Heritage UNDERWRITING GUIDE & RATE BOOK. Equitable Equitable Life & Casualty Insurance Company. A Whole Life Plan To Protect Those You Love

Transcription

1 UNDERWRITING GUIDE & RATE BOOK Heritage P R O T E C T O R A Whole Life Plan To Protect Those You Love UW Guide (9/13) Equitable Equitable Life & Casualty Insurance Company

2 Table of Contents General Information Page 1 Tips for Completing an Application Page 2 Tobacco Use Page 3 Submitting the Application Page 5 Medical Conditions Guide Page 8 Prescription Medication Guide Page 13 Rates Page 18 To Equitable s Family of Agents We understand the importance agents place on having applications approved and issued as soon as possible! The Underwriting Division is committed to this goal and we will work with you through every step of the Underwriting process to achieve it. Please review this Underwriting Guide carefully. It has been designed to help you complete an application and help you understand the process of Underwriting and the procedures used to underwrite the Heritage Protector policy. GENERAL INFORMATION UNDERWRITING GUIDELINES Issue Ages: Ages 50 through age 85. The age is determined as of the application date. The effective date can be backdated up to six months prior to the application date to save age. The appropriate premium must be submitted with the application for backdated policies. Application Receipt: Applications must be received in the Home Office within 14 days of the date signed. Effective Dates: Policy effective dates will usually be the date of the application. Agents may request effective dates up to 60 days beyond the application date Application Questions: The agent, or Tele-underwriter when the Express application is used, must personally ask and record all answers to the application questions. No other person, including the spouse, may answer questions or sign on behalf of the applicant. We do not accept applications with Power of Attorney signatures. State of Residence: The Owner s state of residence determines the application, forms and premium. An application will not be accepted if the agent is not licensed in the Owner s state of residence. The maximum face amount for the Level benefit is $30,000. The maximum face amount for the Graded benefit is $10,000. Page 1

3 TIPS FOR COMPLETING AN APPLICATION It is important to complete the application in its entirety because it becomes the basis for the policy (which is a legal contract). ALWAYS Ask each question, exactly as written (don t paraphrase). Record each answer, exactly as given. Complete the application legibly and in black ink. If there are any corrections or mistakes, have the applicant initial and date each correction or mistake. NEVER Use white out or similar substances for corrections or mistakes. Lead the applicant when they are responding to a question. Allow someone other than the applicant to answer the application questions. CALCULATING THE PREMIUM For Annual Premiums: 1. Determine the premium per $1, Multiply the premium by the face value per $1, Add the $45 policy fee. EXAMPLE Applicant is a 65 year old male, non-smoker, applying for $20,000 face amount. 1. Annual premium per $1,000 is $ Multiple $60.48 x 20 = $1, Add $45. Total annual premium is $1, Monthly bank draft premium is $1, x.085 = $ For Monthly Bank Draft (MBD) Premiums: 1. Determine the premium per $1, Multiply the premium by the face value per $1, Add $3.825 for policy fee to the premium calculated EXAMPLE Applicant is a 65 year old male, non-smoker, applying for $20,000 face amount. 1. MBD premium per $1,000 is $ Multiple $5.14 x 20 = $ Add $ Total MBD premium is $ INITIAL PREMIUM We do not accept C.O.D. Business Checks are to be made out to Equitable Life & Casualty Insurance Company. Drafting the Initial Premium Rather than submitting premium with the application, an agent can request to draft the initial monthly premium in the Premium Payment section of the application. When this is selected, unless indicated otherwise, the first premium will be drafted when the policy is issued. Note: the first premium is drafted when the policy is issued, regardless if the requested effective date is beyond the issue date. Page 2

4 Bank Draft For monthly Bank Draft, the Select Draft Date must be within 10 days of the effective date. The actual date we draw payment from the applicant s account will either be the date chosen or a few days following that date. It will never be before the date chosen. Remember to include a voided check or a bank deposit slip with the application when the insured selects the bank draft option. Renewal Premium Renewal premium is by either Bank Draft (checking or savings account) or direct annual billing. INSURABLE INTEREST Insurable interest will be verified prior to issuing the policy. Insurable interest exists when the beneficiary is likely to suffer financial loss or detriment if the insured dies. Ownership in all cases must be reasonable. Ownership other than a family member may not be allowed. If the Owner is not a family member, proper proof to establish insurable interest will be required. UNDERWRITING INFORMATION SOURCES Prescription History Check: If the applicant applies for the Level benefit, we will check the applicant s prescription history. If the applicant is taking certain medications, the applicant may only qualify for Standard rates or the Graded product. MIB: If the applicant applies for the Level benefit, we will check for any history with MIB. Results of the MIB check may change the underwriting decision. Cross-checking of all current and/or recent applications with Equitable. The total amount of life insurance in force with Equitable cannot exceed the maximum face amount available. SUBMITTING THE APPLICATION Express Application Process To submit an application using the Express Application Process: Page 3 Using the medical questions from the application, pre-qualify the applicant. If the applicant does not qualify for the Level product but does qualify for the Graded product, be sure the prospect will accept that coverage before proceeding. Have the applicant read The Notice of Information Practices and Privacy Policy. The Privacy Policy must be read by the applicant or the agent must read it to the applicant, prior to calling to start the Express application. If the applicant states they have not received a copy of the Privacy Policy, or had it read to them by the agent, the interview cannot be completed. Provide a copy of the Life Buyer s Guide to the applicant.

5 The telephone interviewer will ask you, the agent, for the following information: 1. Is this an Express or Regular application? (your answer should be Express ) 2. The telephone number you are calling from. 3. Your name and agent number. 4. Is there a splitting agent involved? If yes: a. Splitting agent s name and agent number; split percentage 5. Client s first, middle and last name 6. Product information: a. Face amount b. Plan applying for (Level or Graded) c. Will the automatic premium loan be included? The policy must be paid by bank draft so be sure you know whether it is a checking or savings account. DO NOT COLLECT PREMIUM OR A VOIDED CHECK. Premiums will be deducted automatically for the first AND subsequent months. Please be sure your client has the following information readily available: If this policy will replace an existing life or annuity policy (if yes, be sure the applicant has signed the replacement form) Bank name, routing number and account number; draft date (between the 3rd and 28th of the month) Name and address for beneficiaries (Be sure the applicant knows if there are contingent beneficiaries) If the applicant is not the policyowner, the policyowner s authorization and agreement are required during the telephone interview. Below are 2 examples of how the Bank Routing Number and Account Number are presented on a check Page 4

6 Bank Routing Number Check Number Account Number Also, remember that we cannot accept a credit card number or a debit card number this is not the routing or account number. We must have the numbers associated with the customer s checking or savings account. A request for funds is electronically submitted to the customer s bank upon approval of the policy, and Equitable receives payment electronically. Call to complete an Express application. You must call to have the Medical questions verified by one of our interviewers. Call times are 7 AM to 7 PM, Mountain time, Monday through Thursday, and Fridays from 7 AM to 6 PM. DO NOT COACH THE APPLICANT! It is recommended that you explain what will take place but you must not participate in the interview. Our interviewers are trained to identify coaching and, if identified, the interview will be terminated. Once the interview is complete, send the Replacement form (if required) to the Home Office. The replacement form must be received within 14 days of the application date or commission will be charged back. Submit the application by mailing the application or fax to or use the Upload the Application tool on Regular Application Process The application must be completed in its entirety. Areas commonly left unanswered that will delay the underwriting/issue process is: Relationship of owner and/or beneficiary Face Amount Automatic Policy Loan Height/weight Name and address of company whose existing coverage is being replaced. (This is vital as many states require the replacing company to notify the replaced company within a specific time period.) Missing forms Missing signatures To submit an application using the Regular Application Process: Page 5

7 Using the medical questions from the application, pre-qualify the applicant. If the applicant does not qualify for the Level product, be sure the prospect will accept the Graded product before proceeding. If the applicant is applying for the Level benefit, answer all the medical questions in the application including height, weight and cigarette usage. If the applicant is applying for the Graded benefit, check the box indicating the applicant has chosen the guarantee issue product. r By Checking this box, the Proposed Insured elects a guaranteed issue product and to not answer any health questions. Complete the replacement form if replacing any other Life or Annuity policy (if required in your state). Have the applicant review The Notice of Information Practices and Privacy Policy, and Life Buyer s Guide. Submit the application by mailing the application or fax to or use the Upload the Application tool on Do not call to complete a point of sale interview. An interview will only be completed if the Rx or MIB check reveal information not admitted on the application. RISK CLASSES The Level benefit has 2 risk classes: Preferred and Standard. Preferred: Applicants who are non-smokers (have not smoked cigarettes in the past 12 months) without significant medical conditions (all medical questions answered no ) and whose height/weight is within the acceptable range Standard: Applicants who have smoked cigarettes in the past 12 months without significant medical conditions (all medical questions answered no ) and whose height/weight is within the acceptable range Applicants who are non-smokers (have not smoked cigarettes in the past 12 months) with some significant medical conditions (any medical question in Part 2 is answered yes ) and whose height/weight is within the acceptable range An applicant will qualify for the Graded benefit when: The medical questions are not answered on the application Any medical question in Part 1 is answered yes The applicant has smoked cigarettes in the past 12 months and answers yes to any medical question in Part 2 The applicant s height/weight is outside the acceptable range. Page 6

8 HEIGHT/WEIGHT CHART Height Minimum Weight Maximum Weight MEDICAL TERMS ON THE APPLICATION Listed below are definitions of some of the diseases and medical conditions on the Heritage Protector application. These explanations should be helpful to you when reviewing an applicant s medical history or explaining conditions to the applicant. Amyotrophic Lateral Sclerosis (ALS): also known as Lou Gehrig s disease. A progressive, fatal disease that causes gradual degeneration of the nerve cells that control voluntary muscle movement. Atrial/Ventricular Fibrillation: heart condition that causes rapid, irregular heartbeat Chronic Hepatitis: chronic liver inflammation causes from alcohol abuse, drugs, exposure to chemicals or an autoimmune process. Cardiomyopathy: chronic heart condition that diminishes cardiac performance. Chronic Bronchitis/Emphysema: A serious and progressive lung disease, usually caused by chronic tobacco use. Page 7

9 Chronic kidney disease: gradual loss of the kidneys ability to filter waste from the blood. Circulation problems/circulatory disease: lack of circulation caused by carotid artery stenosis or peripheral vascular disease Cirrhosis: A chronic degenerative disease of the liver. Complications of Diabetes: end-organ damage caused by diabetes such as neuropathy (numbness or tingling in feet or legs); retinopathy (eye disease); kidney damage or gastroparesis (delayed emptying of food from the stomach) Heart disease or disorder: includes irregular heart rhythm, valvular heart disease, coronary artery disease and other diseases of the heart muscle. This does not include hypertension (high blood pressure). Internal : cancer affecting any internal organs. Does not include minor skin cancers like basal cell carcinoma. Systemic Lupus: a chronic immune system disorder affecting multiple organs in the body. Transient Ischemic Attack (TIA): mini- stroke. MEDICAL CONDITIONS GUIDE The Medical Conditions section gives a general indication of whether a particular medical condition is insurable for the Heritage Protector product. The Action column gives the probable underwriting action for each medical condition. Because each applicant has a unique medical history, it is impossible to list every possible combination of conditions. However, this guide will help you identify most of the specific conditions that you will encounter. Equitable Life & Casualty reserves the right to decline any application it deems unacceptable for coverage. Underwriting decisions are reserved solely for the Home Office Underwriters. The Company reserves the right to consider each application on its own merits. Call the Underwriting Hotline number, , if you are unable to find a condition in this section. Condition Action AIDS or HIV positive...graded Alcohol abuse/alcoholism Treated within 2 years...graded Treated > 2 years ago...preferred Alzheimer's Disease...Graded Page 8

10 Condition Action Amputation Traumatic...Preferred With history of diabetes...standard Amyotrophic Lateral Sclerosis (ALS)...Graded Aneurysm No surgery or surgery in past 2 years...graded Surgery over 2 years ago...preferred Angina...Graded Angioplasty or Stent Placement Surgery in past 12 months...graded Surgery months ago...standard Surgery > 24 months ago...preferred With history of diabetes...graded Atrial Fibrillation...Graded Blood clots Treatment or surgery in past 2 years...graded More than 2 years ago...preferred Bypass Surgery Surgery in past 12 months...graded Surgery months ago...standard Surgery > 24 months ago...preferred With history of diabetes...graded Treatment within 3 years...graded Last treatment > 3 years ago...preferred Cardiomyopathy...Graded Carotid Artery surgery (endarterectomy) Surgery in past 2 years...graded Surgery > 2 years ago...preferred With history of diabetes...graded Cerebrovascular Accident (CVA) see Stroke Circulatory disease or disorder...graded Cirrhosis of the liver...standard Page 9

11 Condition Action Non-smoker...Standard Smoker...Graded Congestive Heart Failure...Graded Dementia...Graded Defibrillator Surgery in past 12 months...graded Surgery > 12 months ago...preferred Diabetes Diet controlled with complications...standard Diet controlled with amputation, insulin shock or coma in past 3 years...standard On medication History of kidney disease, eye problems or neuropathy...graded History of stroke, TIA, heart disease or circulatory disease...graded Drug Abuse Treated within 2 years...graded Treated > 2 years ago...preferred Heart attack Within the past 12 months...graded months ago...standard > 24 months ago...preferred Heart surgery Angioplasty, stent placement, bypass, or valve replacement in past 12 months...graded Angioplasty, stent placement, bypass, or valve replacement months ago...standard Angioplasty, stent placement, bypass, or valve replacement > 24 months ago...preferred Hepatitis, chronic...standard Hodgkin s Disease (lymphoma) Current treatment...graded Treatment within 3 years...graded Last treatment > 3 years ago...preferred Hospital stay Currently hospitalized...graded Kidney disease, chronic...graded Page 10

12 Condition Action Kidney Failure...Graded Leukemia Current treatment...graded Treatment within 3 years...graded Last treatment > 3 years ago...preferred Lupus Discoid...Preferred Systemic...Graded Lymphoma Current treatment...graded Treatment within 3 years...graded Last treatment > 3 years ago...preferred Melanoma Current treatment...graded Treatment within 3 years...graded Last treatment > 3 years ago...preferred Memory loss...graded Multiple Myeloma Current treatment...graded Treatment within 3 years...graded Last treatment > 3 years ago...preferred Muscular Dystrophy...Graded Organ Transplant...Graded Oxygen usage (constant or intermittent)... In past 6 months...graded More than 6 months ago...preferred Paralysis...Graded Disease...Standard Peripheral Vascular Disease...Graded Stroke Within past 2 years...graded More than 2 years ago...preferred With diabetes...graded Page 11

13 Condition Action Transient Ischemic Attack (TIA) Within past 2 years...graded More than 2 years ago...preferred History of TIA and diabetes, taking oral medication or insulin...graded Valvular heart disease Treatment in past 12 months...graded Surgery in past 12 months...graded Surgery months ago...standard Surgery > 24 months ago...preferred Walker Used for chronic illness in past 6 months...graded Wheelchair confined...graded Page 12

14 PRESCRIPTION MEDICATION GUIDE If your applicant is taking one of the following medications for the specific "Customary Use" or condition noted, the applicant will not qualify for the Level benefit. If the applicant is taking the medication for some other use, call Underwriting at before taking the application. Medication Customary Use Abacavir Adcirca Peripheral vascular disease Afinitor Agenerase Aggrenox Circulation Aldactazide Cirrhosis Alkeran Altretamine Amiodarone Arrhythmia Amyl Nitrate Angina Antabuse Substance abuse Aptivus Aranesp Kidney failure Aricept Alzheimer's Atripla Azasan Azathioprine B Bicalutamide BiDil Congestive heart failure Bosulif Brilinta Angina C Campral Substance abuse Caprelsa Casodex CeeNU CellCept Chlorambucil Leukemia/lymphoma Chymotrypsin Cidofovir Cilostazol Peripheral vascular disease Combivir Cometriq Complera Crixivan Cyclophosphamide Cyclosporine Medication Cytovene Didanosine Digoxin Dipyridamole Disopyramide Donepezil Edurant Effient Emcyt Emtriva Epivir Epogen Epzicom Ergamisol Ergoloid Mesylate Erwinaze Estramustine Ethmozine Etoposide Eulexin Exelon Flecainide Flutamide Fortovase Foscarnet Foscavir Fosrenol Fuzeon Galantamine Ganciclovir Gengraf Gleevec Customary Use D Congestive heart failure Blood clot Angina Alzheimer's E Angina Kidney failure Alzheimer's Leukemia Arrhythmia Alzheimer's F Arrhythmia Kidney failure G Alzheimer's Page 13

15 Medication Hexalen Hivid Hycamtin Hydergine Hydrea Hydroxychloroquine Hydroxyurea Hylenex H Customary Use Alzheimer's Lupus Medication Neoral Neosar Nevirapine Nexavar Nilandron Nitrostat Nitroglycerin Norvir Nylidrin Customary Use Angina Angina Peripheral vascular disease Iclusig Imuran Inlyta Intelence Invirase Iressa Isentress Isosorbide Isoxsuprine Kaletra Lamivudine Levamisole Lexiva Lupron Lysodren Matulane Megace Megestrol Mercaptopurine Methadone Mexiletine Multaq Myfortic Myleran Mylocel Naltrexone Namenda I Angina Peripheral vascular disease K L M Leukemia Substance abuse Arrhythmia Arrhythmia N Substance abuse Alzheimer's Omontys Orthoclone Papaverine Pentoxifylline Plaquenil Plavix Pomalyst Prezista Procanbid Procrit Prograf Propafenone Purinethol Quinidine Ranexa Rapamune Razadyne Reminyl Revatio Renagel Renvela Rescriptor Retrovir Revlimid Reyataz Rilutek Rivastigmine O Kidney failure P Peripheral vascular disease Peripheral vascular disease Lupus Circulation Arrhythmia Kidney failure Arrhythmia Leukemia Q Arrhythmia R Angina Alzheimer's Alzheimer's Peripheral vascular disease Kidney failure Kidney failure ALS Alzheimer's Page 14

16 Medication Sandimmune Selzentry Simulect Soltamox Sprycel Stavudine Stribild Stivarga Sustiva Sutent Tabloid Tarceva Targretin Tasigna Temodar Teslac Thalomid Thioguanine Thymoglobulin Ticlopidine Tikosyn Tonocard Trizivir Truvada Tykerb Customary Use S T Leukemia Peripheral vascular disease Arrhythmia Arrhythmia Medication Xalkori Xeloda Xtandi Zelboraf Zenapax Zerit Ziagen Zidovudine Zolinza Zortress Zytiga X Z Customary Use Valcyte Vantas Vascor VePesid Viadur Viracept Viramune Viread Vistide Vitrase Votrient Wydase V W Angina Page 15

17 Level Benefit Standard Rates If your applicant is taking one of the following medications for the specific "Customary Use" or condition noted, the applicant will qualify for the Level benefit with Standard rates. If the applicant is taking the medication for some other use, call Underwriting at before taking the application. Medication Advair Aerobid Akineton Albuterol Alupent Alvesco Amantadine Aminophylline Apokyn Arcapta Asmanex Atrovent Azilect Azmacort Baraclude Benztropine Bromocriptine Bronkosol Brovana Carbidopa/Levadopa Choledyl Clenbuterol Combivent Comtan Daliresp Dulera Dyrenium Enduron Ephedrine Flovent Foradil Hepsera Incivek Infergen Intal B C D E F H I Customary Use Chronic hepatitis Cirrhosis Cirrhosis Chronic hepatitis Chronic hepatitis Chronic hepatitis Medication Ipratropium Isoproterenol Isuprel Kemadrin Laradopa Lodosyn Lufyllin Maxair Methyclothiazide Mirapex Neupro Pegasys Peg-Intron Pergolide Proair Pulmicort Qvar Rebetron Renese Requip Ribasphere Selegiline Serevent Spiriva Spironolactone Stalevo Symbicort Tasmar Terbutaline Thalitone Theophylline Tilade Torsemide K L M N P Q R S T Customary Use Cirrhosis Chronic hepatitis Chronic hepatitis Chronic hepatitis Cirrhosis Chronic hepatitis Cirrhosis Cirrhosis Cirrhosis Page 16

18 Medication Trihexyphenidyl Tudorza Tyzeka Customary Use Chronic hepatitis Medication Victrelis Xopenex V X Customary Use Chronic hepatitis Call the Underwriting Hotline at for assistance with any questions regarding the contents of this Agent s Underwriting Guide. Page 17

19 Premium Rates per $1,000 of Face Amount $45 annual Policy Fee Level Product Graded Product Preferred Class Standard Class Issue Annual MBD Annual MBD Annual MBD Age Male Female Male Female Male Female Male Female Male Female Male Female To Calculate the Rate (Annual): 1. Determine the premium per $1, Multiply the premium by the face value per $1, Add the $45 policy fee. 4. If the policy will be paid as monthly bank draft, multiply the total premium by.085. OR (Monthly Bank Draft): 1. Determine the premium per $1, Multiply the premium by the face value per $1, Add $3.825 for policy fee to the premium calculated Page 18

20 We re here to serve you! Switchboard Agency Benefits P.R Policyowner Service Supplies Underwriting: Status Prequalification or Express application Agent Website... Mailling Address: Equitable Life & Casualty Insurance Company PO Box 2460 Salt Lake City, UT Equitable PO Box 2460, Salt Lake City, Utah