigue syndrome (full details) No rating to decline Decline Chronic obstructive lung disease (COPD) Table 3 to decline Decline DIR The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. 54 For Agent Use Only Not For Use With The Public

55 Medical Condition Probable Action LIFE DIR Cirrhosis of the liver Decline Decline Colitis, spastic No rating Standard or ER Colitis, ulcerative (full details) No rating to decline ER or decline Concussion, cerebral within six months Postpone Postpone after six months - no residuals No rating Standard or ER Congestive heart failure Table 6 to decline Decline Convulsions (full details) No rating to Table Decline Coronary artery disease (full details) Table 3 to decline Decline Crohn s disease (full details) Table 4 to decline Decline Cyst - sebaceous, Bartholin No rating Standard Cystic fi brosis Decline Decline Cystitis No rating Standard Cystocele, rectocele surgically corrected No rating Standard present No rating Exclusion Rider D & C (dilatation and curettage) - benign results fi rst year No rating ER or decline after one year - no recurrence No rating Standard Depression (full details) - express standard without APS up to $150,000 face amount (best cases) No rating to decline Decline Dermatitis - atopic No rating Standard Diabetes mellitus (depends on age of onset, control)..... Table 4 to decline Decline Dislocation one occurrence - fully recovered No rating Standard others No rating Exclusion Rider Diverticulitis and diverticulosis No rating ER or decline Drug abuse (full recovery) Table 3 to decline Decline Eczema No rating Standard Elbow - tennis acute attack - fi rst year No rating Exclusion Rider after one year - no recurrence No rating Standard or ER The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. For Agent Use Only Not For Use With The Public 55

56 Medical Condition Probable Action LIFE Emphysema (full details) Table 3 to decline Decline Endocarditis Table 3 to decline Decline Epilepsy, petit mal - no attack in one year No rating Decline Epilepsy, grand mal - no attack in one year No rating to moderate rating.. Decline Esophageal stricture, good nutrition No rating, depending on cause ER or decline Eye disorder (minor) - I.e., pink eye, conjunctivitis, stye... No rating Standard Fibrositis, myositis No rating ER or decline Fibromyalgia No rating Decline Fistula and fi ssure, anal No rating Standard or ER Fractured skull, no after effect No rating Standard Fracture (other than skull) full recovery No rating Standard not recovered or pins/plates inserted No rating Exclusion Rider Gall bladder disorder present No rating ER or decline surgically corrected No rating Standard Gastroenteritis No rating Standard Genitourinary disorder minor bladder or cervical infections No rating Standard Glaucoma No rating ER or decline Gout No rating Exclusion Rider Hay fever - seasonal, no disability No rating Standard Headache, migraine, sinus and tension No rating Exclusion Rider Hearing impaired No rating Exclusion Rider Heart attack (full details and records) Table 4 to decline Decline Heart bypass surgery (full details and records) Table 4 to decline Decline Heart valve replacement (full details and records) Table 4 to decline Decline Heartburn No rating Standard Hemorrhoids No rating Standard DIR The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. 56 For Agent Use Only Not For Use With The Public

57 Medical Condition Probable Action LIFE DIR Hepatitis, acute 0-3 months from onset Postpone Postpone 4 months and thereafter Can be no rating ER or decline depending on cause Hepatitis A No rating Standard Hepatitis, chronic (full details and blood profi le) Hep. B (treated and resolved) Table 4 to decline Decline Hep. C (treated and resolved) Table 4 to decline Decline Hernia No rating ER or decline Herniated disc No rating Exclusion Rider High blood pressure - (see page 25 for requirements)..... No rating if well controlled... Standard Hip disorder No rating if able to walk ER or decline Histoplasmosis, nonsystemic, six months after recovery.. No rating Standard Histoplasmosis, systemic, two years after recovery No rating Standard or ER Hodgkin s disease (full details and records) Table 3 to decline Decline Hydronephrosis (depends on cause) No rating to decline ER or decline Hysterectomy defi nitely benign No rating Standard others (full details and pathology) Flat extra to decline ER or decline Ileitis, regional (full details) Table 4 to decline Decline Indigestion No rating Standard Kidney failure, dialysis Decline Decline Kidney infection (pyelonephritis) if no recurrence in 2 years No rating Standard Kidney removal (depends on cause) No rating to decline Decline Leukemia Table 3 to decline Decline Ligament injury - full recovery No rating Standard or ER Lou Gehrig s Disease - ALS Decline Decline Lupus, systemic Table 4 to decline Decline Lupus, discoid (skin only, no steroid use) No rating Standard The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. For Agent Use Only Not For Use With The Public 57

58 Medical Condition Probable Action LIFE Malaria - single attack No rating Standard Mastitis, chronic cystic No rating Standard Melanoma (full details including pathology report) No rating to decline ER or decline Meniere s disease No rating Exclusion Rider Meningitis (full recovery) No rating Standard Menisectomy - full recovery No rating to decline Decline Mental retardation (depends on severity) No rating to decline Decline Mitral insufficiency murmur (depends on age and severity).. Mod. rating/decline ER or decline Mitral stenosis murmur (depends on age and severity)... Mod. rating/decline ER or decline Mitral valve prolapse No rating to decline Standard to decline Mononucleosis (infectious) uncomplicated recovery, prompt recovery No rating Standard Multiple sclerosis Mod. rating/decline Decline Myasthenia gravis Mod. rating/decline Decline Myocarditis Mod. rating/decline Decline Myositis, fi brositis, resolved No rating Possible ER Muscular dystrophy Decline Decline Nephrectomy (depends on cause) No rating to decline Standard to decline Nephritis single episode and no complications No rating Standard or ER others Mod. rating/decline Decline Neurosis (full details) Mod. rating/decline Decline Organic brain syndrome (depends on cause) Table 3 to decline Decline Osteomyelitis No rating Possible ER Pacemaker Table 3 to decline Decline Pancreatitis (full details) No rating to decline Decline Paraplegic (full details re: body functions) Table 6 to decline Decline Parkinson s disease (full details) Table 3 to decline Decline Pericarditis (depends on cause) No rating to moderate rating. ER or decline Peripheral vascular disease (full details) Table 6 to decline Decline Pharyngitis No rating Standard DIR The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. 58 For Agent Use Only Not For Use With The Public

59 Medical Condition Probable Action LIFE DIR Phlebitis full recovery No rating Exclusion Rider multiple episodes (depends on cause) Table 2 to decline Decline Pilonidal cyst No rating Standard Pleurisy single episode and recovered No rating Standard others Rate for cause Decline Pneumoconiosis (depends on cause) No rating to decline ER or decline Pneumonia present Postpone Postpone full recovery, no further work up needed No rating Standard Pregnancy - current no current or past complications No rating Postpone with history of complications No rating to moderate rating.. Decline Prostatitis acute episode - no recurrence for 3 years No rating Standard recurrent/chronic No rating ER or decline Psychosis (full details) No rating to decline Decline Pyelonephritis acute episode, full recovery, no recurrence for 2 years.... No rating Standard multiple episodes No rating to moderate rating.. ER or decline Quadriplegic Highly rated to decline Decline Raynaud s disease (full recovery) No rating Standard Raynaud s phenomenon (depends on cause) No rating to decline ER or decline Rheumatic fever, no heart damage No rating Standard Rheumatism No rating Exclusion Rider Sarcoidosis (depends on stage and organs involved)..... No rating to decline ER or decline Sebaceous cyst - removed No rating Standard Sciatica No rating Exclusion Rider Sinusitis No rating Standard Sleep Apnea consistent cpap use No rating to Table Decline otherwise Table 6 to decline Decline The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. For Agent Use Only Not For Use With The Public 59

60 Medical Condition Probable Action LIFE Strabismus (cross-eyed) No rating Standard Stroke (full recovery) Table 3 to decline Decline Suicide attempt (depends on cause & lapsed time) Table 2 to decline Decline Tennis elbow acute attack - fi rst year No rating Exclusion Rider after one year - no recurrence No rating Standard or ER Thyroid disorder hyperthyroid - if medically stable No rating Exclusion Rider hypothyroid - controlled with medication No rating Standard Transient ischemic attack (TIA) (no residuals) No rating to moderate rating.. Decline Transurethral resection of prostate (TURP) malignancy ruled out No rating Standard Tuberculosis (full recovery) No rating Standard to decline Tumors (not cancer), outside nervous system Usually no rating Standard to decline Ulcer No rating Exclusion Rider Upper respiratory infection No rating Standard Urinary bladder infection (cystitis - acute) No rating Standard Varicocele, hydrocele No rating Standard Vasectomy No rating Standard Varicose veins No rating Possible ER DIR The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. 60 For Agent Use Only Not For Use With The Public

61 Medical Condition LTC = Acceptable for LTC = Declined for LTC IC = Individual Consideration Addison s Disease AIDS, ARC, HIV positive Alcohol Abuse Abstinence, within 3 yrs Abstinence, over 3 yrs Alzheimer s Disease Amputation - One limb, fully adapted, no assistance required Due to disease Due to trauma, within 2 yrs Due to trauma, after 2 yrs Amyotrophic Lateral Sclerosis (ALS) Anemia Cause unknown or severe or with complications Cause unknown, fully evaluated, mild, no complications Cause known. Refer to Cause Aneurysm Non-Cerebral, surgically corrected, completely recovered for 6+ months Cerebral, surgically corrected for over 1 yr..... Present, cerebral Present, Abdominal less than 6 cm, stable for 1 yr Others Any type, current smoking Multiple, regardless of surgery Angioplasty See Coronary Artery Disease Angina See Coronary Artery Disease IC IC IC IC IC Appliances (the cause for the use of Appliance must be acceptable) Cane, use outside home, single point Cane, permanent, physical support, single prong Cane, multiprong Colostomy, difficult with maintenance or not fully adapted IC Respirator/Oxygen, no use in 1 yr., fully recovered from condition IC Respirator/Oxygen, current use or use within one year Wheelchair/Walker, current use or use within 2 yrs Insulin Pumps Arrhythmia Stable Unstable or difficult to control Arteritis Present, well controlled on less than 10 mg of steroids Others Atrial Fibrillation Stable and on Anticoagulant Unstable or difficult to control Over 2 years since episode, no meds IC Arthritis (Osteo, Rheumatoid, Gouty, Ankylosing Spondylosis) All types subject to being unrestricted in ADLs or IADLs and no use of appliances. Minor, NSAIDs or aspirin use only Use of steroids 10 mgs or less and/or other immunosuppressants Use of steroids greater than 10 mg Major joint replacement anticipated Major joint replacement performed, fully recovered for 3 months Ankylosing Spondylosis IC IC The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. For Agent Use Only Not For Use With The Public 61

62 Medical Condition LTC = Acceptable for LTC = Declined for LTC IC = Individual Consideration Asbestosis See Occupational Pulmonary Disease Breast Disorder Asthma Current smoker or smoker within 2 yrs Well controlled, infrequent attacks, no hospitalization or emergency room visits within 2 yrs Poorly controlled or frequent attacks, multiple hospitalizations or ER visits Adequate control, use of steroids 10 mgs or less, and/or infrequent ER visits Ataxia Back Disorder Fully recovered Frequent symptoms or with some limitations/restrictions Current disability or surgery anticipated Bell s Palsy - Fully recovered Blindness Fully compensated independent Others, if not associated with disease Blood Disorders IC IC IC IC Fibrocystic Breast Disease Bronchitis Must be non-smoker for 2 yrs, not disabling and no steroid use greater than 10mg daily or oxygen in 2 yrs. Acute, single or remote occurrence Chronic or bronchiectasis Bypass See Coronary Artery Disease Cancer See Tumors Cardiac Defi brillator Cardiomyopathy Stable, well investigated, no restrictions, no CHF, in 2 yrs Others Carotid Artery Disease Surgically corrected over 6 months ago, No history of TIA or stroke Not surgically corrected, less than 60% stenosis, no symptoms or restrictions, No stroke or TIA Others Blood Pressure Well controlled, average reading below 180/100 and stable for 6 months, no complications Poorly controlled or with complications (kidney disease or uncontrolled diabetes).... Brain Disease or Disorder, Organic Brain Syndrome (OBS) Cataracts With visual impairments causing signifi cant complications or restrictions Others Cerebral Palsy Mild, independent, without required assistance of mechanical aid Others Cerebral Vascular Accident See Stroke Cirrhosis of the Liver The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. 62 For Agent Use Only Not For Use With The Public

63 Medical Condition LTC = Acceptable for LTC = Declined for LTC IC = Individual Consideration Colitis Irritable Bowel Syndrome, Spastic colon, Functional Crohn s Disease, Regional Ileitis or Ulcerative Colitis, active within 1 yr Not active within 1 yr., well controlled Operated, fully recovered, inactive Confusion See Memory Loss Congestive Heart Failure Single, acute episode, fully recovered, over 1 yr Multiple episodes COPD/Emphysema (Chronic Obstruction Pulmonary Disease) Mild, non-smoker, no symptoms Moderate, mild symptoms of shortness of breath, only intermittent use of steroids not currently used, nonsmoker..... Severe, signifi cant symptoms, difficulty walking due to shortness of breath, hospitalization or ER visits, on-going steroid use greater than 10mg. daily Current smoker or history of smoking within 2 yrs., or use of oxygen Coronary Artery Disease (ASHD/Heart Attack) No symptoms or with stable angina, successful medical mgmt for over six months Bypass surgery performed, over 6 months, no restrictions With symptoms or unable angina, bypass, or other surgery recomm With current smoking or smoking after cardiac incident Substandard pricing due to cardiac history IC Dementia Depression Acute or reactional, well controlled and fully functional Manic, major or chronic, no hosp. within 5 yrs., well adapted, fully functional, controlled with anti-depressants Manic, major or chronic, hosp. within 5 yrs Psychosis or personality disorder Suicidal Attempts Diabetes Mellitus Well controlled, no complications, diet, oral meds or 50 units insulin or less Any complications such as peripheral vascular disease, nephropathy, peripheral neuropathy, retinopathy, TIA or stroke Any treatment program with indications of poor control Greater than 50 units of insulin Dialysis Diverticulitis/Diverticulosis Uncomplicated, minimal symptoms or surgically corrected Complicated, disabling or with anticipated surgery Dizziness/Vertigo Cause established refer to cause. Cause unknown, symptoms within one year Cause unknown, no symptoms within one year The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. For Agent Use Only Not For Use With The Public 63

64 Medical Condition LTC = Acceptable for LTC = Declined for LTC IC = Individual Consideration Drug Abuse Gallbladder Disease Prescription drugs, use within 3 yrs Surgically treated Prescription drugs, no use in over 3 yrs Surgery anticipated Illegal drug use within 5 years Illegal drugs, no use within 5 years IC Glaucoma - Signifi cant vision impairment or unstable Eating Disorders Anorexia, bulimia, assistance needed with food preparation or receiving Meals on Wheels Emphysema See COPD Epilepsy/Convulsive Disorders/Seizures Seizures within 2 years Others, controlled, 2+ years or more since last seizure Hepatitis Hepatitis A, within 3 months Hepatitis A, fully recovered for three months, with normal LFTs Hepatitis B, Chronic or non-a, non-b, within 3 years Hepatitis B, Chronic or non-a, non-b, fully recovered for three years, without meds and normal LFTs Alcoholic Hepatitis Fibromyalgia Mild, controlled on minimal meds, no limitations Others Hernia Surgery anticipated Minimal symptoms, surgery not indicated Fistula or Fissure (Anal/Rectal) Associated with other diseases Refer to disease Present, no symptoms Not Associated with other diseases Expected Repair within 6 months or with incontinence Forgetfulness See Memory Loss Fractures Due to Osteoporosis Single fracture, fully recovered no residuals or limitations Multiple fractures associated with vertigo or syncope Complicated recovery or with residuals IC Hip Disorders Refer to Specifi c Condition Hodgkin s Disease Stage I, fully recovered, for 2 years Stage II, within 5 years Stage II, fully recovered for 5 years Stage III-IV Hydrocephalus Hypertension See Blood Pressure Incontinence (Urinary) Mild, no social or functional limitations Others (including use of medications and/or devices) IC IC The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. 64 For Agent Use Only Not For Use With The Public

65 Medical Condition LTC = Acceptable for LTC = Declined for LTC IC = Individual Consideration Joint Replacement See Arthritis Kidney (Renal) Insufficiency or Failure, Dialysis Acute renal failure or insufficiency, current or within 2 years, with or without dialysis Acute renal failure or insufficiency, fully recovered after 2 years Chronic renal failure with or without current dialysis Mild Chronic renal insufficiency Kidney Stones Present, no symptoms, or anticipated surgery Causing symptoms or with surgery anticipated Surgically treated, fully recovered IC Meningitis Fully recovered for 3 months, no residuals With residuals Recurrent episodes Mental/Nervous Disorder See Depression Mitral Valve Prolapse (MVP) No symptoms, no surgery anticipated Multiple Sclerosis Muscular Dystrophy Myasthenia Gravis Ocular only, 1 year since diagnosis Others IC Leukemia Myelodysplasia Acute Chronic, without complications or treatment Lupus Erythematosus Systemic Discoid, well controlled Lyme Disease Fully recovered, no residuals after six months With residuals IC Myositis/Fibrositis Controlled with non-steroidal medication or 10mg or less of steroid, no restrictions or limitations Requiring steroid medication of more than 10mg or with limitations Narcolepsy Well controlled with or without medication for six months Unresponsive to treatment or functional limitations Macular Degeneration No vision loss With signifi cant visual impairment Refer to Vision Impairment Meniere s Disease Current symptoms Fully recovered or controlled for six months Memory Loss Neuropathy Severe or progressive Due to diabetes or alcohol abuse Due to herniated disc or other back disorder, mild and no limitations IC Treated with surgery and fully recovered Cause unknown, fully investigated after one year Cause unknown, without medical investigation IC The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. For Agent Use Only Not For Use With The Public 65

66 Medical Condition LTC = Acceptable for LTC = Declined for LTC IC = Individual Consideration Non-Hodgkin s Lymphoma Less than two years Over two years With bone marrow transplant Obesity (refer to build chart-no ratings) No complications or restrictions With complications or associated with other diseases, assistance required Organ Transplants Osteomyelitis Chronic or recurrent with one year, or single acute episode with 6 months Chronic or recurrent after 1 year or single acute episode after 6 months Osteoporosis Mild to moderate bone loss, no fractures, no restrictions or limitations Associated with fractures or severe bone loss Pacemaker Stable cardio-pulmonary function, implant within 3 months Stable cardio-pulmonary function, implant after 3 months Paget s Disease of Bone Pancreatitis Acute, fully recovered, no alcohol use Chronic Paralysis Paraplegia Parkinson s Disease IC IC IC IC Peripheral Neuropathy Severe or associated with disease Others Peripheral Vascular Disease Non-smoker, no symptoms, no restrictions or limitations, no complications IC Smoker or complications (diabetes or obesity, etc.) Multiple surgeries Personality Disorder Phlebitis Episode within 3 months Single episode over 3 months ago, recovered Multiple episodes, fully recovered for 12 months or continuing anticoagulation Poliomyelitis or Polio IC Fully recovered, no recurrence, no appliances required, no restrictions With recurrence, restrictions or use of appliances or residuals IC Post Polio Syndrome Polymyalgia Rheumatica (PMR) With symptoms, with residual impairments or using more than 10mg of steroid Fully recovered, using less than 10mgs of steroid, within 1 year Fully recovered, using less than 10mgs of steroid, after 1 year Prostatic Hypertrophy (BPH) PSA reading > PSA reading < IC The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. 66 For Agent Use Only Not For Use With The Public

67 Medical Condition LTC = Acceptable for LTC = Declined for LTC IC = Individual Consideration Prostatitis Fully recovered or well controlled PSA reading > Psychosis Pulmonary Disease, Occupational Stable, non-smoker, over 3 years Smoker within 3 years or requiring oxygen or assistance with ADLs or IADLs Pulmonary Embolism Fully recovered, single episode, after six months Multiple episodes after 2 years with or without anticoagulation Requiring a fi lter Quadriplegia Raynaud s Disease - well established, stable.... Raynaud s Phenomenon Associated with connective tissue disease.... Others Retinal Detachment Surgically corrected, no limitations Others Sarcoidosis Inactive, no complications after six months Active, within six months or with complications Scleroderma Localized to skin only, well established Others or generalized IC IC IC IC Seizure Disorder See Epilepsy Sjogren s Syndrome Sleep Apnea Minimal symptoms or well controlled with CPAP or surgery after 6 months Severe symptoms or unresponsive to treatment Spinal Stenosis IC With symptoms or surgery indicated Surgery completed, fully recovered, no residuals Minimal symptoms, not disabling Stroke / TIA Fully recovered, no residuals or restrictions within 1 year Single episode fully recovered, no residuals or restrictions after 1 year Multiple strokes or TIA s with residuals or restrictions, complications of other disease Surgery (Planned or Recommended) In-patient Out-patient Syncope Refer to Dizziness/Vertigo Thrombophlebitis See Phlebitis Thyroid Disorders (excluding cancer) Under control TIA See Stroke IC IC The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. For Agent Use Only Not For Use With The Public 67

68 Medical Condition LTC = Acceptable for LTC = Declined for LTC IC = Individual Consideration Transient Global Amnesia Single episode over 1 year ago, no residuals Multiple episodes Tremor Fully investigated, familial type, no restrictions or limitations Not fully investigated Parkinson s suggested Tuberculosis Exposure only, prophylactic treatment only Fully recovered, off all medications for 1 year, no residuals Active Tumors Ulcer (Peptic, Gastric, Duodenal) Fully recovered, no complications Hemorrhage within 1 year Valvular Heart Disease Single valve, no surgery anticipated Single valve repair/replacement, no ongoing symptoms, fully recovered after 1 year Multiple valve replacements IC IC Vision Impairment Vision stable, well adapted Vision impairments progressing, some restrictions or limitations, not fully adapted Varicose Veins Esophageal Lower extremities, no complications Vascular Disease Arterial (refer to peripheral vascular disease) Carotid Artery Disease (refer to carotid artery disease) Aneurysm (refer to aneurysm) The Probable Action guidelines are provided as a courtesy for general informational purposes and should not be interpreted as tentative quotes or binding in any way. 68 For Agent Use Only Not For Use With The Public

69 After Issue Contract Change Quick Reference Guide 1 LSW Products Contract changes (after the rewrite period of 120 days from the application date) are considered after issue changes. These changes are processed in Customer Services. Please note that additional underwriting requirements may be needed at the underwriter s discretion. The Quick Reference Chart applies to these products: Please check Agent Guides for rider availability by product. Harbor Horizon Harbor-07 Horizon-07 Secure Plus Paragon Secure Plus Provider SecurePlus Advantage 79 LSW Term Foundation IncomeBuilder Please indicate submitting Agency Name/Number as well as Policy Number on All changes should be submitted with a completed Customer Services Agency Transmittal (catalog #45208) to Insurance Product Services M305. Change: Form(s): *Complete F8121 Questions: Underwriting Requirements: Notes: (Indicate Policy # on top of form) Available within the fi rst year: Available on or after fi rst policy anniversary: Add or Increase Benefi ts/riders* * Please check Agent's Guides for rider availability by product. Accelerated Benefi ts Rider Terminal (ABR1) and Chronic (ABR2)* 8083 Complete bottom section of pg 2, include statement: Add to Policy LSxxxxxx Accelerated Benefi ts Rider Critical (ABR3)* 8083 Complete bottom section of pg 2, include statement: Add to Policy LSxxxxxx Accidental Death Benefi t (ADB)* 8121, 8121G, HIPAA Part 1: 1, 8, 10, 11, 12, 15, 20b if changing, Part 2, Part 3, Part 4, Part 8, Part 9 Part 8: include statement Add ADB Additional Protection Benefi t (APB)* 8121, 8121G, HIPAA Part 1: 1, 8, 10, 11, 12, 15, 20b if changing, Part 2, Part 3, Part 4, Part 8, Part 9 Part 8: include statement Add APB Children s Term Rider (CTR)* 8121, 8121G, HIPAA Part 1: 1, 8, 15,20b if changing, Part 2, Part 5, Part 8, Part 9 Part 8: include statement Add CTR Disability Income Rider (DIR)* 8121, 8121G, HIPAA Part 1: 1, 8, 10, 11, 12, 15, 20b if changing, Part 2, Part 3, Part 4, Part 8, Part 9 Part 8: include statement Add DIR (2 or 5)_ * May vary with state special forms. 1 Refer to Form 1441 for National Life Products After Issue Change Requirements. For Agent Use Only Not For Use With The Public 69

70 Change Form(s): *Complete F8121 Questions: Underwriting Requirements: Notes: (Indicate Policy # on top of form) Available within the fi rst year: Available on or after fi rst policy anniversary: Add or Increase Benefi ts/riders* Extension of Benefi ts Rider (EBR)* 8099, 8103, 8106, 8121, 8121G, 8127 (if applicable), HIPAA Part 1: 1, 8, 10, 11, 15, 20b if changing, Part 2, Part 3, Part 4, Part 8, Part 9 Depends on age/amount Available with LTC or ABR2 Part 8: Include statement Add EBR Guaranteed Insurability Rider (GIR)* 8121, 8121G, HIPAA Part 1: 1, 8, 10, 11, 15, 20b if changing, Part 2, Part 3, Part 4, Part 8, Part 9 Part 8: include statement Add GIR Long Term Care (LTC)* 8099, 8103, 8106, 8121, 8121G, 8127 (if applicable), HIPAA Part 1: 1, 8, 10, 11, 15, 20b if changing, Part 2, Part 3, Part 4, Part 8, Part 9 Depends on age/amount Part 8: include statement Add LTC Other Insured Rider (OIR)* 8121, 8121G, 8122, HIPAA Part 1: 1,20b if changing, 15, Part 8, Part entire form Age/Amount requirements for OIR coverage applied for Part 8: include statement Add OIR Overloan Protection Rider* 8121 Part 1: 1, 15, Part 9 Part 8: include statement Add OPR Unemployment Rider (UR)* 8121, 8121G Part 1: 1, 10, 11, 12, Part 8, Part 9 Part 8: include statement Add UR Waiver of Premium (WP)* 8121, 8121G, HIPAA Part 1: 1, 8, 10-12, 14a, 14b, 20b if changing, Part 2, Part 3, Part 4, Part 8, Part 9 Part 8: include statement Add WP Change in Class: Change to preferred non-tobacco class (non smoker change) 8121, 8121G, HIPAA, HIV consent form Part 1: 1, Part 2: 1, Part 8, Part 9 Fully completed F8121 if 3 years after issue Blood/urine - First 3 policy years - thereafter full u/w Part 8: add Change to preferred NT class Change to non-tobacco class (nonpreferred) 8121, 8121G, HIV consent form, HIPAA Part 1: 1, Part 2: 1, Part 8, Part 9 Fully completed F8121 if 3 years after issue Oral fluid or Urinalysis 1 - First 3 policy years; thereafter full u/w Part 8: Change to xxx class * May vary with state special forms. 1 Oral fl uid (if within product/amount guidelines); otherwise urinalysis. OF not available on Paragon, Advantage 79, Horizon, or IncomeBuilder 70 For Agent Use Only Not For Use With The Public

71 Change Form(s): *Complete F8121 Questions: Underwriting Requirements: Notes: (Indicate Policy # on top of form) Available within the fi rst year: Available on or after fi rst policy anniversary: Change in Class Change to better rate class within tobacco group (preferred) 8121, 8121G, HIV consent form, HIPAA Part 1: 1-14, Part 2, Part 3, Part 4, Part 8, Part 9 Exam, blood, urine. APS to be determined upon Und. review Part 8: add Change to preferred (NT or Tobacco) No Change to better rate class within tobacco group (non-preferred) 8121, 8121G, HIV consent form, HIPAA Part 1: 1-14, Part 2, Part 3, Part 4, Part 8, Part 9 To be determined upon Und. review Part 8: add Change to xxx class No Request to reduce or remove rating 8121, 8121G, HIV consent form, HIPAA Part 1: 1-14, Part 2, Part 3, Part 4, Part 8, Part 9 To be determined upon Und. review Part 8: add Remove or Reduce rating No Terminate a Benefi t or Rider: (Any) 8121, 8121G Part 1: 1, 20b if changing, Part 8, Part 9 Part 8: add Terminate (rider name(s)) Increase in Face Amt of Coverage: Universal Life PPI: 8121, 8121G, HIV consent form, HIPAA OIR: 8122, 8121G, HIV consent form, HIPAA Part 1: 1, 8, 10-12, 14a, 14b, 17, 20, Part 2, Part 3, Part 4, Part 8, Part Part 1: 1, 8-12, 13c, 13b, 14 Part 2, Part 3, Part 4, Part 5 Age/Amount requirements for all insurance issued within the last six months F8121 Part 8: add Increase face amount to $ F8122 Part 5: add Increase face amount to $ Available on exception basis only Contact Contract Change at Home Office LSW Term Not Available Decrease in Face Amt of Coverage: Universal Life PPI: 8121, 8121G OIR: Part 1: 1, 17, 20b if changing, Part 2: 2, Part 8, Part Part 1: 1, 14, Part 5, Part 1: Part 8: add Decrease face amount to $ Part 5: add Decrease face amount to $ Available on exception basis only. Contact Contract Change at Home Office. ; decrease no more than 25% of largest total face amount in-force within preceding 12 months. New face amount minimum must be minimum plan amount. LSW Term Not Available * May vary with state special forms. For Agent Use Only Not For Use With The Public 71

72 Change Form(s): *Complete F8121 Questions: Underwriting Requirements: Notes: (Indicate Policy # on top of form) Available within the fi rst year: Available on or after fi rst policy anniversary: Change to Owner or Benefi ciary: Owner Change Absolute Assignment 1491 Use for owner change to or from business entity, trust or business associate/partners Owner Change Ownership Provision Request 1492 Use for owner change to a person non-business insurance Change benefi ciary(ies) 1531 Provide all requested information Owner signature needed on changes Change in Plan of Insurance: Convert LSW Term to LSW UL PPI: 8121, 8121G, strategy allocation form if new policy is indexed 8121 Part 1: 1, 4, 5, 6, 16-22, Part 2, Part 6 (if applicable) Part 7 (if applicable) Part 8, Part Part 8: add Convert $ from Policy #LSxxxxxxx Available only thru fi nal conversion date as stated in the policy Convert LSW Term Spousal policy to OIR on spousal policy 8122 and all related new business forms fully completed F Part 2 Remarks: replacing LSW Term Spousal Rider to OIR on Policy for (PPI name) Available only thru fi nal conversion date as stated in the policy Convert OIR to stand alone policy 8121, 8121G, strategy allocation form if new policy is indexed 8121 Part 1: 1, 6, 16-22, Part 2, Part 6 (if applicable), Part 7 (if applicable), Part 8, Part Part 8: add Convert $ from rider on Policy #LSxxxxxxx Need signatures of Applicant and OIR Term to Term Contact Contract Change at Home Office Change to other Plan of Insurance Contact Home Office Change Death Benefi t Option 8121 Part 1: 1, 18, Part 8, Part 9 Part 8: add Change to DBO No Other: Lost Policy , 4, 5 Dated at on / /, plus signatures Reinstatement Contact Contract Change at Home Office * May vary with state special forms. 72 For Agent Use Only Not For Use With The Public

73 For Agent Use Only Not For Use With The Public

74 National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. Each company is solely responsible for its own fi nancial condition and contractual obligations. LSW is not an authorized insurer in NY and does not conduct insurance business in NY. P: F: [email protected] Centralized Mailing Address: One National Life Drive, Montpelier, VT For Agent Use Only Not For Use With The Public