Critical Illness Freedom Plans Agent Underwriting Guide
PLAN DESCRIPTIONS
Lifestyle Freedom - A Twenty Year Level Term plan of life insurance that includes a Critical Illness Rider. Base Plan
premiums are level and guaranteed for a period of twenty years, or until age 70, whichever is less.
Ultimate Freedom - A Ten Year Level Term plan of life insurance that includes a Critical Illness Rider. Premiums are level
and guaranteed for a period of ten years.
APPLICATION FORM: 9485
ULTIMATE FREEDOM Disclosure-Accelerated Living Benefit Rider Form: 9460
LIFESTYLE FREEDOM Disclosure-Accelerated Living Benefit Rider Form: 9543
CRITICAL ILLNESS APPLICATION COMPLETION
• Employment Information – Record the employer’s name, applicant’s occupation, date of hire, and annual salary. If
applicant is full-time student or a non-working spouse it must be stated on the application.This information is a
MUST. If left off the application, a copy of the application will be returned to you for completion.
• Age – calculate based on age nearest birthday.
• Height and Weight – Record the Proposed Insured’s current height and weight. Refer to the appropriate plan build
table in the Agent Underwriting Guide.
• Owner – complete only if the Owner is different than the Proposed Insured. If Owner is different, they MUST sign
and date below the Proposed Insured’s Signature on the back of the application.
• Beneficiary – A Beneficiary must have a legitimate insurable interest. Full names of Primary and Contingent
beneficiaries must be listed on the application including the beneficiary’s relationship to the Proposed Insured
• Plan Applied For – Indicate the plan applied for by writing “LSF” for Lifestyle Freedom, “UF” for Ultimate Freedom.
Include the Critical Illness benefit percentage on both plans.
• Face Amount – Indicate a dollar face amount or Money Purchase.
• Replacement – Check appropriate box; if replacing coverage, complete the Company name, Policy number, and the
Amount of Coverage on the application. Also, complete any state required Replacement forms.
• QUESTIONS 1-3 on Application Form 9485 — Must have details to all YES answers. Medical condition details
should include current medications, date last seen by physician, name and address of physician. Failure to provide
details to the YES answers may result in the application returned for completion or a telephone interview needed
with the applicant to secure the information. Either of these actions will cause delays in processing.
• Incomplete or unsigned applications will be amended or returned for completion. Please make sure that all blanks
are filled in and the application has been reviewed and signed by the Owner and Proposed Insured.
• Disclosure Form 9460 or 9543 (per plan of insurance) – must be completed with all applications. If underwriting
approved, form is required to finalize.
Unacceptable Medical Conditions
AIDS, HIV+
Alcohol/Drug Abuse Treatment (PAST 2 YEARS)
Alzheimer’s
Aneurysm, aortic or intracranial
Angina Pectoris
Blindness
Cancer (excluding Basal or Squamous cell)
Cardiomyopathy
Cerebrovascular Accident (CVA/Stroke)
Circulatory Disorder (Claudication)
Congestive Heart Failure
Coronary Artery Angioplasty
Coronary Artery Bypass
Coronary Artery Disease
Coronary Thrombosis
Diabetes mellitus type 1 - insulin dependent
Diabetes mellitus type 2 < 35 when diagnosed
Down’s Syndrome
Heart Attack
Hodgkin’s Disease
Ischemic Heart Disease
Kidney (renal) Failure
Leukemia
Liver Disorders (Cirrhosis/Hepatitis C)
Marfan’s Syndrome
Form No. 9527(9/12)
Malignant Tumor
Multiple Sclerosis
Organ or Bone Marrow Transplant or on waiting list
Paralysis
Peripheral Vascular Disease
Pulmonary Embolism
Subarachnoid Hemorrhage
Systemic Lupus Erythematosis
Transient Ischemic Attack (TIA)
Unacceptable Occupations
Professional Athletes (i.e. Boxers,Jockeys)
Blasters & Explosive Handlers
Structual Workers/ Iron Workers
Sky Divers
Mountain Climbers
Racing Drivers
Underground Workers
Underwater Workers
Ineligible persons
Persons on disability
Persons unemployed, except spouses and full-time students
Persons on welfare
BUILD CHARTS
ULTIMATE & LIFESTYLE FREEDOM
HEIGHT
FT.IN.
UNACCEPTABLE
4.8
197+
4.9
204+
4.10
212+
4.11
219+
5.0
226+
5.1
234+
5.2
242+
5.3
249+
5.4
257+
5.5
265+
5.6
274+
5.7
282+
5.8
290+
5.9
299+
5.10
308+
5.11
316+
6.0
325+
6.1
335+
6.2
344+
6.3
353+
6.4
362+
6.5
372+
6.6
382+
6.7
392+
6.8
411+
6.9
412+
LIFESTYLE FREEDOM
ULTIMATE FREEDOM
0-65 Non-Smoker
0-60 Non-Tobacco
18-65 Smoker
18-60 Tobacco
Minimum Premium
$5.00 Wk or $20,000 Face
whichever is greater
$5.00 Wk or $20,000 Face
whichever is greater
Maximum Face Amount
Face $400,000 - CIR $100,000
Face $300,000 - CIR $75,000
Issue Age
Form No. 9527(9/12)