FIELD UNDERWRITING MANUAL FIELD UNDERWRITING MANUAL

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FIELD UNDERWRITING MANUAL FIELD UNDERWRITING MANUAL Powered By Docstoc
					American National Life Insurance Company of Texas

FIELD UNDERWRITING MANUAL
For states that allow waivers
It is the responsibility of the Underwriting Department to properly evaluate all applicants for health insurance coverage. This requires sound, modern underwriting practices consistent with the Company's general philosophy for the selection of health risks. In order to provide the best possible service, the Home Office Underwriting Team must also rely on the field underwriter to develop complete and accurate information at the point of sale. This manual is a guide for the field underwriter. It is intended to help the agent understand the probable underwriting action for commonly encountered medical histories. Naturally, the final action on an application is the decision of the Underwriter, based upon the varying circumstances that each particular case may present. It is important to recognize that the underwriting guide is meant as a basis for decision making, and that other factors, including the Home Office Underwriter's judgement, may affect the final decision.
This document was prepared for the exclusive use of appointed agents. It is not intended for public distribution, nor is it to be used in any solicitation or marketing of an ANTEX health insurance product.
American National Life Insurance Company of Texas P O Box 1998 • Galveston, Texas 77553-1998
UND - 08/15/03

Table of Contents

Page Introduction to the Field Underwriting Manual .................................... 1 Claims ............................................................................................... 95 Drugs Commonly Used ..................................................................... 17-29 Eligibility Requirements ..................................................................... 3 Field Underwriting ............................................................................. 2 Glossary of Terms ............................................................................ 87-94 Height and Weight Charts ................................................................. 15-16 HIPAA ............................................................................................... 13 Incomplete or Postponed .................................................................. 9 Legal Requirements .......................................................................... 10-12 Modified Coverage ............................................................................ 9 New Business Procedures ................................................................ 6 Occupation Guidelines ...................................................................... 4 Parameds, Blood Profiles, Urine Screens ......................................... 6 Policy Changes to In-Force Business ................................................ 82-86 Product Information ........................................................................... 1 Reconsideration of Underwriting Action ............................................. 9 Questions To Aid In The Selection of Good Risks ............................ 7-9 Submitting the Application ................................................................. 9 Unacceptable Health Conditions ........................................................ 30 Underwriting The Application ............................................................. 9 Underwriting Guide............................................................................ 31 Impairment Guide.............................................................................. 32-81

INTRODUCTION
You are an important part of the underwriting process. The guidelines in this manual are designed to assist you in understanding the action of our Underwriting Staff. Attention to these guidelines will help speed up policy issue and to solve placement problems. The most important step in the underwriting process is accurate and detailed answers to all questions on the application, especially the medical questions. It is important that the application show the entire health history for all applicants to assure that it may be underwritten in an accurate and timely manner. Failure to properly record complete and accurate information could result in either unnecessary delays or serious problems at time of claim.

Managed Care Major Medical Expense Policy
It is an alternative to the traditional fee-for-service program with the intent of controlling health care costs and improving utilization of services. This coverage provides major medical expense insurance with a preferred provider component. Expense participation is shared through copayments, deductibles and coinsurance with high maximum benefits per Insured. Like the traditional major medical plan, it also has the state approved clauses for pre-existing conditions, contestability, and time limit on certain defenses. The Managed Care Program is designed to integrate the financing and delivery of appropriate health care services to policyholders with the following elements: arrangements with selected providers to furnish a comprehensive set of health care services to members; explicit standards for the selection of health care providers; a benefit management program which includes an authorization process and utilization review; and financial incentives for members to use provider and procedures covered by the plan. In areas that have no preferred providers, and indemnity plan may be available - An indemnity plan is the traditional fee for service contract based on reasonable and customary charges.

Product Information
Individual and family health insurance coverage is provided by American National Life Insurance Company of Texas. This protection is needed in today's environment of soaring health costs by providing access to the health care delivery system and protection against financial catastrophe. Underwriting guidelines, procedures and forms vary among plans. Be sure to consult the marketing materials relative to your specific product and state. By following the procedures outlined in this manual and the marketing guidelines, you will maximize your percentage of issued health insurance applications.

Traditional Major Medical Expense
This coverage provides benefits to offset hospital, surgical and physician's expenses resulting from treatment for sickness or injury, and especially in the event of a large, catastrophic expense. In as much as the policy and/or certificate contains a high maximum benefit amount for each Covered Insured, it also contains expense participation (deductible and coinsurance) to help keep the medical expenses and premium to a minimum. The clauses for pre-existing conditions, contestability and time limit of certain defenses are state specific and approved.

Field Underwriting
The agent is authorized to solicit, write applications and otherwise transact the business of insurance in any state where he/she is both properly licensed by the state and authorized by American National Life Insurance Company of Texas to conduct business. The agent can not solicit applications in any manner prohibited by or inconsistent with the provisions of the Company's rules, regulations, or policy. If you have any questions regarding any type of solicitation transaction contact Moody Insurance Group. ANTEX adheres to state laws and regulations with regard to licensing and appointment of agents. In observance of these laws, the following practices are not acceptable: 1. Applications completed and signed by an agent who is not licensed or appointed in the state where the application was written or resident state for the applicant. 2. Applications completed prior to the effective date of the agents license/appointment date or after the license/appointment expires. 3. Applications completed by two agents unless both agents are licensed and appointed. 4. Applications submitted with a new agent appointment in a state that prohibits this practice. 5. Applications completed by an employee of the agent and signed by the licensed/appointed agent of the Company, unless the employee is licensed and appointed. 6. Applications altered or corrected with regard to the signature of the proposed insured, the date signed, the city and state of the applicant, or the licensed resident agent's signature altered. 7. Stamped signature rather than handwritten ink signatures. 8. Typed applications or applications completed in pencil. Good Field Underwriting is critical to the success of Individual Health Operations, and consists of more than just careful questioning of the proposed insured. The following suggestions should help you and your clients in obtaining coverage quickly and on the most equitable basis: 1. Select good risks. 2. Furnish complete information on past medical history to include dates, name of condition or diagnosis, type of treatment, and physician information. 3. If medical history is involved, identify the disease or condition for which treatment was obtained. Do not underestimate the applicant's knowledge of the diagnosed condition or the reason for the operation or

treatment. (See Special Medical Questions section.) 4. When "IC" (Individual Consideration) is shown for a condition, the following information should always be provided: • Full name, and correct/complete address(es) of doctor(s), including specialists; • Name of the condition, symptoms, treatment and results; • Has any special testing been performed or recommended? If so, fully explain. • Has any special advice or treatment been given or discussed? If so, explain fully. • Always answer the five W's — Who? What? When? Where? Why? 5. The writing agent is never authorized to disregard an applicant's answers, or to impose his or her judgment as to what is or is not important to record. The writing agent is never authorized to accept or alter an application for the proposed insured. 6. Only the Underwriting Department can make the final decision; therefore, never suggest or promise that a policy will be issued without change. 7. "Pre-Sell" medical exclusions when an applicant has a medical impairment. 8. When the spouse is applying for coverage, he/she should also sign the application. This will facilitate ordering an APS, if necessary.

Issue Ages
Ages 0 through 63 In certain circumstances, individuals 31 days old through age 24, may qualify for Child-Only coverage. Child rate varies by product. Please refer to the specific product for premium quotes. The custodial adult or legal guardian should be the applicant and able to attest to the health history of the minor child(ren). Proof of the guardian's ability to contract on behalf of the child should accompany the application. All such applications must be submitted with the signature of the custodial parent or legal guardian with sufficient knowledge of the health of the minor dependent. Write in the name of the parent or guardian in question 4.1 and include "Not to be covered" immediately after his or her name. Also, write in the age, date of birth and social security number. The parent or guardian will need to sign the application as the applicant and all dependents 18 years of age and over. One or more members of the immediate family are eligible for coverage under the same certificate/policy. The family includes husband, wife, and their unmarried dependent children prior to age 19 (24 if a full-time student, may vary by state). Legally adopted

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children and stepchildren of the applicant or spouse will also be considered part of the family group. Children must be dependent on the insured or spouse and living in the same household. An application may be written for a newborn child at the age of 30 days provided the child has had the routine four-week examination. The discharge exam done at age 2-3 weeks is not sufficient. The mother will be considered, if applying, with medical records and verification of good health. Foster children are not eligible for coverage unless required by state law. Grandchildren will be considered under the statutes of the relevant resident state. A non-custodial divorced parent may apply for coverage for his/her child. The custodial parent should sign the application verifying the health status of the child and the non-custodial parent should sign as the owner. ANTEX will not accept an application on a pregnant female nor a father nor the siblings of the unborn child.

4. Have you had cholesterol readings in excess of 250 and/or been treated for elevated cholesterol or triglycerides in the past 2 years? 5. Have you had any convictions for DUI or DWI or more than 3 moving violations in the past 12 months? 6. Have you taken any prescription medication in the past 2 years for a recurrent or chronic condition? (e.g. Reflux, Arthritis, or Asthma, etc.) 7. Have you recently applied for coverage and been turned down, rated, or offered modified coverage within the past 12 months?

Eligibility Requirements Income
Financial stability is essential to good persistency. Premiums generally should not exceed 5% of disposable income.

Residence/Citizenship
The applicant's primary residence must be in a state where the product is approved for sale. Check your product availability chart. If applicant is not a citizen of the United States, he or she must have resided in the U.S. for a minimum of 2 years, hold a permanent visa or Green Card, have an established physician in this country from whom medical records can be obtained, be able to speak and read English. If unable to communicate in English, the agent must certify that the questions on the application were translated and the applicants understand the terms and conditions of the coverage.

Rating Classes
Tobacco User -- Applicants who have used tobacco products, including smokeless or chewing tobacco within the past 12 months prior to the application. The Home Office will randomly test applicants for the use of these products. This random test will be initiated and authorized by the Home Office. Standard -- Applicants who have not used tobacco within 12 months proceeding the applicantion date, but who are not eligible or do not qualify for the Preferred Rates. Substandard -- Applicants who would require an extra premium or exclusion waiver(s) for certain health conditions that are otherwise not insurable. Preferred -- The applicant must be 19 years or older, applying as a primary insured or spouse, generally healthy and lead a healthy lifestyle. Applicant must be able to qualify according criteria listed below.

Occupation
The occupation of a proposed Insured is a major factor in their eligibility for major medical insurance. Applicants with occupations that are exceptionally hazardous will be declined. Please review the guidelines on page 4 and non-medical guidelines on page 5.

Preferred Rating Questionnaire
If any of the following apply, preferred rates are not available.

Medical Exclusions / Rider Special Class Rating Answers 'yes' to any of the questions in the Preferred Rating Questionnaire 1. Have you used tobacco in any form in the past 12 months prior to the application? 2. Are you currently within the standard weight range listed in the build chart provided in the Field Underwriting Manual? 3. Have you had blood pressure readings in excess of 140/95 and /or been treated for hypertension in the past 2 years?

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OCCUPATIONAL GUIDELINES

INELIGIBLE OCCUPATIONS Professional athletes (exception for bowlers and golfers) Asbestos workers Atomic or nuclear energy personnel Crop dusters (any work with exposure to hazardous chemicals) Toxic waste handlers Underground miners Explosive workers Pyro technical workers

ELIGIBLE OCCUPATIONS (Twenty Four Hour Occupational Rider and Accident Rider will not be available) Drillers and roughnecks Jockeys or horse/animal trainers Logging and logging related activities Racing Rodeo performers Overnight fishermen Offshore workers (oil well personnel) Quarry workers Fire fighters Policemen and Law enforcement Security guards Divers Construction and high elevation workers

OCCUPATIONS WITH INDIVIDUAL CONSIDERATION Bar, tavern, or billiard hall employee or owner Massage therapist Liquor store employee or owner Long haul truck drivers Entertainers Casino, horse or dog track employee or owner

NOTE: Individuals working in some environments will require special investigative underwriting procedures.
The above list is not all inclusive of what might and might not be acceptable to American National Life Insurance Company of Texas, but is to act as a barometer to express Company philosophy related to occupations and avocations.

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NON-MEDICAL UNDERWRITING
AUTOMOBILE RACING
PROFESSIONAL & RECREATIONAL WAIVER

UNDERWATER DIVING - Non-Professional
99' OR LESS 100' OR MORE STANDARD WAIVER

AVIATION
STUNT FLYING, CROP DUSTING OR HAZARDOUS FLYING DECLINE

COMMERCIAL PILOTS OR STANDARD CREW MEMBERS Domestic scheduled passenger and freight flights within the contiguous United States PRIVATE, STUDENT or INSTRUCTOR PILOTS WAIVER

AVOCATIONS
Policies are not designed to cover avocations where a significant risk of injury occurs.
SKYDIVING, HANG GLIDING, PARACHUTING BUNGY JUMPING, RODEO, MOUNTAIN CLIMBING, SPELUNKING AND RAFTING, ETC. PARTICIPATION WITHIN 3 YEARS AFTER 3 YEARS, NO PARTICIPATION

WAIVER STANDARD

MILITARY
All active members of the military (except reserves and national guard) are ineligible as they have adequate coverage through the armed forces. MEMBERS OF THE MILITARY RESERVE AND NATIONAL GUARD Applicants who are currently members of the military reserve or national guard will be underwritten in the usual manner. Participation in these military organizations will not impact the underwriting process.

CERTIFICATE/POLICY SUSPENSION
A current policy/certificate holder who is a member of the military reserve or the national guard and called to active duty will need to notify the company in writing of his activation and include a copy of the orders. Upon termination of the active duty status he will have to notify ANTEX in writing within 90 days of return to civilian life that he wants to reinstate his coverage. Coverage will be reinstated without underwriting. Any increases in premium will apply to the reinstated policy. This may vary by state law.

FOREIGN TRAVEL OR RESIDENCE
Any applicant who is contemplating foreign travel or plans to reside in a foreign country may be subject to unsatisfactory living conditions, increased risk of infectious disease and accident hazards. It may be difficult to obtain medical records from a foreign country in the event of a claim. If an applicant is planning to reside in a foreign country indefinitely, we will not consider for health insurance. Any travel in the course of business or pleasure will be considered if it is no longer than 3 months. Consideration will be given to applicants taking infrequent pleasure trips up to three months. If the trips are longer or frequent (4 or more), then coverage will not be considered. EACH APPLICATION MUST BE CONSIDERED ON A INDIVIDUAL BASIS DUE TO THE EVER CHANGING POLITICAL CLIMATE IN FOREIGN COUNTRIES.

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NEW BUSINESS PROCEDURES
Application
The application becomes an important part of your applicant's insurance contract. It is necessary that all statements be complete and accurate. Use black ink when filling out the application and date the application the date it is completed. The application is the foundation of the "Policy/Certificate" which is a legal contract between the insured and the insuring company. All applications must be signed by the primary applicant and the writing agent. The term "application" will refer to either an application or an enrollment application depending upon the type of coverage. You must use an application and other forms approved and required in the state where the application will be signed. Ask each applicant each question in person, making sure the answers are recorded exactly as given. If medical history is non-existent or appears incomplete, re-question the applicant. All health conditions and treatment must be fully documented; no spaces are to be left blank. If the answer is "none", the client should write the word "none". The phrase "not applicable" or "N/A" is not acceptable. Do not allow the client to use dashes or ditto marks. The applicant must initial all alterations. Never allow the use of liquid paper or white out. Applications must be submitted to the Home Office within 5 working days after completion.

Pre-Authorized Check Drafting
If business is written on this basis, a copy of a voided check or deposit slip with bank account and routing number must accompany the application.

Underwriting Requirements
Underwriting will order requirements after reviewing the application. Attending Physicians Statement, Paramedical Examinations and Inspection Reports will be requested if it is deemed necessary by the Home Office Underwriter. For applicants age 55 and above, an APS will be requested by the Home Office or an examination will generally be required if a doctor has not been seen within the last two years.

Dating of Policies/Certificates
We require evidence of insurability before coverage can be provided. For consideration of coverage, a fully completed application along with the full initial premium plus any applicable fees must be submitted to Home Office within 5 days after completion. The applicant and all dependents listed on the application must meet the ANTEX underwriting requirements. If approved, coverage will begin on the effective date as indicated on the Certificate Schedule Page. The Effective Date will be either the date requested on the application, if no more than 45 days in the future or the date approved by the Home Office Underwriter. At the time of policy delivery, if there has been a change in health status, do not deliver the policy, contact the Home Office Underwriting Department immediately.

Status on Pending Applications:
You may obtain status on your pending applications through the Company's website. This new policy status inquiry system is designed for up-to date status checks via the Internet. It is user friendly and will allow you to not only check the status of a pending application, but to communicate directly with the underwriter working on a particular case. To use the Internet services, follow the simple instructions below: Access the Moody Insurance Group home page at www.moodyinsurancegroup.com 1. Click on Agent Access 2. Type in User ID: ANTEX 3. Type in Password: Money You may also contact your Customer Service Department @ 1.800.899.6805

List Bill
To establish a List Bill, there must be a minimum of two employees and a maximum of ten. List Bill applications are available in the following states: AZ, AR, IL, IN, IA, KS, LA, MI, MO, MS, NE, NM, NV, OH, OK, PA, SC, TX. List Bill policies/certificates will be dated on the 1st of the month. The required salary deduction forms, ANL-3100 and ANL-3100 LBA m u s t a c c o m pany the application. L i s t b i l l applications will be underwritten together and policies/certificates generated as each file is approved.

Initial Premium
The initial modal premium must be paid with the application in most cases. However, if any proposed Insured has certain medical conditions, is anticipating treatment of a medical condition, or in your best judgement may be a poor risk, call ANTEX to determine whether or not to submit cash.

Fax-A-Quote
Under this program, the agent can Fax a completed application with evidence of insurability to the Underwriting Department. The evidence should be in the form of medical records or a copy of an examination and laboratory results, which were done for life and/or health insurance, provided these requirements were within 180 days of the application date. No money should be taken with the application. Acceptance or

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denial will be communicated within 24 to 48 hours of receipt and valid for 15 days. If the applicant is interested in the offer, the policy will be issued on a C.O.D. basis. The agent must be properly licensed and appointed with American National Life Insurance Company of Texas (ANTEX).

4. When was the doctor last seen? When was applicant discharged from the doctor's care? 5. What was the date of the last symptom? 6. Was there any radiation of pain or numbness to the legs or arms? 7. Any type of disability received?

Special Medical Questions
Use these questions as a guideline to provide information that will help eliminate some APS's.

Blood Pressure
1. Is medication taken? (How often?) How long was applicant under treatment? Name of medications? 2. How often is blood pressure checked? (Who checks it?) 3. What are the readings? (Give average and when last checked & age.) 4. Date of onset of elevated blood pressure?

Checkup
1. What was the date and reason for the checkup? 2. What symptoms prompted the checkup? 3. What tests were done and what were the results of each? 4. What medication was given? 5. Were any further studies recommended or planned?

Epilepsy, Seizures or Fainting Spells
1. Describe type of seizure, epilepsy or fainting spell.
2. What were the dates of first episode and latest episode? 3. How often do symptoms occur? (Give dates.) 4. What studies have been done? (Give dates and results.) 5. How treated? What medications are taken? (Date M.D. last seen.)

Arthritis
1. Type (i.e. Rheumatoid, Osteo, Gouty, etc.). 2. What joints are involved? (Any swelling or deformity?) 3. What was the date of most recent arthritic episode? 4. What activities are restricted and how often? (How disabling is it?) 5. Age of onset?

Heart Murmur
1. When was symptom diagnosed? 2. Name type of murmur (if known). 3. How was it diagnosed? (What tests were done and dates?) 4. What doctor did the tests and what doctor checked it most recently? 5. Is there any restriction of activities? 6. Any medication? What kind?

Asthma, Emphysema, Bronchitis and Other Respiratory Conditions (including Allergies)
1. How many attacks occur per year? What was the date of the last attack? 2. How disabling are the attacks? (How many days lost from work or school, and what medication was used to control the attack?) 3. Between attacks, what medications are used and how frequently? 4. Are any injected drugs required? (How often?) What are the drugs? 5. Was any hospitalization required? (When and how many days?) 6. Any history of tobacco use?

Back and Neck
1. What areas of the back or neck were affected? 2. How long was applicant out of work? How long were there symptoms present? 3. How was the ailment treated? For how long? Still taking medication?

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Kidney, Bladder, Other Urinary Tract Disorders
1. Give name of the disorder. 2. How many episodes have occurred? (Give dates.) 3. What tests were done and what were the results? (Any surgery recommended?) 4. How was disorder treated? (Give name of any medications.) 5. Is applicant still taking medication? 6. If a kidney stone (urinary stone) was present, was it passed, removed, or still present? How was it removed?

Tumor, Polyp, Cyst
1. Where was growth located? (Where and what organ?) 2. When was it removed and how? (Surgery, burned off, radiation?) 3. Where was growth removed? (Doctor's office, outpatient, or hospital). 4. What did the doctor call it? (Technical name or pathological diagnosis.) 5. Was any treatment or follow-up needed after it was removed? 6. Was the growth diagnosed as cancer?

Mental and Emotional Histories including; Anxiety, Depression and Any Form of Counseling
1. What was diagnosis? 2. How was ailment treated and by whom? Any hospitalization? (When, where, how long)? 3. What were dates and types of counseling, psychotherapy, etc.? 4. What medications were taken and are any medications taken currently? (If none, when was medication discontinued?) 5. Is there any disability? (When and for how long?) 6. Is applicant still under medical care? (What therapist?) If not, when discharged?

Other Conditions (Not listed above)
Always include complete name, address, zip code, and telephone number of the attending physician (and specialty, if known). 1. When was the doctor seen? (Give dates and reason for visit.) 2. What tests were done? 3. What did the doctor call the ailment or disorder? 4. Was medication prescribed? If yes, include the name of the medication. (You can usually obtain the name and dosage from the prescription bottle.) 5. Is medication still being taken? (If not, when was it stopped?) 6. Are there any symptoms, or episodes? (How often?) (Include dates.) 7. Is there any residual impairment? 8. Were any other doctors seen? (If yes, repeat the questions.)

Stomach, Intestine, Colon
1. Was an ulcer found? What type? 2. Was it treated and for how long? 3. When was medication last taken? (Name of medication?) (On any special diet?) 4. Was there any bleeding? 5. Was hospitalization required or contemplated? (When and for how many days?) 6. Was any abdominal surgery performed? (When?) (Why?) 7. Gastritis, irritable bowel syndrome, hiatal hernia or esophageal reflux? Which? How treated? 8. History of ulcerative colitis or Crohn's Disease?

Construction
1. What is the nature of your employment industry? 2. Is worker's compensation available through your employer? 3. Are you covered by worker's compensation? 4. Describe your job duties. 5. Describe your daily activities. 6. Where is the job site or location? 7. Work with any equipment on site? If yes, describe equipment and duties including percentage of time working with equipment. 8. Any injuries on the job within the past 2 years? 9. How long have you been employed in this position? 10. Do you hold any certificates or licenses?

Thyroid
1. Is applicant hyperthyroid (overactive) or hypothyroid (underactive)? Are nodules present? Goiter present? 2. How was ailment treated? (medication, surgery?) 3. What medication is taken and the amounts? 4. What symptoms did applicant have?

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Truck Driving
Average number of miles per day? Any travel outside the state? If yes, where? How often? Any traffic violations in the past 3 years? Dates? Types of violations? DL#? Any overnight stays?

Filed Incomplete or Postponed
Incompletion occurs when the requested information is not received within 45 days after the application date. However, once received, the file can be reopened and a policy issued if the applicant is insurable. Postponements generally occur on risks who are currently highly questionable, but whose history indicates a definite possibility that a satisfactory judgement can be made at a later date.

General (not listed anywhere)
What is the activity/avocation? How often is the activity/avocation performed? Any special license or certification?

Reconsideration of Underwriting Action
Medical exclusions and certain deletions may be reconsidered when there has been an improvement in health status. These may be reviewed after the first policy anniversary with a written request from the Insured and a current report from the attending physician without cost to the Company. An example would be elevated blood pressure condition which has remained within normal limits for one year. (Note: Some conditions remain unacceptable. Refer to the Impairment Guide in this manual). A reconsideration date can be offered in some situations at the time of initial underwriting; you will be advised when this is possible.

Submitting The Application
Before submitting the application to the Home Office, please be sure that: 1. The application, check for the full modal premium, and all other necessary forms are filled out completely, signed and attached together; 2. Within 5 days after completion, mail applications directly to: ANTEX — Issue Department P.O. Box 1998 Galveston, Texas 77553-1998

Underwriting The Application
Underwriting is necessary to determine the degree of risk an applicant for health insurance represents. The risk appraisal is based on information obtained from the following sources: Attending Physician Statements Para Medical Examination Blood Profile Urinalysis Personal History Interview Inspection Reports Medical Information Bureau Special Questionnaires Pharmaceutical Records Department of Motor Vehicle

Counteroffers
Counteroffers may be available when a waiver has been attached for the following conditions: allergy, ulcer/peptic disease, irritable bowel/simple colitis, condyloma, primary hypothyroidism, esophageal reflux disease, otitis media, prostatitis without enlarged prostate, cystitis excluding interstitial, herpes, sinusitis, gastritis excluding alcoholic and erosive, acne, gout, attention deficit hyperactivity disorder, simple bronchitis in non-tobacco user, osteoarthritis excluding large joint involvement, and pharyngitis. A counteroffer, when available, may range between 20% and 100% increase of premium for the individual. The offer is available for adults only on some plans. The individual will be underwritten in the usual manner. It is the agent's responsibility, after conferring with the client, to request a counteroffer.

Modified Coverage
It may be necessary to issue coverage with a medical condition that has been waived or excluded or deny coverage to an applicant due to health history. A medical waiver is available for certain health conditions that would otherwise not be insurable. A substandard extra premium is used for heights and weights in accordance with the build chart in this manual. Final disposition regarding an application is the decision of the Home Office Underwriter. It is possible that two applicants with similar conditions could result in significantly different final action based on other factors.

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PRIVACY AND LEGAL INFORMATION
AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions about this Notice, please contact: Morris Soler, FLMI AVP, Privacy Officer One Moody Plaza, Galveston, Texas 77550 409.766.6420

auditing purposes, for research studies, and for emergencies. We also provide protected health information when otherwise required by law, or for law enforcement purposes, legal proceeding, military activity and national security, to a coroner, funeral director or medical examiner, and when required by the Secretary of the Department of Health and Human Services.

2. Your Rights
Although your health record is the physical property of American National Life Insurance Company of Texas, the information belongs to you. You have the right to: * * request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522 obtain a paper copy of the notice of privacy practices upon request inspect and obtain a copy of your health record as provided for in 45 CFR 164.524 amend your health record as provided in 45 CFR 164.528 obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528 request communications of your health information by alternative means or at alternative locations revoke your authorization to use or disclose protected health information except to the extent that action has already been taken

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. We are required by law to protect the privacy of your information, provide this notice about our information practices, and abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. You can request a copy of our notice at any time.

* * * *

1. Uses and Disclosures of Protected Health Information
We use protected health information about you for health care operations, underwriting, claims processing and policyholder service. For example, we would use or disclose protected health information to MIB, a non-profit membership organization of life and health insurance companies, which operates an information exchange on behalf of its members. Any other uses or disclosures of your protected health information will be made only with your written authorization. You may revoke this authorization at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization. We may use or disclose identifiable information about you without your authorization for other reasons. Subject to certain requirements, we may disclose protected health information without your consent or authorization as for public health purposes, for

You have the right to inspect and copy your protected health information for as long as we maintain the protected health information. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. Please contact our Privacy Contact if you have questions about access to your records. You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. We are not required to agree to a restriction that you may request. If we agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction. You may request a restriction by submitting a letter to the Health Underwriting Department, P.O. Box 1991, Galveston, Texas 77550. You have the right to amend your protected health information. This means you may request an amendment of protected health information about you

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in a record for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Contact if you have questions about amending your records. You have the right to received an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purpose other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members or friends, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations. You have a right to request receipt of confidential communications by alternative means or at alternative locations if you clearly state that disclosure could endanger you. You have the right to have this request reasonably accommodated. You have the right to obtain a paper copy of this notice from us. You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint. You may contact our Privacy Contact, Morris Soler, Assistant Vice President, HIPAA Privacy Officer, American National Life Insurance Company of Texas, 1 Moody Plaza, Galveston, Texas 77550, 409.766.6420 for further information about the complaint process. This notice was published and became effective on April 14, 2003.

NOTICE OF PRIVACY POLICY
American National Life Insurance Company of Texas One Moody Plaza Galveston, Texas 77550
American National Life Insurance Company of Texas is committed to providing insurance and annuity products and services designed to meet your needs. We are equally committed to respecting your privacy and protecting the information about you that we may receive. We have prepared this notice to advise you what information we collect, how we use it and how we protect it.

WHAT INFORMATION WE COLLECT
As an essential part of our business, we obtain certain personal information about you in order to provide a financial product or service to you. Some of the information we receive comes directly from you on applications or other forms, and may include information you provide during visits to our Web site. We may also receive information from physicians, testing laboratories and other health providers, and from consumer reporting agencies. The types of information we receive may include addresses, social security numbers, family information, current and past medical history and financial information, including information about transactions with other financial institutions.

WHAT INFORMATION WE DISCLOSE
We do not disclose nonpublic personal information about our current or former customers to any nonaffiliated entity, except as permitted by law. Examples of the disclosures which we are permitted by law to make include: disclosures necessary to service or administer an insurance or annuity product that you requested or authorized; disclosures made with your consent or at your direction; disclosures made to your legal representative; disclosures made in response to a subpoena or an inquiry from an insurance or other regulatory authority; disclosures made to comply with federal, state or local laws and to protect against fraud.

OUR PRIVACY PROTECTION PROCEDURES
We protect information about you from unauthorized access. Our employees and agents receive training regarding our privacy policies, and access to information about you is restricted to those individuals that need such information in order to provide products and services to you. Examples of activities requiring access to personal information include: underwriting; claims processing; reinsurance and policyholder service. Finally, we employ secure technologies in order to safeguard transmission of information about you through our web sites, and we have established and maintain procedures to comply

11

with all state and federal laws and regulations regarding the security personal information. 4977 (5/01)

OPT OUT PROVISION
American National recognizes an individual's desire to restrict the sharing of information about himself. The Company will comply with a request to "Opt-out" except when necessary to share information in the administration of an insurance contract as permitted by law. American National does not share information with other entities for marketing purposes. We may, however, need to share information with nonaffiliated third parties that provide essential services such as underwriting, policy and claim administration and reinsurance. Such entities are required to agree to maintain the confidentiality of such information. The foregoing types of information sharing are specifically permitted by the federal and state privacy laws and regulations as exceptions to opt-out requirements.

FAIR CREDIT REPORTING ACT PRE-NOTIFICATION
Federal law requires that a notice be given to each applicant that an inspection report may be completed as part of the underwriting process.

NOTIFICATION REGARDING MEDICAL INFORMATION BUREAU (MIB)
The general rules of the Medical Information Bureau of which American National Life Insurance Company of Texas is a member require that each applicant for insurance be given pre-notification regarding the MIB and specifically that the Bureau, upon request, will supply American National Life Insurance Company of Texas with information in its file. American National Life Insurance Company of Texas may also release information to the Bureau.

State Health Plans
In those states with Catastrophic Health Insurance Plans (CHIP), we are obligated by law in selected states to advise residents who have been declined or issued coverage that has been modified of their eligibility for the state plan. This notification will either be sent with the policy or the declination letter.

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HIPAA (Health Insurance Portability & Accountability Act) INFORMATION
HEALTH INSURANCE PORTABILITY ACCOUNTABILITY ACT (HIPAA) & ELIGIBILITY REQUIREMENTS
The Health Insurance Portability and Accountability Act was passed by Congress in August of 1996 and it became effective July 1, 1997. HIPAA provides certain Americans guaranteed access to health insurance coverage regardless of existing health conditions and individual health plans are guaranteed renewable except for non payment of premiums, fraud and discontinuance of a plan for all covered. A health insurer offering individual health coverage must offer coverage on a guaranteed issue basis to an eligible individual, unless a state has implemented any acceptable alternative mechanism (High Risk Pool, Mandatory Group Conversion or Risk Spreading).

Creditable Coverage means, with respect to
an individual, coverage of the individual under any of the following: 1. A group health plans 2. Individual Health insurance plan by specific state law 3. Medicare 4. Medicaid 5. Health insurance plans for members of the U.S. Armed Forces and their dependents 6. A medical care program of the Indian Health Service or of a tribal organization 7. A State health benefit risk pool 8. Health insurance plans for employees of the U.S. Government and their dependents 9. A public health plan (as defined in regulations) 10. A health benefit plan under section 5(e) of the Peace Corps Act (22-2504e) A period of Creditable Coverage shall not be counted if there was more than a 63-day period during all of which the individual was not covered under any creditable coverage. (May vary by state).

Agents Responsibility
The agent is responsible for explaining the coverage options that are available to applicants who are considered "HIPAA Eligible". Form ANL- 4635 - A, "What You Should Know About HIPAA from the American National Family of Companies" is required with each major medical health insurance application submitted to American National. This document provides assistance to the agent in explaining HIPAA eligibility.

Eligibility Criteria
In general, an "Eligible Individual" (a person guaranteed access to coverage) if the following criteria are met: 1. Have prior creditable coverage for a period in the aggregate of 18 or more months and the most recent prior Creditable Coverage was under a group health plan, governmental plan, or church plan (or health insurance coverage offered in connection with any such plan) or any plan specifically designated by a state law; With no greater than a 63 day break in coverage. 2. Not be eligible for coverage under a group health plan, part A or part B of Medicare, or Medicaid (or any successor program) and do not have other health insurance coverage; 3. Have elected and exhausted any applicable COBRA (or similar state law) continuation.

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Guaranteed Access Mechanisms
Please refer to the following chart to determine the Guaranteed Access Mechanism for your client.1
HIPPA Individual and Out-of-State Group Market Access Methods for “Eligible Individuals”2

STATE ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE FLORIDA GEORGIA HAWAII ILLINOIS INDIANA IOWA KANSAS LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW MEXICO NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VIRGINIA WEST VIRGINIA WISCONSIN WYOMING

METHOD NO MARKETING NO MARKETING ANL-2001 STATE RISK POOL NO MARKETING NO MARKETING NO MARKETING ANL-2001 ANL-2000A MANDATORY GROUP CONVERSION ANL-2001 STATE RISK POOL STATE RISK POOL BASIC & STANDARD PLANS STATE RISK POOL STATE RISK POOL NO MARKETING NO MARKETING NO MARKETING STATE RISK POOL STATE RISK POOL ANL-2001 NO MARKETING STATE RISK POOL BASIC & STANDARD PLANS NO MARKETING STATE RISK POOL ANL-2000B NO MARKETING BASIC & STANDARD PLANS STATE RISK POOL NO MARKETING ALTERNATIVE MECHANISM NO MARKETING STATE RISK POOL NO MARKETING ANL-2001 STATE RISK POOL STATE RISK POOL2 ANL-2001 ANL-2001 STATE RISK POOL ANL-2001

NOTE: 1. Guarantee Issue Product is the ANL-2001-P or ANL-2000-P. We offer this product to Eligible Individuals with a choice of the $1,000 deductible under this indemnity version or the $1,000 deductible under the PPO version. No optional benefits available. 2. If person is certified ineligible for Pool, must guarantee issue ANL-2001.

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Major Medical Rate-Up Chart for Height and Weight Female
Risk Add 20% Add 40% Add 50% Not to Std. to Std. to Std. Premium Premium Premium Acceptable 149-163 152-166 155-169 158-173 161-176 164-179 169-185 171-187 174-190 178-195 183-200 187-205 194-212 199-218 211-231 223-243 235-255 164-178 167-181 170-184 174-189 177-192 180-195 186-202 188-204 191-207 196-213 201-218 206-224 213-231 219-238 232-252 244-264 256-276 179-193 182-196 185-199 190-205 193-208 196-211 203-219 205-221 208-224 214-231 219-236 225-243 232-250 239-258 253-273 265-285 277-297 194+ 197+ 200+ 206+ 209+ 212+ 220+ 222+ 225+ 232+ 237+ 244+ 251+ 259+ 274+ 286+ 298+

Major Medical Rate-Up Chart for Height and Weight Juvenile 0 - 13
Height Minimum* Average Weight Weight 24" 28" 32" 36" 40" 44" 48" 50" 52" 54" 56" 58" 60" 62" 64" 66" 68" 70" 72" 9 13 18 23 29 35 42 46 51 56 63 69 74 80 87 93 100 106 113 13 18 23 29 36 44 53 58 64 70 78 86 94 103 112 121 130 139 149 Add 25% to Std. Premium 23 - 30 31 - 40 41 - 52 53 - 62 63 - 77 78 - 91 92-100 101-111 112-123 124-131 132-140 141-153 154-169 170-182 183-195 190-211 196-228 212-237 229-250 Risk Not Acceptable 31+ 41+ 53+ 63+ 78+ 92+ 101+ 112+ 124+ 132+ 141+ 154+ 170+ 183+ 196+ 212+ 229+ 238+ 251+

Height 4'10" 4'11" 5'0" 5'1" 5'2" 5'3" 5'4" 5'5" 5'6" 5'7" 5'8" 5'9" 5'10" 5'11" 6'0" 6'1" 6'2"

Weight Normal 90-148 92-151 94-154 97-157 97-160 99-163 102-168 105-170 108-173 111-177 115-182 118-186 122-193 125-198 129-210 135-222 141-234

Major Medical Rate-Up Chart for Height and Weight Male
Weight Normal 105-183 106-186 109-190 112-196 115-202 118-207 122-213 126-220 130-227 134-230 138-236 142-240 147-248 153-253 158-261 163-269 170-277 178-286 187-295 196-304 Add 20% Add 40% to Std. to Std. Premium Premium 184-201 187-205 191-209 197-216 203-222 208-228 214-234 221-242 228-250 231-253 237-260 241-264 249-273 254-278 262-287 270-306 278-318 287-327 296-336 305-345 202-219 206-224 210-228 217-236 223-242 229-249 235-255 243-264 251-273 254-276 261-284 265-288 274-298 279-303 288-313 307-333 319-349 328-368 337-377 346-386 Add 50% Risk to Std. Not Premium Acceptable 220-237 225-243 229-247 237-256 243-262 250-270 256-276 265-286 274-296 277-299 285-308 289-312 299-323 304-328 314-339 334-360 350-385 369-409 378-418 387-427 238+ 244+ 248+ 257+ 263+ 271+ 277+ 287+ 297+ 300+ 309+ 313+ 324+ 329+ 340+ 361+ 386+ 410+ 419+ 428+

*Minimum weight and below will require an APS for consideration. Note: The average weight shown is given as a reference only. Also, infants under the age of 6 months may require an APS for consideration, if the normal weight is less than the minimum weight referencedabove.

Major Medical Rate-Up Chart for Height and Weight Juvenile Ages 14 - 19
Minimum* Weight Average Weight Height 54" 56" 58" 60" 62" 64" 66" 68" 70" 72" 74" 76" 63 68 73 79 85 91 97 104 110 117 124 131 79 85 92 100 109 117 126 135 144 154 164 174 Add 25% to Std. Premium 132-140 141-153 154-169 170-182 183-195 196-211 200-228 212-237 229-250 238-259 240-264 245-269 Risk Not Acceptable 141+ 154+ 170+ 183+ 196+ 212+ 229+ 238+ 251+ 260+ 265+ 270+

Height 5'1" 5'2" 5'3" 5'4" 5'5" 5'6" 5'7" 5'8" 5'9" 5'10" 5'11" 6'0" 6'1" 6'2" 6'3" 6'4" 6'5" 6'6" 6'7" 6'8"

*Minimum weight and below will require an APS for consideration. Note: The average weight shown is given as a reference only.

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Build
Overweight
Of significant importance in evaluating one's insurability is the relationship of an individual's height and weight. An overweight individual has an increased incidence of cardiovascular disease and renal disease. In addition, there is added stress to the weight bearing joints and bones. Obesity may also be associated with other disorders such as diabetes, psychological disorder or a malfunctioning thyroid or pituitary gland. In addition, obesity usually complicates numerous other diseases and surgical procedures. Recovery time may also be prolonged.

Underweight
Underweight generally is of less significance than overweight concerning long term disabilities and illnesses. However, abnormally thin individuals may have difficulty gaining weight because of nutritional deficiencies, a chronic illness, nervous problems or alcoholism. Frequently, thin individuals have a low resistance to acute illnesses, especially respiratory infections.

Weight Reduction
When weight reduction has been accomplished by voluntary diet, and the weight has been stable for six months or more, full credit will be given for the weight loss if less than 25 lbs. You may enter the height and weight table by using the current weight. If there has been a weight loss of 25 lbs. or more and the weight has not been stable for a period of 12 months, half credit will be given. To enter the height and weight table, add half of the weight loss to the current weight level. ex: Female 5'7" . . . 231 lbs. Lost 36 lbs. within two months. Current weight is 195 lbs. Allow 1/2 credit by adding 18 lbs. to 195. Enter height and weight table at 5'7" . . . 213 lbs. A 40% rate-up in premium is required.

16

List of Commonly Used Drugs
NAME Accupril Aciphex Aclovate Actonel Acyclovir Adalat Adderall Adipex Advair Aerobid Albuterol Aldactazide Aldomet Aldoril Alesse Alprazolam Allopurinol Altace Alupent Amaryl Ambien Amerge Amitriptyline Amoxicillin Anafranil Anaprox Anaspaz Ansamycin Antabuse Antivert Apresoline ARAVA Aricept Arthrotec Atrovent COMMON USE Hypertension GERD, peptic ulcers, dyspepsia Skin disorders, dermatitis Osteoporosis Herpes Infection, AIDS Hypertension Attention Deficit Disorder Obesity-Weight Control Asthma - respiratory disorders Asthma Asthma Hypertension High Blood Pressure High Blood Pressure Contraception Anxiety, panic disorder, depression Gout Hypertension Asthma Diabetes Mellitus Insomnia/Sleeping Disorder MigraineAttack/Headaches Anxiety/Depression Antibiotic - many types of infections, tonsillitis, otitis, cystitis, gonorrhea, botulism Obessive compulsive disorder, depression Non-Steroid Anti-Inflammatory, pain, arthritis Ulcer, irrtable bowel, neurogenic bladder HIV infection Alcohol Abuse Dizziness High Blood Pressure Rheumatoid Arthritis Alzheimer's Disease/Dementia Osteo & rheumatoid arthritis COPD, emphysema, bronchospasm, allergies, bronchitis
17

Asacol A.S.A.(Asprin) Azmacort Atacand Atarax Atenonol Ativan Atromid Avalide Avandia Avapro Avonex Axid AZT Azulfidine Baclofen Bactrim Benemid Baycol Beclomethasone Beclovent Beconase Inhaler Belladonna Benadryl Bentyl Benzac Betaseron Betimol Bextra Biaxin Bicillin Blocadren Brethine Buspar Calan Calcitonin Calcitriol Capoten Capozide Captopril Carafate

Ulcerative Colitis & Proctitis Pain, Fever Asthma Hypertension Antihistamine/ Depression/Sleep Cardiovascular/Hypertension Anxiety/Depression Lowers Cholesterol Hypertension Diabetes Mellitus/Hyperglycemia Hypertension Multiple Sclerosis GERD, Upper GI disorder AIDS Gastrointestinal/Colitis, Inflammatory bowel disease Multiple sclerosis, spinal cord disorders Urinary Tract Infection/Antibiotic Gout/Hyperuricemia/Gouty Arthritis Lowers Cholesterol Asthma Asthma Asthma, allergies Rectal, bladder, urethal spasm Allergies, motion sickness Irritable bowel syndrome, gastrointestinal syndrome Acne Multiple Sclerosis Hypertension, angina, glaucoma, ocular hypertension Arthritis, colon polyps, pain, dysmenorrhea Antibiotic/Infectious Process Infectious disorders Myocardial infarction, angina, cardiovascular disorder Asthma Anxiety Cardiovascular/ Hypertension Osteoporosis, bone disease Hypoparathyroidism, renal failure Hypertension Hypertension Hypertension Ulcer
18

Carac Cardizem Cardura Catapres Ceftin Cefzil Celebrex Celecoxib Celestone Celexa Cephlasporin Chlorothiazide Chlorpromazine Cimitidine Cipro Claritin Cleocin Clindamycin Clinoril Clofibrate Clomid Clonazepam Clonidine Concerta Cogentin Cognex Colbenemid Colchicine Compazine Contuss Copegus Corgard Cortef Cortisol Coumadin Cozaar Cyclobenzaprine Cylert Cystospaz Cytomel

Skin disorder, keratoses, skin cancer Cardiovascular/Hypertension Hypertension/Benign Prostatic Hyperplasia Hypertension Antibiotic/Infectious Process Antibiotic/Infectious Process Osteo/Rheumatoid Arthritis Osteo/Rheumatoid Arthritis Dermatitis, psoriasis, allergies, asthma Depression Many types of infections, bronchitis, URI's, otitis, sinusitis Diuretic, edema, hypertension Psychotic Disorder/Nausea/Vomiting Ulcer Disease/Gastrointestinal Reflux Disease Antibiotic, URI's, UTI's, PID, prostatitis, bone & joint infections, acne Allergic Rhinitis/Chronic Urticaria Antibiotic/Infectious Process Infectious disorders Neuromuscular/Arthritis Lowers Cholesterol Infertility Seizure & panic disorder Hypertension/Cardiovascular Attention Deficit Disorder Parkinson’s Disease Alzheimer's Disease, dementia Gout Acute Gout/Chronic Gouty Arthritis Anxiety, nausea, vomiting Decongestant, cough, bronchitis, URI's Hepatitis C Cardiovascular/High Blood Pressure Adrenal insufficiency, dermatitis Adrenal disorder, Cushings Syndrome Blood Thinner, Stroke, Heart Disease Hypertension Musculo-skeletal disorders, spasms Attention Deficit Disorder Ulcer, irritable bowel, neurogenic bladder, rhinitis Thyroid Replacement
19

Dalmane Danocrine Daraprim Darvocet Daypro DDAVP Decadron (Steroid) Deltasone Demerol Demulen Depakote Depakene Depo provera Desogen Desyrel Detrol Dexedrine Diabeta Diabenese Diamox Diazapam Dibent Dicyclomine Diflucan Digoxin Dilantin Diovan Dipentium Diphenoxylate Dipyridamole Disalcid Disopyramide Ditropan Domperidone Donnatal Doxepin Doxycycline Dramamine Duracef

Sleeping Aid/Hypnotic Endometreosis/Severe Fibrocystic Breast Disorder Malaria Moderate Pain Relief/Analgesic Osteo and Rheumatoid Arthritis Diabetes Insipidus, Enuresis Musculoskeletal, respiratory Arthritis, respiratory disorders, allergies, colitis Pain Killer, analgesic Contraceptive Seizure/Convulsive disorders Seizure/Convulsive disorders Abnormal uterine bleeding, amenorrhea, menopause Oral Contraceptive Depression/Sedation Urinary tract disorders, incontinence Attention Deficit Disorder/Narcolepsy Diabetes Mellitus Diabetes Mellitus Glaucoma, fluid retention Tranquilizer Urinary tract disorders, incontinence, irritable bowel syndrome Irritable bowel syndrome, gastrointestinal symptoms Fungus Infections Heart Disease/Cardiovascular Seizure/Convulsive disorders Hypertension Ulcerative colitis Diarrhea Cardiovascular Disorders Pain, fever, arthritis Cardiovascular Disorder Urinary Urgency/Incontinence & Frequency Gastrointestinal disorders, gastritis Gastrointestinal/Ulcer Antidepressant Antibotic, URIs, UTIs, PID, prostatitis, bone & joint infections, acne Nausea, motion sickness, vertigo Infectious disorders
20

Dur-a-gest Dynacirc Effexor Efudex Elavil Eligard Elmiron Enbrel Enduron Entex Erythromycin Esidrix Estradiol Eskalith Ethambutal Etrafon Euthroid Evista Exelon Famcyclovir Famvir Feldene Fioricet Fiorinal Flagyl Flexeril Flovent Floxin Fluoroqunolones Fluoxetine Flurouacil Fosamax Furosemide Glipizide Glucophage Glucotrol Glyburide Guanethidine Habitrol

Congestion, URIs Hypertension Anxiety/Depression Actinic Keratosis/Basal Cell Carcinoma / Skin Disorders Depression Prostate cancer Bladder pain, interstitial cystitis Rheumatoid Arthritis Diuretic Allergies, Nasal Congestion /Sinusitis Many types of infections, acne, pneumonia, gastroenteritis Hypertension/Diuretic Menopause Symptoms/ Abnormal Uterine Bleeding Manic Depression Tuberculosis Anxiety, depression Thyroid Disorders Osteoporosis prevention Alzheimer's Disease/dementia Genital herpes, zoster, shingles Viral Infections/Herpes/AIDS Musculoskeletal/Pain Analgesic/ Pain Analgesic/ Pain Vaginitis/Yeast Infection Musculoskeletal Pain and Disorders Asthma Antibiotic/Infectious Disease Infections of bone, intestine, respiratory tract Depression, panic disorder, OCD, PMDD, bulimia Cancer, keratoses, skin cancer Treatment or Prevention Osteoporosis Diuretic Diabetes Mellitus/Hyperglycemia Diabetes Mellitus/Hyperglycemia Diabetes Mellitus/Hyperglycemia Diabetes Mellitus/Hyperglycemia High Blood Pressure Smoking Cessation
21

Halcion Haldol Humbid Humira Humulin Hycort Hydrocodone Hydrocortisone Hydralazine Hydro- Chlorothiazide Hydrodiuril Hygroton Hyosine Hytrin Hyzaar Ibuprophen Iletin Insulin Imipramine Imitrex Imodium Imuran Inderal Indocin (NSAID) Indomethacin Intal Inspra Insulin Interferon Isoniazide Isoptin Isordil Isosorbide Dinitrate Keftabs Keflex Kefurox Kerlone Ketoprophen Klonopin

Hypnotic/Sleeping Aid Psychosis Respiratory Infection/ Sinusitis/ Bronchitis Rheumatiod arthiritis, inflammatory bowel disease Diabetes Mellitus Skin disorders, ulcerative colitis, joint/muscle inflammatory disorders, asthma Analgesic, Pain Relief Adrenal insufficiency, dermatitis, ulcerative colitis, ileitis Diuretic, hypertension Diuretic Diuretic Hypertension/Urinary Retention Motion sickness, nausea, gastrointestinal disorders Hypertension/ Urinary Retention Hypertension Arthritis, gout, fever, pain, headaches Diabetes Mellitus Panic Disorders/Depression/Bed Wetting Migraine Headaches Diarrhea Rheumatoid arthritis, immune disorders, MS, Crohn's Disease Cardiovascular/ HBP, Migraine H/A Musculoskeletal Arthritis, bursitis, tendonitis, inflammatory disorders Bronchitis/Asthma Hypertension Diabetes Mellitus Hepatitis, cancer, liver disease Tuberculosis Cardiovascular/ Hypertension Cardiovascular/ Heart Disease Cardiovascular/ Heart Disease Antibiotic/ Infection Process Infection Infectious disorders, otitis media, respiratory infections Hypertension Osteo & rheumatoid arthritis, dysmenorrhea, pain Anxiety/Panic Disorders
22

Klotrix Lamisil Lanoxin Lasix Lescol Levaquin Levbid Levo Dopa Levsin Levsinex Librax Librium Lipitor Lithium Lodine Lomotil Lopid Lopressor Lorazepam Lortrel Lovastin Lozol Ludiomil Lumigan Lupron Marcobid Macrodantin Mavik Maxair Maxolon Maxitrol Maxzide Meclizine Meclomen (NSAID) Medrol Medroxyprogesterone Mellaril Meridia Mesalamine Methotrexate Methyldopa

Potassium Supplement Fungus Infection Cardiovascular/ Heart disease Diuretic, edema Cholesterol, elevated lipids Infections, sinusitis, URIs, UTIs, skin infections Ulcer, irritable bowel, neurogenic bladder, rhinitis Parkinson’s Disease Ulcer, irritable bowel, neurogenic bladder Ulcer, irritable bowel, neurogenic bladder Gastrointestinal Anxiety High Cholesterol/Elevated Lipids Manic Depression Pain, inflammation, arthritis Diarrhea Hyperlipidemia Cardiovascular/ High Blood Pressure Anxiety/ Depression Diuretic/ High Blood Pressure Elevated Lipids/Hyperlipidemia Hypertension Anti-Depressant Glaucoma, ocular hypertension Endometriosis/ Hormone Alteration/Infertility Urinary tract infections Urinary Tract Infection Hypertension, heart disease, angina Asthma Nausea and vomiting, GERD Eye Disease/Glaucoma High Blood Pressure/Diuretic Dizziness/Vertigo Musculoskeletal Asthma/ Arthritis/ Allergies/ Colitis Abnormal uterine bleeding, amenorrhea, menopause Anti-Psychotic Weight Loss/Diet Control Ulcerative colitis Cancer/ Rheumatoid Arthritis/ Psoriasis High Blood Pressure
23

Meticorten MetroGel Mevacor Miacalcin Micronar Micronase Minipress Mobic Moduretic Monopril Mycoleutin Myochrysine Mysoline Nadolol Naldecon Naprelan Naprosyn (NSAID) Naproxen Nasalide Nasacort Neoral Neptazane Neurontin Nexium Nifedipine Nitro-Bid Nitro-Dur Nitroglycerine Norethindrone Norinyl Normodyne Norpace Nortriptyline Norvasc NPH Insulin Ocufen Orasone Orinase

Arthritis, respiratory disorders, allergies, colitis Skin Infections, vaginosis, Crohn's Disease, colitis Lowers Cholesterol, hyperlipidemia Osteoporosis Amenorrhea, endometriosis, abnormal uterine bleeding Diabetes Mellitus High Blood Pressure Osteoarthritis Diuretic, edema Hypertension HIV infection Rheumatoid & psoriatic arthritis, pemphigus Anti-Convulsant, seizure disorder Cardiovascular Disorder Antihistamine/Allergies Arthritis, pain , headache, fever Musculoskeletal Disorders Inflammation, pain, arthritis, gout, bursitis Allergies Allergic Rhinitis Rheumatoid arthritis, psoriasis, tissue rejection Glaucoma Seizure/Convulsion Disorders Gastrointestinal disorders, GERD, esophagitis, duodenal ulcer, H-pylori Cardiovascular/Hypertension Cardiovascular Disorders Cardiovascular Heart Disease Cardiovascular/Heart Disease/Angina Amenorrhea, endometriosis, abnormal uterine bleeding Hormone/Contraceptive Cardiovascular/Hypertension Anti-Arrhythmic/Cardiovascular Anxiety Cardiovascular/Hypertension Diabetes Mellitus Arthritis, eye inflammation Arthritis, respiratory disorders, allergies, colitis Diabetes Mellitus
24

Olanzapine Ortho-Novum Ortho-Cyclen Orudis Oruvail Pamelor Parlodel Paxil Penicillin Pentasa Pepcid Percocet Percodan Peri-Colace Permax Persantine Phenergan Phenobarbitol Piperacillin Pitressin Plaquenil Plavix Plendil Podophyllin Precose Prednisone (Steriod) Prilosec Prelone (Steriod) Premarin Prevacid Prilosec Prinivil Prinizide Pravachol Probenecid Procan Procardia Progesterone Proloprim Promethazine

Psychotic Disorders Hormone/Birth Control Birth Control Arthritis, dysmenorrhea, pain Rheumatoid/ Osteoarthritis Anxiety Hormone/Cocaine Abuse/Infertility Anxiety/Panic Disorders Many types of infections, tonsillitis, otitis, cystitis, gonorrhea, botulism Ulcerative colitis Gastrointestinal Disorders Moderate Pain Relief Pain Killer/Analgesic Gastrointestinal Parkinson’s Disease Anti-Anginal/Heart Disease/Vascular Disorder Allergy/ Nausea/ Vomiting/Sedation Convulsions/ Seizures/ Sedation Infectious disorders, skin infections, respiratory infections Diabetes insipidus Lupus Erythematosus/ Rheumatoid Arthritis Atherosclerosis/ Stroke/ Myocardial Infarction Hypertension Genital warts Diabetes Mellitus Respiratory/ Musculoskeletal/Colitis Upper Gastrointestinal Disorders Allergies/ Breathing Disorders Hormone Upper Gastrointestinal Disorders Ulcer disease, GERD, esophagitis Hypertension Hypertension Cholesterol/ Atherosclerosis/Lipidemia Arthritis, gout, hyperuricemia Anti-Arrhythmic/Heart Disease Cardiovascular/ High Blood Pressure Hormone Male/Female Disorders Urinary tract infections, bronchitis Motion sickness, nausea, dizziness, sedation, allergy
25

Propranolol Propulcid Propylthiouricil Proscar Protonix Proventil Provera Provigil Prozac Questran Quiafenex Quidtix Quinidine Recaltrol Reglan Regroton Relafen Remeron Remicade Relpax Respiradol Restasis Restoril Rhinocort Ridural Rifabutin Ritalin Rocaltrol Rocephin Rofecoxib Roferon Rowasa Rufen (NSAID) Rhythmid Salflex Sarafem Scopolomine Sectrol Seldane Septra Serevent

Cardiovascular/ Hypertension Upper Gastrointestinal Disorders Thyroid Disorders Prostate Disorders Esophagitis, GERD, heartburn Asthma / Bronchitis Hormone Replacement Multiple sclerosis, narcolepsy Anti-Depressant Lowers Cholesterol, hyperlipidemia Expectorant, URIs, bronchitis, lung disorders URI, sinusitis Anti-Arrhythmic, heart disorder Parathyroid Disease Gastrointestinal Disorders, GERD, nausea High Blood Pressure Rheumatoid & Osteoarthritis Depression/Mental Disorders Crohn’s Disease, rhematoid arthritis Migraine headaches Psychotic Disorders Dry eye syndrome Sedative/Hypnotic, sleep disorder Allergic Rhinitis Rheumatiod arthritis, psoriasis HIV infection Attention Deficit Disorder Hypoparathyroidism, renal failure Infections, URIs, UTIs, bone & joint, skin, gonorrhea Osteoarthritis/ Dysmenorrhea Hepatitis, cancer, liver disease, sarcoma Ulcerative Colitis/ Proctosigmoiditis Musculoskeletal Atrial fibrillation/ Tachycardia/Cardiac Arrythmia Pain, fever, arthritis Depression, panic disorder, OCD, PMDD, bulimia Motion sickness, nausea, gastrointestinal disorders Cardiovascular/Hypertension Antihistamine, allergies Infectious Process/Otitis, Urinary Tract Infection Asthma/Respiratory Disorders
26

Serzone Sinemet Sinequan Singulair Slo-Bid SOMA (compound) Spironolactone Sonata Skelaxin Stelazine Sular Sulfamethoxazole Sulfapyridine Sulfasalazine Sulfisoxazole Sulindac Symmetrel Synthyroid Tagamet Tamadol Tarka Tavist Tegretol Tenorectic Tenormin Tequin Testosterone Tetracycline Theobid Theo-Dur Thorazine Ticlid Tigan Timoptic Tenex Tofranil Tolectin (NSAID) Tolinase Travatan

Depression/Mental Disorders Parkinson’s Disease Anti-Depressant/Mental Disorders Asthma Asthma /Bronchitis Musculoskeletal Pain/Spasm/Arthritis Diuretic, edema, hypertension Insomnia/Sleep Disorder Musculoskeletal Pain Anti-Psychotic, psychosis Hypertension Infectious Process/Urinary/Ear/Colon Ulcerative colitis, rheumatoid arthritis Ulcerative colitis, rheumatoid arthritis Otitis media, respiratory infections, pelvic inflammatory disease Inflammatory disease, arthritis, gout, rheumatoid disorders Parkinson’s/Viral Disease Thyroid disorder Gastrointestinal disorder, ulcer Pain - non-narcotic Hypertension Respiratory/Allergy Anti-Convulsant, seizure disorder High Blood Pressure Cardiovascular/Hypertension Infections, sinusitis, URIs, UTIs, skin infections Hormone deficiency Infections, URIs, acne Asthma Asthma Anti-Psychotic, psychosis Stroke, CVA Nausea and vomiting Hypertension, angina, glaucoma, ocular hypertension Hypertension Anti-Depressant/Enuresis Musculoskeletal disorder Diabetes Mellitus Glaucoma, ocular hypertension
27

Trazadone Tranxene Trental Triam cinolone Triamterene Trichloroacetic Acid Trimpex Trinalin Ultram Unipres Univasc Urex Urised Urispas Valium valtrex Vanceril Vantin Vasopressin Vasotec Ventolin Verapamil Vestide Viadur Viagra Vicodin Vioxx Visken Vistaril Vivactil Warfarin Wellbutrin Wytensin Wygesic Xalatan Xanax Xenical Zantac Zaroxolyn Zebeta Zestril

Depression/Sedation Anxiety Peripheral Vascular Disease Arthritis, asthma, allergy, dermatitis Hypertension/Diuretic Removal warts & callous tissue Urinary tract infection , bronchitis Respiratory/Congestion/Allergic Rhinitis Moderate PainRelief/Musculoskeletal Hypertension Hypertension Urinary Tract Infection Urinary Tract Infection Urinary tract infections, incontinence Anxiety Genital herpes, zoster, shingles Asthma/ Respiratory Disorders Infectious Process/Bronchitis/Otitis Diabetes insipidus Cardiovascular/ Hypertension Asthma Cardiovascular/Hypertension Herpes Prostate cancer Impotence Pain Relief Osteoarthritis/Dysmenorrhea Cardiovascular/ Hypertension Antihistamine / Anti-nausea Antidepressant Blood Clots/Stroke/Heart Attacks Mental/Nervous Disorders Hypertension Pain Killer/Analgesic Glaucoma, ocular hypertension Anxiety/Manic Disorders Weight Loss/Maintenance Gastrointestinal Disorders Diuretic/Hypertension Hypertension High Blood Pressure
28

Zetia Ziac Zithomax Zithomycin Zocor Zoloft Zomig Zostrix Zovirax Zyloprim Zyprexia Zyrtec

Elevate cholesterol and triglycerides Hypertension Infectious disorders, otitis media, tonsillitis Infectious disorders, otitis media, tonsillitis Hyperlipidemia Mental/Nervous Disorders/Depression Migraine Treatment & Prophylaxis Arthritis, postherpetic neuralgia, diabetic neuropathy Herpes / Zoster Gout/Gouty Arthritis Psychotic Disorders Allergic Rhinitis/Allergies/Urticaria

29

UNACCEPTABLE HEALTH CONDITIONS
There are a number of reasons why the Company would have to decline coverage on an individual: 1. If the applicant requires in excess of 3 medical exclusions; 2. If the applicant is receiving medical benefits 3. If surgery, special tests, treatment or doctor's appointment scheduled or recommended but not yet performed; 4. If any family member is pregnant at the time of application (whether on the application or not). In this case, no coverage is issued to any family member. We will consider an application taken 30 days or more after delivery; 5. If weight exceeds maximum allowable as indicated on the height and weight tables; 6. United States residency is less than two years or the applicant does not anticipate permanent residence in the United States; 7. Driving Criticism a. Careless or reckless driving, speeding tickets, at fault accident, other moving violations; 3 or more within 12 months 5 or more within 24 months b. DUI or DWI, or arrest within 2 years 8. Felony, conviction, DUI, imprisonment within 5 years

9. Premium rating exceeds the maximum allowable by Company; 10. The following medical conditions are unacceptable:

Addison's Disease AIDS/ARC Alcoholism or Abuse 0-5 years Aortic Stenosis Arteriosclerosis Black Lung Blood Pressure - Uncontrolled Buerger's Disease Bundle Branch Block Bypass Surgery Cancer Internal-10years Skin-1-3 years Melanoma 10 years Congestive Heart Failure Coronary Insufficiency

Cardiomyopathy/Myocardiopathy Cardiovascular - Renal Disease Carotid Artery Disease Cerebrovascular Accident (CVA) Transient Ischemic Attack (TIA)/Stroke Cerebral Embolism/Thrombosis/Hemorrhage Chorea, Huntington's Cirrhosis, Liver Cor Pulmonale Cretinism Cystic Fibrosis Diabetes Drug Addiction/Abuse 0-10 years Emphysema Epilepsy 0-5 years Esophageal Varices Heart Attack Hemophilia Hepatitis (Type B) 0-2 years Hepatitis C Hodgkin's Disease Hydrocephalus Leukemia Locomotor Ataxia Lupus Erythematosus (Systemic or Disseminated) Multiple Sclerosis Muscular Dystrophy Myasthenia Gravis Myxedema Nephrotic Syndrome Neurofibroma, Multiple Pacemaker Paget's Disease of Breast Paraplegia Parkinson's Disease Peripheral Vascular Disease Polycystic Kidney Disease Polycythemia, Primary Pneumoconiosis Pott's Disease Pulmonary Embolism 0-1 year Quadriplegia Raynaud's Disease/Syndrome-5 years Stroke Thromboangiitis Obliterans (Buerger's Disease) NOTE: There are many conditions for which a person may be declined - The above list is some of the more prevalent unacceptable disorders.

30

UNDERWRITING GUIDE
There are two columns of information to be concerned with in the underwriting guide. The first column lists alphabetically the most common health conditions encountered in underwriting. Where appropriate, specific recovery periods are referred to, such as "within 5 years". This period refers to the time since occurrence or the diagnosis in the case of an acute condition, or the time since the last episode in a recurrent condition. References are also made to "recovered" or "no residuals", which are self-explanatory. Underwriting action for some conditions depends on severity. Where possible, we have included specific references to symptoms and/or treatments which may help clarify the severity level. In all cases, however, the underwriter's judgment after reviewing all of the facts will determine the appropriate action. The second column of information lists the most likely underwriting action.

The abbreviations used in the underwriting action column are defined as follows: S D IC W = = = = Standard Decline Individual Consideration Waiver

31

IMPAIRMENT GUIDE
The prescription drug benefit and doctor office visit rider may not be available with certain medical conditions such as: Acne, Gout, Mental/Nervous Disorders (if approved), Seizure Disorders, Headaches, Hyperactivity (ADHD), Sinusitis, Asthma, Allergy, Gastrointestinal Disorders, Hernias, Urinary Tract Disorders, Herpes, Thyroid Disease, Arthritis, Bronchitis, Otitis Media, Rheumatism, Tonsillitis, Pharyngitis.

HEALTH CONDITION
ADDISON'S DISEASE A disorder of the adrenal glands ADHESIONS The abnormal adhering or uniting of two surfaces present operated recurrent AIDS/ARC Acquired Immune Deficiency Syndrome, generally a fatal disease which attacks the body's immune system. AIDS Related Complex, a constellation of chronic signs and symptoms with an increased incidence of AIDS, without the typical manifestations characterized by full-blown AIDS. ALBUMINURIA Presence of the protein albumin in the urine. ALCOHOL ABUSE More than 24 drinks per week (one drink = 1 oz of liquor, 4 oz of wine, 12 oz of beer) Current Abstinent for 5 years ALCOHOLISM The use of alcohol to the extent that is causes impairment in interpersonal, social or professional functioning Present, AA recommended and non-compliant or counseled by Health Care Professional Abstinent for 5 years ALLERGY A state of hypersensitivity induced by exposure to a particular antigen resulting in an immune reaction. Mild: Hay fever, seasonal, treated with over the counter medications. Moderate: allergic rhinitis, requires doctor visits for treatment with a short course of medication(s) lasting only 1-2 weeks in duration - no more than 3 times a year - uncomplicated course not requiring a desensitization program or frequent or going use of the following type drugs: nasal sprays oral medications or steroids (except those used in nasal sprays). not more than 3 episodes per year over 3 episodes per year or requiring above treatment

ACTION
Major Medical
D

W S W

D

IC

D IC

D IC

S

S W

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

32

IMPAIRMENT GUIDE HEALTH CONDITION
ALLERGY (continued) Severe: Require more than 3 physician visits per year, oral steroids, pending allergy work-up, complicated by other disorders such as asthma, sinusitis, otitis, bronchitis and eczema. Desensitization/Allergy shots (if otherwise insurable) AMPUTATION Traumatic one to three fingers more than three digits, one hand, one arm, one foot or one leg more than one extremity Due to disease ANAL or RECTAL FISSURE Splitting or drainage from the anus Crohn's disease and ulcerative colitis ruled out present cured, one occurrence (after 6 months) recurrent ANAL FISTULA/FISTULA-IN-ANO Crohn's disease and ulcerative colitis ruled out present to 2 years cured, no recurrence within 2 years recurrent ANAL or COLON POLYP (See Polyp) A growth in the anal area or colon ANEMIA Aplastic, Sickle Cell, Thalassemia Major, Cooley's Mediterranean Pernicious, no organic cause found. 0-18 years of age 19-64 years of age Congenital Hemolytic unoperated operated/splenectomy recent to 2 years after 2 years Iron deficiency - evaluated and corrected ANEURYSM A sac filled with blood and formed by the stretching of the wall of an artery or vein. Intracranial Aorta (Thoracic or Abdominal) Congenital (other than brain, thoracic, abdominal) present to 2 years operated after 2 years

ACTION
Major Medical
D

W

S IC IC D

W S W

W S W

D D W D W S S

D D D IC

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

33

IMPAIRMENT GUIDE HEALTH CONDITION
ANEURYSM (continued) Traumatic, of smaller vessels present operated, simple ligation within 1 year after 1 year, no other cardiovascular impairment Arteriovenous (malformation) present operated, removed, no residuals within 1 year after 1 year ANGINA PECTORIS ANGIOPLASTY ANOREXIA NERVOSA; BULIMIA Eating disorder characterized by a disturbed sense of body image and morbid fear of obesity. present to 2 years after 2 years, normal weight, no ongoing emotional disorders AORTIC COARCTATION A narrowing or constriction of the aorta. present operated, no residuals, no medication within 2 years 2-5 years after 5 years, no other cardiovascular impairments AORTIC STENOSIS A narrowing of the aortic valve orifice of the heart. APPENDICITIS Abscess/Inflammation of the appendix present to 1 year operated ARTHRITIS (See Rheumatism) Osteoarthritis Mild limited pain, no loss of joint mobility, treated with over the counter medications. No doctor visits. Osteoarthritis Moderate pains in hands, small joints, 2-3 doctor visits per year, daily medication, no limitations

ACTION
Major Medical
D D IC D D IC D D

D IC

D D W IC

D

W S

S

W

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

34

IMPAIRMENT GUIDE HEALTH CONDITION
ARTHRITIS (See Rheumatism) (continued) Osteoarthritis Severe: progressive pain, joint limitation, monthly doctor visits, crippling or non-crippling Rheumatoid Arthritis Psoriatic Arthritis Reiter's Syndrome Degenerative Joint Disease Gonococcal Arthritis Juvenile Arthritis ASCITES Abnormal accumulation of fluid in the abdominal cavity. present recovered ASTHMA A condition marked by recurrent attacks of dyspnea and wheezing due to spasmodic contraction of the bronchi. Mild: no doctor visits, no wheezing, no time lost from work or school. Treated with over the counter medications only. Moderate: no hospitalizations, no time lost from work or school, 2 - 3 doctor visits per year, no more than 3 episodes per year lasting no more than 1 week each duration - medication may include only oral inhalers, oral medications without steriod components, and nasal sprays (may include steriods) non-smoker. no more than 3 episodes per year over 3 episodes per year Severe: requires frequent medication or medication in excess of 1 week per episode, frequent doctor visits, oral or injectable steriods or oral medications with steriod components, more than 2 medication, requires breathing treatments or oxygen use, work up is pending, is complicated by other disorders such as allergy, sinusitis, otitis, bronchitis, eczema, or history of abnormal pulmonary function Desensitization shots (if otherwise insurable) Smoker

ACTION
Major Medical
IC D D D W D D

D IC

S

S W

D W D

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

35

IMPAIRMENT GUIDE HEALTH CONDITION
ATRIAL (AURICULAR) FIBRILLATION Under age 40 years 1 brief attack, no evidence of heart disease 0 - 2 years after 2 years, no further symptoms or treatment Over 40 years of age ATRIAL SEPTAL DEFECT An opening in the wall of tissue which divides the upper chambers of the heart. present operated, no residuals within 1 year after 1 year children adults AUTISM BACK SPRAIN/STRAIN/PAIN acute, single episode, no hospitalization within 1 year after 1 year two or more occurrences, or single episode with disability or hospitalization within 3 years after 3 years frequent massages, physical therapy or chiropractic care Sciatica BELL'S PALSY Facial paralysis acute, recovered chronic or residuals BLINDNESS not due to disease - self sufficient due to disease BLURRED VISION within 1 year, no work up, diagnosis not established after 1 year

ACTION
Major Medical
D S IC

D D Usually S IC IC

W S

W S W IC

S W

Usually S IC

D IC

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

36

IMPAIRMENT GUIDE HEALTH CONDITION
BLOOD PRESSURE High Blood Pressure (Hypertension) Date of onset, age, changes in medication and /or fluctuations in readings will be taken into consideration for the assessment of this condition. Applicants must demonstrate documented control with regular physician consultations for a minimum of 3 consecutive readings at least one week apart for blood pressure of 140/85 or less prior to the application date. Controlled blood pressure, uncontrolled blood pressure and co-morbility factors related to blood pressure are as follows:

ACTION
Major Medical

Controlled Blood Pressure: 25-49 years of age - average BP under 140/85 50-64 years of age - average BP under 150/90 no more than 2 BP medications per day plus diurectic Uncontrolled Blood Pressure: 25-49 years of age - average BP over 140/85 50-64 years of age - average BP over 150/90 3 or more BP medications daily - none a diurectic Related Co-Morbidity Factors: Hypertension with hyperlipidemia Hypertension with ratable build Hypertension with tobacco use LOW BLOOD PRESSURE: No history of syncope or associated disease Otherwise S IC W W D W* (25% + $1000 Rx deductible with Major Medical Light Plan)

D

*Exclusion Waiver:
"This policy shall not cover treatment for hypertension including but not limited to office visits, consultations, advice, and/or medications used for the treatment of hypertension or elevated blood pressure."

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

37

IMPAIRMENT GUIDE HEALTH CONDITION
BRAIN TUMOR unoperated (benign or malignant) operated - malignant within 10 years after 10 years, no residuals operated - benign after 1 year- no medication, seizures or symptoms after 5 years - no residuals BREAST AUGMENTATION BREAST REDUCTION recent to six months no symptoms, additional diagnosis or treatment after 6 months, negative mammogram BREAST TUMOR OR CYST (Fibrocystic Breast Disease - see page 51) benign cystic mastopathy and benign calcifications 0-2 years after 2 years, no additional symptoms, cysts, or calcifications, 3 stable mammograms fluid filled cysts, micro calcifications, or other findings pending mammogram, surgery or workup malignant; cured present to 10 years after 10 years no recurrence, no metastasis after 10 years with augmentation BRONCHITIS Inflammation of the bronchial tubes Mild: no doctor visits, no wheezing, no time lost from work or school, treated with over the counter medications - no more than 2 episodes a year Moderate: no hospitalizations, no time lost from work or school, episodes lasting less than one week, non smoker, required short course of the following type drugs: antibiotics, decongestant, or inhalant sprays 1 - 2 episodes per year Severe: over 3 to 4 episodes per year continuous medication including injectable and oral steroids, breathing treatments, smoker desensitization/allergy shots (if otherwise insurable)

ACTION
Major Medical
D D IC W S W

W S

W S W D D S W

S

W D D W

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

38

IMPAIRMENT GUIDE HEALTH CONDITION
BUERGER'S DISEASE An inflammation of the lining of the blood vessels in the extremities with obstruction causing impaired circulation and gangrene. BUNDLE BRANCH BLOCK (See CARDIOVASCULAR DISORDERS) BUNION (See Foot Disorders) present operated, recovered BURSITIS (See Rheumatism) BYPASS OPERATIONS Coronary bypass (See CORONARY ARTERY DISEASE) Intestinal bypass/Gastric stapling within 5 years after 5 years, weight stable with no recurring GI problems CANCER, INTERNAL (including Hodgkin's Lymphoma) Any malignant growth or tumor present surgically removed, no metastasis or lymph node invasion after 10 years with lymph node invasion or metastasis - after 15 years Cancer In Situ - surgically treated, negative follow-up CANCER, SKIN Basal Cell present 1 occurrence; 3 months after 3 months - no recurrence multiple recurrences Squamous Cell present 1 occurrence; 0-1 year after 1 year - no recurrence multiple recurrences Melanoma present surgically removed, no metastasis or recurrence; 0 - 10 years after 10 years

ACTION
Major Medical
D

W S

D IC

D S IC IC

D W S IC D W S IC D D IC

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W- Waiver

39

IMPAIRMENT GUIDE HEALTH CONDITION ACTION
Major Medical
IC

CARCINOMA IN SITU, CERVIX (See CANCER, INTERNAL) CARDIOMYOPATHY-MYOCARDIOPATHY Disease of the heart muscle. CARDIOVASCULAR DISORDERS Cardiovascular Defects Aortic Coarctation A narrowing or constriction of the aorta. present operated, no residuals, no medication within 2 years 2 - 5 yeasrs after 5 years, no other cardiovascular impairments Atrial Septal Defect/Ventricular Septal Defect An opening in the wall of tissue which divides the chambers of the heart. present operated, no residuals, no medication within 1 year after 1 year children adults Patent Ductus Arteriosus A channel between the aorta and the pulmonary artery. present operated, no residuals within 1 year after 1 year, no residuals adult Pulmonary Stenosis A narrowing of the opening between the pulmonary artery and the right ventricle Mitral Stenosis A narrowing of the left atrioventricular orifice Tetralogy of Fallot A combination of congenital defects: pulmonary stenosis, interventricular septal defect, dextroposition of the aorta and right ventricular hypertrophy

D

D D W IC

D D

Usually S IC

D D Usually S IC

D

D

D

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

40

IMPAIRMENT GUIDE HEALTH CONDITION
CARDIOVASCULAR DISORDERS (continued) Transposition of the Great Vessels Cardiovascular malformation where the aorta arises entirely from the right ventricle and the pulmonary artery from the left ventricle. Heart Valve Disorder Bicuspid Aortic Valve An aortic valve with 2 cusps instead of the normal 3 cusps Mitral Regurgitation/Insufficiency A backflow of blood from the left ventricle into the left artrium due to insufficiency of the mitral valve. Mitral Valve Prolapse Prolapse of the mitral valve sometimes causing regurgitation. Incidental finding - no treatment, no symptoms, no other cardiac disorder or symptoms - after 1 year. Symptomatic, under treatment, chest pain, shortness of breath or not fully worked up. After 5 years, no symptoms or treatment Heart Rythym Disorder Arrhythmia Any variation from the normal rhythum of the heart beat Atrial Fibrillation An arrhythmia in which small area of the atrial myocardium becomes uncoordinated resulting in a abnormal rhythum Under age 40 years 1 brief attack, no evidence of heart disease 0 - 2 years after 2 years, no further symptoms or treatment Over 40 years of age Bradycardia Slowness of the heartbeat Irregular heartbeat A heart beat that does not occur at regular intervals Tachycardia Excessive rapidity of the action of the heart Heart Murmurs Murmurs An unnatural sound heard over the area of the heart. Systolic Diastolic

ACTION
Major Medical

D

D

D

S D W

IC

D S IC

IC

IC

IC

IC D

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

41

IMPAIRMENT GUIDE HEALTH CONDITION
CARDIOVASCULAR DISORDERS (continued) Heart Blocks Atrioventricular Blocks 1st degree - PR interval <.20, no history or symptoms of heart disease, incidental finding on EKG. 2nd degree 3rd degree Bundle Branch Blocks A disturbance in the electrical conduction within the heart. Right incomplete, no other heart disorders Right complete Left incomplete Left complete Fascicular or Hemiblock Wolf-Parkinson-White Syndrome Surgically treated Otherwise Heart Disease Angina Pectoris (Coronary Insufficiency) Arteriosclerosis/Atherosclerosis Arteriosclerosis Atherosclerosis Incidental finding on x-ray Otherwise Cardiomegaly (enlarged heart) Carotid Artery Disease Occlusive disease of the arteries to the brain. (Stroke, CVA, TI A , decrease blood supply to the brain). Claudication, Intermittent Pain and cramping in the leg muscles causing lameness and indicative of vascular disease. Coronary Artery Disease Myocardial Infarction, Thrombosis, Occlusion Coronary Bypass - Heart Attack Cor pulmonale/Pulmonary Hypertension Heart failure secondary to chronic obstructive lung disease or other pulmonary disorder.

ACTION
Major Medical

S IC D

Usually S IC IC D D

IC D

D

D IC D D

D

D

D D

D

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

42

IMPAIRMENT GUIDE HEALTH CONDITION
CARDIOVASCULAR DISORDERS (continued) History of Congestive Heart Failure Chronic inability of the heart to provide an adequate flow of blood. Myocarditis Inflammation of the heart lining. Single attack, no residuals recent to 2 years after 2 years CARPAL TUNNEL SYNDROME A common painful disorder of the wrist and hand. present recent to 5 years after 5 years, no symptoms operated, 0-1 year after 1 year, no residuals CATARACTS Clouding of the lens of the eye. Traumatic / Congenital / Senile present operated no artificial lens with artificial lens Secondary to disease CELLULITIS Inflammation of the skin. present recovered CEREBRAL PALSY A motor function disorder caused by a brain defect or lesion present at birth (or shortly thereafter) CESAREAN SECTION under 45 years of age, no subsequent normal delivery otherwise CEREBRAL EMBOLISM, THROMBOSIS, HEMORRHAGE CVA, stroke, TIA

ACTION
Major Medical

D

D S

W S W S

W S W D

W S

D

W S

D

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

43

IMPAIRMENT GUIDE HEALTH CONDITION
CERVICITIS Inflammation of the neck of the uterus. Abnormal PAP smear Atypical squamous cells of undetermined significance (ASCUS) 0- 1 year after one year-normal PAP smear; no abnormal pathology Cervical Intraepithelial Neoplasia (CIN I, II & III) 0-2 years after 2 years- all tests normal including PAP smear Cervical Cancer in-situ (See Cancer-Internal) Human Papilloma Virus 0-3 years after 3 years-no residuals, lesions, or abnormal pathology Surgically treated - no recurrence - normal PAP smear 0 - 6 months after 6 months - no recurrence CHOLECYSTITIS, CHOLELITHIASIS Inflammation of the gall bladder, presence of stones in the gall bladder. history of no stones, one attack recent to 3 years after 3 years recurrent attacks operated, cholecystectomy recent to 3 months after 3 months stones present CHOREA, HUNTINGTON'S A chronic, degenerative neurological disease. CHOROIDITIS, IRITIS, UVEITIS or RETINITIS An inflammation of a specific part of the eye. recent to 2 years recovered after 2 years recurrent attacks secondary to other disease CHRONIC FATIGUE SYNDROME (Epstein-Barr Virus) Caused by the virus that causes infectious mononucleosis recent to 5 years recovered after 5 years CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

ACTION
Major Medical

W S W S

W S W S

W S W W S W

D

D S IC D

D IC D

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

44

IMPAIRMENT GUIDE HEALTH CONDITION
CIRRHOSIS, LIVER Hardening and scarring of the liver. CLAUDICATION, INTERMITTENT CLEFT PALATE/LIP A congenital defect of the upper mouth. unoperated corrected, no further treatment required COLITIS Inflammation of the colon. Irritable bowel syndrome, spastic, mucous or simple colitis present to 3 years, well established, no complications, asymptomatic with medication after 3 years, recovered, no medication Ulcerative colitis, Crohn's Disease, Ileitis or Proctitis single attack, recovered, no medication, no surgery within 5 years within 6 to 10 years after 10 years recurrent attacks, under treatment, colostomy or ileostomy present COLLAGEN DISEASES / DISORDER A group of generalized vascular disorders affecting connective tissue characterized by fibrinoid necrosis or vasculitis. These include lupus erythematosis, discoid lupus, scleroderma, rheumatoid arthritis, polymyositis, dermatomyositis, osteogenesis imperfecta, Ehlers-Danlos Syndrome, Marfan's Syndrome, rheumatoid arthritis, polyarteritis nodosa COLLAPSED LUNG - SEE PNEUMOTHORAX COLOSTOMY/ILEOSTOMY Surgical creation of an artificial opening from the colon or other part of the intestine CONCUSSION, BRAIN or CLOSED HEAD INJURY A condition caused by a blow on the head. recent to 6 months after 6 months, no residuals with subdural hematoma CONDYLOMA ACUMINATA (See Veneral Warts)

ACTION
Major Medical
D D

W S

W S

D W S D

D

D

D Usually S IC

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

45

IMPAIRMENT GUIDE HEALTH CONDITION ACTION
Major Medical
D

CONGESTIVE HEART FAILURE Chronic inability of the heart to provide an adequate flow of blood. CONNECTIVE TISSUE DISORDER A group of generalized disorders affecting connective tissue (see Collagen Disease). Also included is Mixed Connective Tissue Disease CONVULSIONS (See Seizure Disorders) CORNEAL ULCER An ulcer on the cornea of the eye. present cured viral infection, after 6 months with no residual scarring traumatic, after 2 years CORONARY INSUFFICIENCY CORONARY OCCLUSION, THROMBOSIS (See Cardiovascular Disorders) COR PULMONALE COSTOCHONDRITIS present Fully recovered (no symptoms, no treatment) CROSS-EYE, WONDERING EYE OR WALLEYE (See Strabismus) CUSHING'S DISEASE Hyperactivity of the adrenal and pituitary glands present 0-2 years after complete resolution after 2 years-normal adrenal function-no medications or replacement hormones. CYSTIC FIBROSIS An abnormality of body secretions, manifested mainly as a respiratory disorder CYSTITIS (BLADDER INFECTION) Inflammation of the urinary bladder acute, single attack recovered within 6 months after 6 months no residuals or complications

D

W S S D

D D

W S

D D S

D

W S

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

46

IMPAIRMENT GUIDE HEALTH CONDITION
CYSTITIS (BLADDER INFECTION) (continued) recurrent attacks recent to 2 years after 2 years Interstitial cystitis CYSTOCELE - See Uterine Displacement Hernia protrusion of the bladder through the vaginal wall. DEAFNESS, Hearing loss not due to illness, hearing aid present, no cochlear implant high frequency loss other DEPRESSION (See Mental/Nervous Disorders) DERMATITIS - See Skin Disorders DETACHED RETINA Separation of the retina from the back wall of the eyeball. present to 12 months recovered after a year, no recurrence, no residuals, no underlying causes more than one occurrence, same eye DEVELOPMENTAL DELAY Motor coordination and speech delay. 0-18 years of age 18 years and over DEVIATED SEPTUM A defect in the partition which separates the nasal cavities. operated, no further treatment required, after 6 months, no obstruction unoperated or with residuals DIABETES MELLITUS/HYPERGLYCEMIA A metabolic disorder causing excess sugar in the blood and urine. DISC DISEASE / SPINAL STENOSIS / SUBLUXATION herniation, rupture or slipped disc present single occurrence recovered within 5 years

ACTION
Major Medical
W S W

S W IC

W

S D

D IC

S W

D

W

W

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

47

IMPAIRMENT GUIDE HEALTH CONDITION
DISC DISEASE / SPINAL STENOSIS / SUBLUXATION (continued) after 5 years, no residuals, no pain, no weakness no symptoms more than one occurence, operated, recovered, one surgery 0-5 years after 5 years, no problem continued symptoms or treatment, multiple surgeries Chiropractic treatment, massage or physical therapy Sciatica DISLOCATION, STRAIN OR SPRAIN OF JOINT knee cap, shoulder, elbow or ankle, single occurrence present to 2 years after 2 years recurrent or chronic (more than 1 occurrence) hip, operated or unoperated, congenital dislocation traumatic dislocation within 3 years after 3 years, operated, no prosthetics, uncomplicated Chiropractic treatment, massage or physical therapy DIVERTICULITIS The formation and inflammation of small pouches along the colon. one brief attack recent to 2 years after 2 years recurrent attacks operated, recovered, no residuals or subsequent attacks DIZZINESS (see Vertigo) DOWN'S SYNDROME DRUG ABUSE/ADDICTION recent to 10 years after 10 years DUODENAL ULCER (See Ulcer, Stomach/Duodenal) DUODENITIS (Inflammation of the duodenum) Ulcer disease ruled out 1 episode - fully recovered 0-1 year after 1 year Multiple attacks IC

ACTION
Major Medical
S W IC W W IC

W S W

W S W

W S W S

D IC

W S W

LEGEND
S - Standard IC - Individual Consideration D - Uninsurable W - Waiver

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IMPAIRMENT GUIDE HEALTH CONDITION
DUPUYTREN'S CONTRACTURE A contraction of the palm and fingers present history of alcoholism ECZEMA (also see Skin Disorders) A skin disease. present if associated with Asthma or treated with oral steroids EMOTIONAL DISORDERS (ANXIETY/DEPRESSION) (Same action as Mental/Nervous Disorders) EMPHYSEMA A serious and usually progressive lung disease with destruction of the air sacs and obstruction of airways. symptomatic or treatment incidental finding on x-ray, asymptomatic, normal PFT ENCEPHALITIS Sleeping sickness; brain inflammation present to 1 year recovered, after 1 year, no residuals with residuals ENDOMETRIOSIS A condition resulting in the implantation of endometrial tissue on various organs in the female pelvis. present ablated or controlled with medication 0-1 year after 1 year total hysterectomy 0-1 year after 1 year after menopause ENDOMETRITIS Inflammation of the tissue lining of the uterus. present recovered after 6 months - no residuals ENURESIS Nocturnal only. Genital urinary tract disorder ruled out. No behavior problem such as ADHD, anxiety, or depression neurogenic bladder

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EPIDIDYMITIS Inflammation of the duct attached to the upper part of each testicle. one uncomplicated attack, cured others EPILEPSY (See Seizure Disorders) EPSTEIN-BARR VIRUS (See Chronic Fatigue Syndrome) Cause by the virus that causes infectious monomucleosis recent to 5 years recovered after 5 years ERECTILE DYSFUNCTION / IMPOTENCE Inability of the male to achieve or maintain penile erection Primary - Neurogenic Vascular psychogenic Secondary to another disorder ESOPHAGEAL STRICTURE Narrowing of the esophagus recent to 2 years after 2 years-no residuals or need for dilatation treatment or medication with current symptoms or treatment ESOPHAGEAL VARICES A varicose vein within the esophageal or gastric area. ESOPHAGEAL REFLUX (GERD)/ESOPHAGITIS Reflux of gastric contents into esophagus present: 0-15 years of age over 15 years of age 0-3 years after 0-3 years (no symptoms or treatment) with continual symptoms or treatment, pending diagnostic evaluation, pending surgery Barrett's Esophagus Respiratory tract complications EYE CONDITIONS / DISORDERS Cataracts Clouding of the lens of the eye Traumatic / Congenital / Senile Present operated No artificial lens with artificial lens Secondary to disease

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EYE CONDITIONS / DISORDERS (continued) Choroiditis, Iritis, Uveitis or Retinitis An inflammation of a specific part of the eye. recent to 2 years recovered after 2 years recurrent attacks secondary to other disease Exophthalmos An abnormal protrusion of the eye. present corrected secondary to disease Glaucoma Elevated pressure within the eyeball present secondary to other disease Ocular Herpes Ocular Histoplasmosis - recovered, no progressive visual loss Optic Neuritis Optical Atrophy - degeneration of optic nerve fibers Strabismus An abnormal condition in which the eyes are not coordinated unoperated operated within 1 year after 1 year, no further surgery required FIBROCYSTIC BREAST DISEASE (See Breast Tumor or Cyst for tumor or calcification) 0-2 years after 2 years - no additional symptoms, cysts or calcifications and 3 stable mammograms requires medical treatment pending mammogram, surgery, biopsy (will consider when results or procedures is provided) diagnosis inconclusive FIBROMYALGIA (See Rheumatism) FLOATING KIDNEY (See Nephroptosis)

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FOOT DISORDERS Club foot Flat foot (Pes Planus) Heel spur Hammer toe Ingrown toenail Plantar fasciitis Bunion present surgically corrected FRACTURE Fracture except skull, spine, hip-present not completely healed Simple-fully recovered, no residuals/complications, no hardware with hardware Skull 0-6 months after 6 months-no seizures, no residuals, no complications, no medications Hip 0-3 years after 3 years - no residuals, normal bone density with prosthesis / hardware Spine 0-1 year after 1 year, no residuals, no complication, no symptoms, no hardware due to osteoporosis Pathological FUNGUS DISEASE (Pulmonary and systemic) (disease caused by a fungus organism). These include aspergillosis, blastomycosis, chromomycosis, coccidioidomycosis, histoplasmosis, mucormycosis, sporotrichosis GANGLION CYSTS A form of cystic tumor occuring on a tendon. present treated, no recurrence GASTRITIS Inflammation of the stomach. Viral Gastritis 1 episode, fully recovered, no other gastrointestinal symptoms S W D S W S W W S D D

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GASTRITIS (continued) Atrophic, Chronic, Erosive gastritis No history of cancer or alcohol abuse 0-1 year after 1 year Multiple Attacks GLAUCOMA Elevated pressure within the eyeball Present secondary to other disease GLOMERULONEPHRITIS, NEPHRITIS or BRIGHT'S DISEASE An inflammation of the kidney. one attack, prompt recovery within 3 years after 3 years, no proteinuria, no red blood cells, normal kidney function multiple attacks, chronic/abnormal urinalysis GOITER (See Thyroid Disorders) GONORRHEA A sexually transmitted disease. 1 acute episode-cured, no relapses, complications or treatment Chronic, recurrent, relapse History of other sexually transmitted diseases, such as pelvic inflammatory disease, herpes virus, syphilis, chlamydia, urethritis, arthritis cholangitis or any complications GOUT Gouty Arthritis present 0-30 years of age 31-64 years of age complications of kidney stones, hypertension, diabetes, uric acid deposits, etc. HAMMER TOE (See Foot Disorders) HEADACHES Nonspecific-treated with over-the-counter medications-no office visits or medical consultation required. Muscular contraction, tension, histamine, migraine, sinus, vascular, cluster - requires prescription medication 0-5 years After 5 years - no medication, diagnosis established - all

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HEADACHES (continued) testing normal complicated with depression HEARING LOSS (See Deafness) HEART ATTACK (See Cardiovascular Disorders) HEART MURMURS (See Cardiovascular Disorders) An abnormal sound heard over the area of the heart. HEMANGIOMA A benign tumor consisting of a mass of blood vessels. Superficial Deep Cavernous Port wine stain HEMOPHILIA - FACTOR VIII Disorder of blood coagulation HEMORRHOIDS Internal or external varicose veins of the anus. present, symptomatic Present, asymptomatic 0-5 years After 5 years - no symptoms, treatment, bulging, bleedingno surgery or banding discussed Operated/banded - no complications or residuals HEPATITIS Inflammation of the liver. acute, infectious - Hepatitis A recovered 0-6 months after 6 months - normal liver function tests Hepatitis B recovered, 0-2 years after 2 years-normal liver function tests Hepatitis C, D and Australian HIATAL HERNIA A protrusion of the stomach through the diaphragm. asymptomatic-no surgery contemplated, no medication symptomatic -work-up complete, treated with medication work-up incomplete treated with surgery 0-6 months after 6 months - no symptoms no medications

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HERNIA A rupture or bulging of an organ through all or part of its retaining structure. present operated, no recurrence after 6 months HERNIATED DISC (See DISC DISEASE) HERPES An inflammatory disease caused by the herpes virus. Ocular Oral Genital HERPES ZOSTER (See SHINGLES) HIRSCHSPRUNG'S DISEASE (MEGACOLON) A congenital condition causing an abnormally large colon. present surgically corrected, no symptoms recent to 2 years 2 to 5 years - no residuals after 5 years - no residuals HISTOPLASMOSIS A systemic fungus infection. Can involve skin, lungs, spleen, liver, etc. systemic, cavitary, immune mediated, generalized, pulmonary 0-2 years after 2 years, no residuals eyes - recovered, no progressive visual loss HIVES (URTICARIA) A vascular reaction of the skin marked by transient welts and severe itching. acute, single attack, recovered chronic HODGKIN'S DISEASE A malignant disease of the lymphatic system within 10 years after 10 years, no metastasis, disease free. HYDROCELE A cyst on the covering of the testes unoperated operated

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HYDROCEPHALUS A condition marked by abnormal accumulation of fluid in the cranial vault, enlarged head and prominent forehead. HYDRONEPHROSIS An accumulation of urine in the kidney causing enlargement due to an obstruction of the ureter, with atrophy of the kidney. present cause resolved, no residuals, normal follow-up studies HYPERACTIVITY/ATTENTION DEFICIT DISORDER children 5 to 16 years attend regular classes, take 1 medication (cylert, ritalin, adderall, concerta) no learning or mental disabilities age 16 to 21 (full time student) adult more than 1 medication HYPERCHOLESTEROLEMIA/HYPERLIPIDEMIA (Elevation of the lipids in the blood) Consideration is given to age of onset, number of medications required, changes in medication, fluctuation in readings. Applicant must demonstrate good control of disorder for 1 year. Controlled hypercholesteremia - hyperlipidemia Onset after age 25 No medication with cholesterol reading of 240mg or less One medication with cholesterol reading of 241mg - 270mg Triglyceride reading not exceeding 500mg Uncontrolled hypercholestermia - hyperlipidemia Onset prior to age 25 Cholesterol readings over 270mg Triglyceride readings over 500mg Cholesterol /HDL ratio over 8.0 Related co-morbidity factors Hypercholesteremia with hypertension Hypercholesteremia with ratable build History of tobacco abuse History of elevated blood sugar HYPEREMESIS GRAVIDARUM (See Pregnancy) HYPERTENSION (See Blood Pressure) HYPERTHYROIDISM (See Thyroid Disorders)

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HYPOGLYCEMIA A deficiency of blood sugar marked by fatigue, restlessness, malaise, irritability and weakness. under control by diet uncontrolled by diet HYPOSPADIAS/EPISPADIUS A defect on the ventral dorsal surface of the penis so that the urethral meatus is located incorrectly present surgically repaired with no other genitourinary anomalies HYSTERECTOMY (See Uterine Disorder) IMMUNE DISORDER (A group of disorders resulting from the functional impairment of components of the immune system). These include HIV, AIDS combined, immune deficiency, chronic granulomatosis disease and globunemia INFERTILITY history of treatment within 5 years after 5 years INSOMNIA - (See SLEEP DISORDERS) INTESTINAL OBSTRUCTION Any blockage of normal intestinal flow. single episode, cause identified 0 to 6 months 6 months to 2 years after 2 years no residuals or complications colostomy/iliostomy present IRITIS (See Choroiditis) JAUNDICE (yellow staining of body tissue resulting from abnormal elevation of bile products such as bilirubin) due to liver disease cause undetermined physiologic jaundice of newborn Bilirubin over 18mg. JAW DISORDERS, TMJ present operated, no residuals or further surgery required within 2 years after 2 years, asymptomatic, no prosthetics

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JUVENILE MYXEDEMA (See Thyroid Disorders) KELOID An overgrowth of scar tissue. present-asymptomatic, small removed, no recurrence within 6 months KIDNEY STONE OR COLIC stone present - one side stone present - both sides single attack 0 - 2 years after 2 years - no treatment, symptoms, infection, no stent in place 2 - 4 attacks/episodes 0 - 5 years over 4 attacks/episodes Preventive treatment KNEE DISORDERS sprains, torn ligaments, fluid, recurrent symptoms single episode 0-1 year after 1 year, no treatment, therapy or symptoms 2 - 3 episodes 0-3 years after 3 years, no treatment, therapy or symptoms chronic (more than 3 episodes) knee replacement torn cartilage LABYRINTHITIS Inflammation of the inner ear. no associated disease, single attack, recovered chronic or recurrent LEUKEMIA A malignant disease of the blood-forming organs, resulting in an excessive number of white blood cells. LEUKOPLAKIA Development of white patches on the mucous membrane of the tongue or cheek. unoperated operated within 3 years, no tobacco use after 3 years, no tobacco use malignant (see Internal Cancer)

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LIPOMA Encapsulated tumor of fatty tissue. present, asymptomatic operated LIVER ABSCESS A localized collection of pus in the liver 0-1 year 1-3 years after 3 years - no complications or residuals more than 1 episode LUNG ABSCESS 0-1 year 1 to 3 years after 3 years no residuals or complications more than 1 episode LUPUS ERYTHEMATOSUS A systemic connective tissue disorder of unknown cause. LYME DISEASE An acute, recurrent inflammatory infection transmitted by ticks. LYMPHADENOPATHY LYMPHOMA Non Hodgkin's Lymphoma MALARIA A parasitic disease carried by mosquitoes. single attack, recovered within 2 years after 2 years recurrent attacks MANIC DEPRESSION MARFAN'S SYNDROME (including eye related disorders) MASTITIS Inflammation of the breast. acute, recovered chronic operated with residuals no residuals

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MASTOIDITIS An inflamed mastoid. acute, single episode, recovered chronic or recurrent within 2 years after 2 years, no residuals, no symptoms, no recurrence operated 0-1 year after 1 year-no residuals MEATAL STENOSIS A narrowing or contraction of the opening of the urethra. Present Surgery or dilatation-no residual or additional treatment required 0-1 year after 1 year, no residual, symptom free MELANOMA, MALIGNANT (See CANCER - SKIN) The most serious form of skin cancer. present removed within 10 years, no metastasis after 10 years MENIERE'S DISEASE SYNDROME A chronic disease of the inner ear 0 to 2 years after 2 years, no residuals or complications recurrent MENINGITIS Inflammation of the lining of the brain and spinal cord. complete recovery, no residuals within 1 year after 1 year with residuals MENOPAUSE A normal cessation of menstruation, physiological or surgical asymptomatic symptomatic MENORRHAGIA (See Uterine Disorders)

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MENTAL/NERVOUS DISORDERS (all ages) Anxiety, mild depression, adjustment disorder counseling and/or medication (excluding antipsychotics) recent to 1 year - no co-morbidity recovered, after 1 year hospitalization and/or treatment with antipsychotics recent to 5 years recovered, no treatment after 5 years obsessive compulsive disorder panic attacks schizophrenia manic depressive/bipolar sleep disorder/insomnia - see sleep disorder MENTAL IMPAIRMENT (see Developmental Delay) MIGRAINES (See Headaches) MONONUCLEOSIS An acute, infectious disease marked by fever and swelling of the lymph glands. present recovered after 6 months MULTIPLE SCLEROSIS A chronic disease characterized by hardened patches of brain or spinal cord. MUSCULAR DYSTROPHY Progressive wasting of muscle. MYASTHENIA GRAVIS Muscular fatigue and weakness of unknown cause. MYOCARDIAL INFARCTION (See Cardiovascular Disorders) MYOCARDIAL INSUFFICIENCY (See Cardiovascular Disorders) MYOCARDITIS (See Cardiovascular Disorders) MYOSITIS (See Rheumatism) MYXEDEMA (See Thyroid Disorder)

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NARCOLEPSY A condition resulting in an uncontrollable desire for sleep. untreated treated-after 1 year, well controlled NEPHRECTOMY Surgical removal of a kidney. Donor, recovered-normal kidney function Trauma, recovered within 6 months after 6 months, no residual, normal renal function Other causes, recovered 0 to 2 years 2 to 5 years after 5 years Impaired renal functions Kidney transplant recipient Malignant-(See Internal Cancer) NEPHROPTOSIS Floating (loose and displaced) kidney incidental finding, asymptomatic, no treatment planned present, with symptoms surgical treatment recent to 6 months after 6 months, normal renal function, asymptomatic NEPHROTIC SYNDROME An abnormal condition of the kidney with excessive protein in the urine NEURALGIA / NEURITIS Inflammation and pain along the course of a nerve. current resolved-no symptoms, treatment or residual NEUROFIBROMA / NEUROMA Benign tumor(s) of the nerve sheath. single operated, recovered unoperated multiple NEUROFIBROMATOSIS (VON RECKLINGHAUSEN'S DISEASE) A condition marked by various size tumors on peripheral nerves, muscles, bones and skin.

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OPTIC ATROPHY Degeneration of the visual portion of the eye, often associated with Multiple Sclerosis. ORCHITIS An inflamed testicle present recovered recurrent OSTEOARTHRITIS (See Arthritis/Rheumatism) OSTEOCHONDRITIS Inflammation of a cartilage and the adjoining bone present to 2 years recovered after 2 years-no symptoms, treatment or residual OSTEOMYELITIS Infection of the bone present recovered within 5 years after 5 years-no symptoms or residuals OSTEOPOROSIS/OSTEOPENIA A loss of calcium in the bone under 50 years of age over 50 years of age severe - T-score below -2.5 S.D. mild to moderate (osteopenia), T-score -1 to -2.5 S.D. complication or fracture under treatment (otherwise insurable) OSTEOSARCOMA (See Cancer, Internal) OTITIS MEDIA Infrequent No more than 2 episodes per year treated with antibiotics only Frequent 3 or more episodes per year treated with antibiotics, nasal sprays, and antihistamines 0-2 years after 2 years, no recurrence, treatment, symptoms or tubes in place, normal hearing Complicated 4 or more episodes per year or complicated by tonsil/adenoid hypertrophy, allergies, sinusitis, persistent drainage from the ear

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OTITIS MEDIA (continued) 0-3 years after 3 years, no recurrence, treatment, symptoms or tubes in place, normal hearing Under treatment for acute episode Under preventative treatment Tubes present, one placement, continued symptoms Hearing test, tube placement, any additional test or workup pending OTOSCLEROSIS Hardening of the connections of the tiny ear bones unoperated operated within 1 year after 1 year, normal hearing OVARIAN CYST benign present resolved malignant (See CANCER) Stein-Leventhal Syndrome (Polycystic Ovarian Disease) PACEMAKER PAGET'S DISEASE Bone - A progressive, chronic disorder of bone metabolism Breast - A rare type of cancer involving the breast PANCREATIC CYST/TUMOR unoperated benign operated 0 to 5 years after 5 years - no residual malignant (See cancer) PANCREATITIS Inflammation of the pancreas, frequently due to excessive drinking cause unknown within 2 years after 2 years chronic or recurrent, requiring surgery PAPILLOMA OR POLYPS OR VOCAL CORDS (See Polyps) PARALYSIS

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PARAPLEGIA PARKINSON'S DISEASE PATENT DUCTUS ARTERIOSUS (See Cardiovascular Disease) A congenital heart defect that leaves a channel between the aorta and the pulmonary artery PECTUS EXCAVATUM PELVIC INFLAMMATORY DISEASE (PID) Inflammation of the female reproductive organs Unoperated 0 to 2 years after 2 years, no residuals Operated 0 to 6 months after 6 months - cured, asymptomatic Recurrent PEPTIC ULCER (See ULCER) PERICARDITIS Inflammation of the pericardium Viral present 0-6 months after 6 months, no residual all others PEYRONIE'S DISEASE present corrected without residuals PERIPHERAL VASCULAR DISEASES Vascular disease of the extremities involving arteries, veins and lymphatics (including Arteriosclerosis Obliterans, Thromboangiitis Obliterans/Buerger's Disease, Intermittent Claudication) PERNICIOUS ANEMIA (See Anemia) PHARYNGITIS/STREP THROAT (Inflammation of the pharynx) infrequent 2 episodes per year treated with antibiotics only W D D

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PHARYNGITIS/STREP THROAT (continued) frequent 3 or more episodes per year - or treated with anitbiotics, antihistamines, nebulizers, humidifiers complicated 5 or more treatment periods per year, complicated by tonsillitis, tonsil and/or adenoid hypertrophy surgery recommended or discussed, work up or testing pending PHLEBITIS Inflammation of a vein single attack, recovered within 1 year after 1 year-no blood thinner/aspirin multiple attacks, chronic, edema, diuretics, support hose required leg ulcers PILONIDAL CYST A cyst at the base of the spine, often recurrent unoperated operated, no recurrence Multiple occurrences PLEURISY Inflammation of the tissues covering the lungs. recovered - cause benign within 6 months, cause known after 6 months - no residuals PNEUMONIA / PNEUMONITIS Infected or inflamed lungs. single attack, recovered, after 6 months multiple attacks PNEUMOTHORAX (COLLAPSED LUNG) traumatic recovered spontaneous single attack, recovered within 1 year after 1 year-no lung disease multiple attacks

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POLIOMYELITIS A viral disease of the gray matter of the spinal cord, which may result in muscle atrophy and permanent deformity. present post polio syndrome other residuals POLYCYSTIC KIDNEY DISEASE A kidney composed of numerous cysts POLYCYSTIC OVARIAN DISEASE (See Ovarian Cyst) POLYCYTHEMIA An excess of red blood cells. POLYPS Anal/Colonic-A growth in the anal canal. present removed-benign (1 to 3 polyps) 0-3 years after 3 years-no recurrence, treatment or symptoms removed-benign (4 or more polyps) 0-5 years after 5 years-no recurrence, treatment or symptoms malignant (See Internal Cancer) Rectal (See Anal/Colonic) Nasal-A growth inside a nasal cavity/canal. present operated-no recurrence, treatment, symptoms or residual recurrent malignant (See Internal Cancer) Vocal-A growth on the larynx/vocal cords. present removed/benign 0-2 years after 2 years-full recovery, no residual, symptoms, treatment or speech therapy malignant (See Internal Cancer) Endocervical (See Uterine Disorder) POTT'S DISEASE Tuberculosis of the vertebrae/spine.

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PREGNANCY current - any family member miscarriage one spontaneous abortion-after 3 months multiple or habitual abortions-no deliveries complications ectopic, eclampsia, pre-eclampsia, hyperemesis gravidarum, placenta previa child bearing age after menopause sterilized Gestational Diabetes Mellitus not currently pregnant, blood sugar level returned to normal age 45 and under history of premature births within 3 years multiple premature births, last birth within 5 years - under 45 years of age previous cesarean section (see Cesarean Section) PREMATURITY (underdevelopment; the condition of a child born early) 0-12 months of age 12 months and older - no history of breathing problems, failure to thrive/reflux or eating disorder, normal weight for age no current treatment, no pending tests. Any of the above present PROCTITIS (See Colitis Ulcerative) Inflammation of the lining of the rectum. PROSTATE HYPERTROPHY (BPH) Benign unoperated, incidental finding mild, no signs or symptoms or treatment, 1 or 2+ in size symptomatic, under treatment, nocturia, incontinent of urine, weak stream, frequency, urgency operated within 1 year after 1 year, normal size with none of the above symptoms elevated PSA - over 6.0 mg/ml malignant (See Internal Cancer) PROSTATITIS Inflammation of the prostate. single attack, recovered chronic or recurrent

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PROTEINURIA Presence of protein in the urine cause known - refer to cause cause unknown PSORIASIS A chronic skin disease, resistant to treatment, resulting in thick scaly patches. PSYCHONEUROSIS (See Mental/Nervous Disorder) PSYCHOSIS (See Mental/Nervous Disorder) PTOSIS OF THE EYELID Drooping of the upper eyelid(s) unoperated operated, no residuals after 3 months PULMONARY EMBOLISM OR INFARCTION Blood clot lodging in the pulmonary artery. after 1 year recovered, returned to unrestricted activity, no underlying disease PURPURA A condition of the skin marked hemorrhages into the skin due to low platelet count. thrombocytopenia purpura spleen not removed splenectomy within 1 year after 1 year - normal blood values other purpuric conditions PYELITIS OR PYELONEPHRITIS Inflammation of the renal pelvis, or kidney and renal pelvis. one attack, prompt recovery recent to 6 months after 6 months two attacks, recovered recent to 2 years after 2 years chronic

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PYLORIC STENOSIS A narrowing of the pylorus (located between the stomach and duodenum) Infants unoperated operated - normal weight, no residuals, recovered Adults unoperated operated QUADRIPLEGIA RAYNAUD'S DISEASE/SYNDROME within 5 years after 5 years RECTAL ABSCESS unoperated or recurrent operated, no recurrence within 3 months after 3 months-recovered-no signs or symptoms recurrent RECTAL POLYP (See Anal Polyp/Colon Polyp) RECTOCELE (See Uterine Displacement) Slipping or bulging of the rectum into the vagina. REGIONAL ILEITIS (See Colitis, Ulcerative) REITER'S SYNDROME (See Arthritis) RENAL ABSCESS Abscess in the kidney substance. present recovered within 1 year after 1 year, no residuals multiple occurrences RENAL CALCULUS (See Kidney Stones) RENAL COLIC (See Kidney Stones) RETINAL DETACHMENT (See Detached Retina) RETINITIS (See Choroiditis) D

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RHEUMATIC FEVER Acute fever and joint discomfort sometimes resulting in cardiac involvement. recent to 2 years after 2 years, no treatment, no antibiotics with cardiac involvement or residuals RHEUMATISM Inflammation, degeneration, or metabolic, derangement of the connective tissue structures of the body, especially the joints and related structures including muscle, bursae, ligament, tendons and fibrous tissue. Arthritis Osteoarthritis Mild: limited pain, no loss of joint mobility, treated with over the counter medications. No doctor visits. Osteoarthritis Moderate: pains in hands, small joints, 2-3 doctor visits per year, daily medication, no limitations Osteoarthritis Severe: progressive pain, joint limitation, monthly doctor visits, crippling or non-crippling Affecting spine, hip, shoulder, knee (waiver joint also) Rheumatoid Arthritis Psoriatic Arthritis Reiter's Syndrome Degenerative joint disease Gouty Arthritis Gonococcal Arthritis Juvenile arthritis Bursitis present to 2 years after 2 years, no symptoms, no treatment, no limitation, full recovery. chronic Fibrositis/Myositis/Fibromyositis single attack, recovered recent to 2 years after 2 years, no residuals, symptoms or treatment multiple attacks recent to 5 years after 5 years, no residuals, symptoms or treatment Synovitis/Tendonitis/Tenosynovitis single attack, recovered recurrent 0-2 years after 2 years, no symptoms or treatment

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RHEUMATISM (continued) Spondylitis Rheumatism present after 1 year, no symptoms or treatment, fully recovered Fibromyalgia SARCOIDOSIS/BOECKS SARCOID A chronic granulomatous disorder of unknown etiology affecting the lungs, liver or other organs usually with involvement of the lymph nodes. Generalized Localized Resolved SALPINGITIS / SALPINGO-OOPHORITIS (See Pelvic Inflammatory Disease) SCHIZOPHRENIA SCIATICA Inflammation of the sciatic nerve, usually marked by pain and tenderness along the course of the nerve through the thigh and leg. SCOLIOSIS (See Spinal Curvature) SCLERODERMA A collagen/connective tissue disorder local occurrence / skin systemic SEIZURE DISORDER Febrile children under age 16 0-2 years since last seizure after 2 years, no seizure, no medication Epilepsy, Petit Mal, Grand Mal, Psychomotor, convulsions of unknown cause recent to 5 years after 5 years, no seizure, no medication, normal EEG SHINGLES (HERPES ZOSTER) A viral infection involving the nervous system 1 acute attack, recovered chronic/post herpetic neuralgia D

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SINUSITIS Allergy or infection of the nasal sinus Infrequent 2 episodes per year treated with antibiotics only Frequent 3 or more episodes per year - or treated with antibiotics, antihistamines, nebulizers, humidifiers Complicated 5 or more treatment periods per year, complicated by tonsillitis, tonsil and/or adenoid hypertrophy Surgery recommended or discussed, work up or testing pending Complicated or co-existing with allergy SKIN DISORDERS Acne Actinokeratosis Dermatitis and/or eczema treated with topical steroids associated with asthma or treated with oral steroids Psoriasis Hives acute, single attack, recovered chronic, recurring Rosacea Tattoo Moles benign malignant (see Cancer) Lentigo Seborrheic Keratosis Warts SKULL FRACTURE (See Fracture, Skull) SLEEP APNEA Central Obstructive Secondary to tonsil/adenoid infection/hypertrophy Unoperated Operated - no complications - all symptoms resolved Secondary to other forms of obstruction Use of C-PAP machine SLEEP DISORDER/INSOMNIA Current short term treatment, less than 2 months in duration Prescribed hypnotic only (drugs may include ambien, restoril, dalmane, halcoin, ProSom, and sonata Prolonged use (over 2 months duration) 0-2 years after 2 years

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IMPAIRMENT GUIDE HEALTH CONDITION
SLEEP DISORDER/INSOMNIA (continued) Associated with anxiety or depression or taking hypnotic/sleep medication and anti-anxiety/anti-depression medication Associated with restless leg syndrome Associated with obstructive sleep apnea SPASTIC COLITIS (See Colitis, Spastic) SPINA BIFIDA A congenital failure of the bony spinal canal to close behind the cord. unoperated operated, no residuals recent to 1 year after 1 year, full recovery, no symptoms or treatment operated, with residuals SPINA BIFIDA OCCULTA A lesser degree of Spina Bifida without protrusion of the spinal cord and its membranes. present, asymptomatic/incidental finding symptomatic operated, no residuals, symptoms or treatment SPINAL CURVATURE (KYPHOSIS, LORDOSIS, SCOLIOSIS) Kyphosis is a backward curve, Lordosis is a forward curve and Scoliosis is a lateral curvature. 0 - 18 years over 18 years - mild to moderate symptoms others with rods, hardware, etc. SPONDYLITIS (See Rheumatism) SPONDYLOLISTHESIS A forward dislocation of a lumbosacral vertebra. unoperated operated within 2 years after 2 years, no symptoms, treatment or residuals operated, with residuals STRABISMUS An abnormal condition in which the eyes are not coordinated unoperated operated within 1 year after 1 year, no further surgery required

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IMPAIRMENT GUIDE HEALTH CONDITION
STRESS URINARY INCONTINENCE present surgically corrected without residual neurogenic bladder STROKE SUICIDE ATTEMPT, GESTURE, IDEATION SYNOVITIS/TENOSYNOVITIS (See Rheumatism) SYNCOPE/FAINTING SYPHILIS untreated treated, no residuals - negative serology - no other STD TENDONITIS (See Rheumatism) TENNIS ELBOW Injury to the tendinous attachments to the elbow. single attack, recovered recurrent within 2 years after 2 years, no further attacks, treatment or limitation TESTICULAR DISORDERS Enlarged testicle cause benign cause undetermined Hydrocele present surgically corrected without residual Orchitis present recovered recurrent Undescended testicle unoperated operated Varicocele present surgically corrected without residual THROMBOANGIITIS OBLITERANS (See Cardiovascular Disorders)

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IMPAIRMENT GUIDE HEALTH CONDITION
THROMBOPHLEBITIS (See Phlebitis) THYROID DISORDERS Adult Myxedema present treated Goiter-Enlargement of the thyroid gland. present - controlled, no pending surgery operated-normal thyroid test, no medication, no enlargement Hashimotos Disease present treated and resolved without residual Hyperthyroidism-An over active thyroid. present medically or surgically treated Hypothyroidism-An under active thyroid. controlled with medication Juvenile Myxedema or Cretinism Thyroiditis-Inflammation of the thyroid gland present resolved without residual 0-2 years, hormone replacement therapy only after 2 years, no treatment or symptoms residuals or symptomatic TIC DOULOUREUX A form of facial neuralgia. current to within 2 years after 2 years, surgically corrected, full recovery TINNITUS A noise in the ear such as ringing, buzzing, clicking present after 1 year - total resolution, no symptoms, treatment residuals TONSILLITIS Infrequent 2 episodes per year treated with antibiotics only Frequent 3 or more episodes per year - or treated with antibiotics, antihistamines, nebulizer, humidifiers Complicated 4 or more treatment periods per year, complicated by sinusitis, tonsil and/or adenoid hypertrophy Surgery recommended or discussed, work up or testing pending with sleep apnea - or use of C-PAP machine

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IMPAIRMENT GUIDE HEALTH CONDITION
TONSILS/ADENOID - HYPERTROPHY Abnormal enlargement of tonsil and adenoid tissue Asymptomatic 0-18 years over 18 years, no breathing problems/obstruction or treatment, no infections Symptomatic, obstructive, under treatment, not fully worked up, test pending, use of oxygen or C-PAP machine Associated with sleep apnea TORTICOLLIS / WRYNECK Torsion (twisting) of the neck. brief, non-disabling, recovered after 1 year, no recurrences congenital, chronic or recurrent within 2 years after 2 years - no residuals TOURETTE'S SYNDROME A general disorder characterized by tics and a variety of behavioral manifestations. TRANSIENT ISCHEMIC ATTACK (TIA) TREMOR TUBERCULOSIS Pulmonary 0-1 year after 1 year, treated, no residuals or symptoms exposure only, INH therapy 0-6 months after 6 months, negative x-ray Non-Pulmonary (renal, joint, bone, lymph gland) 0-5 years after 5 years, full recovery, no treatment or symptoms, normal x-ray Tuberculosis of the spine (Pott's Disease) ULCER, STOMACH/DUODENAL PEPTIC present to 1 year - no bleeding or complications single occurrence more than 1 occurrence, bleeding complications 0-5 years after 5 years, no recurrence, complication, or bleeding

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IMPAIRMENT GUIDE HEALTH CONDITION
ULCER, STOMACH/DUODENAL PEPTIC (continued) Treated by surgery, adequate workup, no symptoms, complications, or bleeding 0-1 year after 1 year, no symptoms, treatment or recurrence ULCERATIVE COLITIS (See Colitis, Ulcerative) UREMIA (Acute Renal Failure) Acute Episode due to infection, burns, chemicals or injury 0-1 year after 1 year - full recovery, normal tests chronic - end stage renal disease URETERAL or URETHRAL STRICTURE Narrowing of the ureter or urethra. present resolved, no residuals or dilations current to 2 years after 2 years URETERITIS or URETHRITIS Inflammation of the ureter or urethra (Non-Gonorrheal) present to 2 years after 2 years - no recurrence URINARY TRACT DISORDERS Cystitis (Bladder Infection) Inflammation of the urinary bladder acute, single attack recovered within 6 months after 6 months no residual or complications recurrent attacks recent to 2 years after 2 years Kidney Stone or Colic stone present - one side stone present - both sides single attack 0 to 3 years after 3 years - no treatment, symptoms, infection, no stent in place 2 - 4 attacks/episodes 0 - 5 years over 4 attacks/episodes preventive treatment

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IMPAIRMENT GUIDE HEALTH CONDITION
URINARY TRACT DISORDERS (continued) Nephrectomy Surgically removal of a kidney Donor, recovered-normal kidney function Trauma, recovered within 6 months after 6 months, no residual, normal renal function Other causes, recovered 0 to 2 years 2 to 5 years after 5 years Impaired renal functions Kidney transplant recipient Malignant - (See Internal Cancer) Nephroptosis Floating (loose and displaced) kidney incidental finding, asymptomatic, no treatment planned present, with symptoms surgical treatment Nephrotic Syndrome An abnormal condition of the kidney with excessive protein, in the urine Polycystic Kidney Disease A kidney composed of numerous cysts Proteinuria cause known - refer for cause cause unknown Pyelitis or Pyelonephritis Inflammation of the renal pelvis, or kidney and renal pelvis one attack, prompt recovery recent to 6 months after 6 months two attacks, recovered recent to 2 years after 2 years chronic Ureteritis or Urethritis Inflammation of the ureter or urethra (Non-Gonorrheal) present to 2 years after 2 years - no recurrence UTERINE DISORDERS Abnormal PAP smear Atypical squamous cells of undetermined significance (ASCUS) 0-1 year after 1 year - normal PAP smear; no abnormal pathology

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HEALTH CONDITION

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UTERINE DISORDERS (continued) Cervical Intraepithelial Neoplasia (CIN I, II, & III) 0-2 years after 2 years - all tests normal including PAP smear Cervical Cancer in-situ (see Cancer - Internal) Abnormal uterine bleeding, menometrorrhagia 0-2 years malignancy ruled out after 2 years-cause known, no further bleeding or treatment needed cause unknown - cancer ruled out Congenital malformations treated - no complications/symptoms/residuals untreated Chronic pelvic pain Dilation & Curettage (D&C), no malignancy done for miscarriage other causes (see Abnormal Uterine Bleeding) Displacements/Uterine/Pelvic retroversion, asymptomatic, incidental findings otherwise Urethrocele Cystocele Enterocele Uterine prolapse (decensus) Rectocele Displacements treated by surgery - no residuals, treatment follow-up concluded 0-1 year after 1 year Dysmenorrhea Endocervical Polyp present operated, no residual, no cancer Fibroid tumor present-no cancer treated-no residuals Human Papilloma Virus 0-3 years after 3 years, no residual, lesion, or abnormal pathology Surgicallly treated - no recurrence - normal PAP smear 0-6 months after 6 months - no recurrence Hysterectomy - no cancer Pelvic Relaxation - mild, no evidence of any overt displacement otherwise Premenstrual Syndrome (PMS) other gynecological disorder ruled out

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HEALTH CONDITION
VAGINITIS Inflammation of the vagina. acute, recovered chronic or recurrent within 2 years recovered after 2 years-no residual/recurrence VARICOCELE A varicose condition of the spermatic cord. unoperated operated VARICOSE VEINS Ulcerated, large engorged or swollen veins. present removed, cured within 5 years after 5 years - no recurrence or symptoms treated by injections stasis ulcer VENEREAL WARTS (CONDYLOMA ACUMINATA) 0-3 years after 3 years, no residuals, no recurrence, no abnormal pathology including PAP smear VENTRICULAR SEPTAL DEFECT (See Cardiovascular Disorders) VERTIGO/DIZZINESS Sensation of rotation or movement on one's self or one's surroundings ("dizziness") Labyrinthitis, Meniere's Disease, CNS disorder ruled out sufficient workup - no cause found Vertigo - unqualified, idiopathic Benign Positional Vertigo 0-1 year after 1 year WHIPLASH (See Back Sprain - Strain) WOLF-PARKINSON-WHITE SYNDROME (See Cardiovascular Disorders) ZOSTER (See Shingles)

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Policy Change Information
OVERVIEW These types of changes include requests from the insured or agent to change the coverage either by increasing or decreasing benefits; adding or deleting benefits, adding or deleting family members or reinstating coverage that has lapsed. Changes that increase the liability of the Company require underwriting approval. This would include requests to decrease deductible or stop loss amounts, increase co-insurance, add or increase benefits or add family members. Benefits not affecting the liability of the company do not require underwriting approval. Some of these requests can be requested by telephone. Refer to the chart titled Health Policy Change Requirements for procedures on various policy service requests. BENEFIT CHANGE & ADDING FAMILY MEMBER An application is required to be completed in full for a change that increases liability of the Company and for all requests for reinstatement. The application must be signed and dated by the insured and agent (if involved). Grace period Premium payments under the Group Policy are subject to a 31-day Grace period. During the Grace period, coverage under the Group Policy will remain in effect. If a premium is not paid on or before the date it is due, it may be paid during the following 31 days. The Grace period will not apply if, at least 30 days before the premium due date, ANTEX has delivered to you or mailed to your last address as shown in ANTEX’s records written notice of Antex’s intent to terminate coverage under the Group Policy. COVERAGE FOR NEWBORNS AND ADOPTED CHILDREN If coverage is provided under the Group Policy for Covered Persons other than you, a child is born to or adopted by you and living with you will also be a Covered Person. This coverage will be free, without action by you, but it will last only through the 31st day following the child’s date of birth or date of adoption. To add the child permanently after the first 31 days of free coverage we must receive a written or oral request from the insured - this request must be within 31 days of the date of birth or date of adoption. COMPLETING THE APPLICATION The “Special Requests” Box at the top of the application should indicate what is being requested. (i.e. decrease deductible to $1,500; add spouse; reinstate coverage). Complete the section entitled Schedule of Family Members or Proposed Insureds on all applicable family members. All questions on the application must be answered and details provided when indicated. The primary insured must sign the application in all instances. Faxed copies of an application can not be accepted. UNDERWRITING POLICY CHANGES AND REINSTATEMENTS All medical history is reviewed including claims information on file. Current underwriting guidelines are followed and insurability requirements must be met. As with New Business applications, the underwriting review process may include requests for information through a Personal History Interview, Attending Physicians Statement, Exam, Blood Profile, Inspection Report, Motor Vehicle Report, or the Medical Information Bureau. Benefit changes – If current guidelines would require modification to coverage with a rating, it is normal underwriting procedure to deny a benefit change to avoid compromising current benefits. Reinstatement – If reinstatement of coverage can be approved with modifications of coverage, this offer is made and must be accepted by the primary insured in writing before coverage is reinstated. PLAN CHANGES – PPO vs INDEMNITY Changes from PPO to Indemnity or Indemnity to PPO do not require underwriting approval as long as no change in the basic benefit structure is requested (i.e. – deductible, stop-loss, co-insurance). In order to facilitate such a change, it is imperative that the insured understand the change being requested and how it affects the coverage. The request must be provided in writing. If a request is received by telephone from the insured, the Policy Service Department will send a letter to the insured outlining the differences in the present coverage and the requested coverage. In addition, an application can be submitted with

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completion of questions 1-4. The form must be signed and dated by the primary insured and the agent. Submit the request to the Policy Service Department for handling. The Policy Service Department can be contacted by direct mail: Health Policy Service Department P.O. Box 1990 Galveston, Texas 77550 Any requests not requiring written confirmation may be submitted via e-mail to American National at ‘health_pos@anico.com’. REINSTATEMENT PROVISION NO REQUEST FOR REINSTATEMENT WILL BE CONSIDERED BY ANTEX/ANICO IF IT IS MORE THAN 180 DAYS AFTER YOUR CERTIFICATE HAS LAPSED. If a periodic premium is not paid before the Grace Period ends, coverage under the Group Policy will lapse. Later acceptance of the premium by ANTEX, or by an agent authorized to accept payment, without requiring an application for reinstatement will reinstate your coverage under the Group Policy. ANTEX will require an application for reinstatement. All representations made in this application will be subject to all of the provisions of the Group Policy, including. TIME LIMIT ON CERTAIN DEFENSES. If the application for reinstatement is approved by ANTEX, coverage under the Group Policy will be reinstated as of the approval date of the reinstatement Enrollment Application. Lacking such approval, the coverage under the Group Policy will be reinstated on the 45th day following the date of the conditional receipt unless ANTEX has previously notified you in writing of its disapproval. The reinstated coverage under the Group Policy will only cover loss, which results from an injury sustained after the date of reinstatement or sickness that begins ten days or more after the date of the reinstatement. In all other respects, your rights and the rights of ANTEX will remain the same as they were immediately before the due date of the defaulted premium, subject to any provisions noted on or attached to the certificate outlining the reinstated coverage under the Group Policy.

Any premium ANTEX accepts for a reinstatement will be applied to a period for which premiums have not been paid. No premium will be applied to any period more than 60 days prior to the reinstatement date. COMPLETING APPLICATION FOR REINSTATEMENT Any health certificate that has been lapsed for 45 days, but not longer than six months, will be considered for reinstatement with completion of currently approved new business application and collection of the current modal premium. If the reinstatement is approved, coverage will be reinstated with a current date and a lapse in coverage. Certificates lapsed for more than six months will not be eligible for reinstatement. In these situations, the individual will have to reapply for coverage. There may be circumstances, which necessitate an exception to these guidelines. Any exception must be approved by the Health Underwriting Department. Utilizing the new business application eliminates any confusion regarding the correct form required for reinstatement. It also eliminates the need for the agent to maintain supplies that are used on an infrequent basis; and eliminates the need for the Company to maintain single purpose forms. In addition, it provides the underwriter the current medical information needed to evaluate the request for reinstatement. In effect, it eliminates the need for a “Good Health Statement”. · Complete the special Request section by writing “Reinstatement Request for Policy/Certificate #XXXXX. Complete Benefit and Premium Payable section only of there is a requested change in coverage or billing. Complete all other questions and be sure to record the names of all covered insureds including their medical history. Sign the application and authorization. Complete Modification of Health Insurance Form. Collect the current modal premium.

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Health Policy Change Requirements

Type of Change

Requirements

ViaPhoneCall

Underwriting Required

Premium Due

Name Correction

Notification from Primary Insured Legal Documentation

Yes

No

No

Name Change Legal Address

No

No

No

Notification from Primary Insured Proof of Age Notification by primary Insured Health Applicaiton

Yes

No

None

Age Correction Add New Born 0-31 days Over 31days

No Yes

No No

See C See A

No

Yes

First Modal premium None

Add Family Members

Health Application Note: Primary Insured must sign (see B) Notification from Primary Insured

No

Yes

Delete Family Members

Yes

No

None

Add Benefits Increase Benefits

Health Application Health Application Exception: Inc. Deductible Notification from Primary Insured. Exception: Dec. Deductible (Application is required) Notification from Primary Insured Memo or Letter and Form ANL-2703 Notification from Primary Insured Notification from Primary Insured

No No Yes

Yes Yes No

See A See A See A

Decrease Benefits

Yes No

No Yes

See A See A

Delete Benefits

Yes

No

None

Beneficiary

No

No

None

Change Mode of Payment Change Method Of Payment

Yes

No

If applicable

Yes

No

If applicable

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Health Policy Change Requirements

Type of Change Reconsider of Waiver Reconsider Rating

Requirements Memo or Letter from Primary Insured Memo or Letter From Primary Insured. See B

ViaPhoneCall No

Underwriting Required

Premium Due

Yes

None

No

Yes

None

Reinstatement Re-date *Lapsed for 32-180 days

Fully Completed Application See B

No

Yes

One Modal Premium

Correction

Memo or Letter From Primary Insured or Legal documentaion

No

No

No

Duplicate Policy

Memo or Letter From Primary Insured

No

No

$15 Fee

Conversions * Divorce

Application excluding any Medical Information

No

No

First Modal Premium

*Dependent Eligibility ceases under existing coverage

Application excluding any Medical Information

No

If Applicable

First Modal Premium

*Replacements

Fully Completed Application

No

Yes

First Modal Premium

*Group

Application excluding any Medical Information

No

Yes

First Modal Premium

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LEGEND
A. The premiums must be collected for add-ons or increase in benefits. If the change is for a quarterly, semi-annual or annual mode, a pro-rated premium may be collected. B. Evidence of insurability is required for assessment of risk. Requests for medical information will be generated by the Underwriting Department. C. If the premium increases due to the age correction, back premiums will not be required. The policy will be adjusted to reflect the age correction and the Insured will be notified of the new rate prior to the premium due date.

Customer Service: 1-800-899-6805 Note: On those changes that do not require written notification, the Insured can, if they wish, use
the Health Service Request Form provided in the All-Inclusive Brochure to document the request for change.

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GLOSSARY
AIDS (Acquired Immune Deficiency Syndrome) Transmissible viral disease due to infection with HIV

Aphasia – loss of ability to communicate orally or in writing
and the ability to understand spoken or written language.

AIDS Related Complex (ARC) - a group of signs and
symptoms representing a severe stage of HIV infection.

Apnea – cessation of breathing. Arthritis – inflammation of the joints marked by pain,

Abnormal PAP Smear - deviation from norm of cells
taken from uterine cervix or cells undergoing questionable changes taken from uterine cervix.

swelling, heat, degenerating cartilage and bone hypertrophy.

Asthma – recurrent attacks of difficult breathing with wheezing and bronchial spasm. Atrophy – wasting away of an organ, muscle or tissue.

Abnormality – malfunction or deformity, contrary to normal. Acne – inflammatory disorder of the skin with papular pustules,
and pustular lesions that leave pits and scars.

Attention Deficit Disorder – abnormal impairment consisting of hyperactivity, uncontrolled impulses, and disruptive behavior.

Acute - having a short and relatively severe course,
sudden and severe onset of symptoms.

Autism - preoccupation with inner thoughts, daydreaming, Adrenal Gland Disorder – abnormal condition, disease
or impairment of the adrenal gland. fantasies, delusions and hallucinations, ego-centric subjective thinking with lack of objectivity and connection and reality.

Adverse Selection / Anti - Selection selection against
the company. The tendency of less favorable insurance risks to seek or continue insurance to a greater extent than others. Also, the tendency of policy owners to take advantage of favorable options in insurance contracts.

Back Disorder - abnormal condition, disease, or
impairment of the back, organs, and structure thereof.

Bacteria in Urine – abnormal presence of micro organisms in the urine.

Albuminuria – presence of albumin or protein in the urine. Alcohol Use – intake of ethanol or alcoholic beverages.

Bladder Disorder – abnormal condition, disease, or
impairment of the uninary bladder.

Blood Study – a scientific test/analysis of any of the Alcoholics Anonymous – support organization for
those with alcohol related problems. bloods components.

Bone Disorder – abnormal condition, disease, or imAllergy – hypersensitivity caused by exposure to certain
antigens such as environment, drugs, food, etc. pairment of any bone.

Ammenorrhea – Absence of menses Anemia - abnormal reduction in number of erythrocytes and red blood cells.

Bradycardia – a slow heart rate, less than 60 beats per
minute.

Brain Disorder – abnormal condition, diseases, or impairment of the brain. Breast Aspiration – fluid removed by needle within a
sac or cyst in the breast(s).

Angina – spasmodic, suffocating choking chest pain. Angioplasty – procedure to eradicate area in narrowing or disease in blood vessels by use of a balloon instrument.

Breast Changes – any change that occurs in the breast
tissue.

Anorexia – lack or loss of appetite for food. Anxiety – unpleasant response to conflict and unreal or
imagined danger such as panic attacks, agoraphobia and phobias.

Breast Disorder – abnormality within the breast tissue. Breast Implants – surgical enlargement of breast/chest
area by inserting synthetic liquid filled devices into breast tissue.

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Breast Reduction – surgical removal of breast tissue to
reduce the breast size.

Cocaine – a product made from coca leaves used in
local anesthetic and when prepared in a salt mixture becomes an illicit, abusive, addicting drug.

Bronchitis – infection or inflammation of one or more
bronchi.

Bursitis – inflammation of a bursa or sac like tissue used
to protect area of friction such as area between bones.

Coinsurance - A provision in health insurance contract by which the insurer and insured share in specific ratio payment of the covered losses under a policy. Colitis – inflammation or infection of any part of the co-

Calendar year - starts on January 1 and ends on December 31 of the same year. Calculus – a stone like mass. Cancer – neoplastic disease to any body tissue with multiplication of abnormal cells. Cardiospasm – a functional constitution or spasm of the
muscular sphincter at the gastroesophageal junction.

lon.

Community Rating - A rating process which applies the same premium charge for each insured regardless of age, gender, occupation, health status or place of residence. Congenital – disorders or defects existing at birth and
originating during the gestational period.

Congenital Heart Disease – pathological condition of the
heart existing at or prior to birth.

Carotid Artery Disease – athromatous plaques that occlude the carotid arteries.

Coordination of Benefits (COB). A method of integrating benefits payable under more than one health insurance plan so that the insureds benefit from all sources do not exceed 100% of allowable medical expenses.

Cellulitis – an inflammation of the skin and subcutaneous
tissues.

Cephalgia – a general term referring to headache from
any cause.

Co-payment- The amount which shall be charged to the
covered individual by the provider for services rendered. The member is responsible at the time of service, for payment of the co-payment charge directly to the provider.

Cesarean Section – surgical abdominal delivery of a
newborn.

Chest X-Ray – a photograph of the lungs and the chest
cavity.

Cosmetic Surgery – surgery performed to change, correct, or enhance appearance and/or function. Cost Containment - The control or reduction of inefficiencies in the consumption, allocation or production of health care services, that contribute to higher than necessary costs.

Chiropractor – a practitioner licensed to treat disease,
body disorders using chiropractic methods.

Cholecystitis – inflamation or infection of the gallbladder. Chronic -persisting over a long period of time. Chronic Headaches – recurring head pain that persists in spite of evaluation and treatment. Chronic Obstructive Pulmonary Disease – any disorder such as asthma, bronchitis and emphysema marked by persistent obstruction of bronchial flow that becomes persistent and irreversible.

Cost Shifting - When a program (e.g.,Medicare)
limits benefit payments to hospitals or physicians, they experience a shortfall in revenue. Hospitals and physicians make up the difference by increasing their charges to individuals who are capable of paying their own medical bills themselves or with the help of private insurance. It is estimated that 30% of each medical bill is a direct result of cost shifting. Additionally, cost shifting can result when legislation favors one insured approach over another.

Counseling – professional guidance using psychological methods and advise in consultation.

Chronic Skin Rash – skin disorder persisting over a
long period of time.

Counselor – one who treats by offering professional
guidance through psychology, advise and consultation.

Claudication – usually referred to as Intermittent Claudication and characterized by severe pain in the legs during walking and relieved by rest.

Cretinism – arrested physical and mental development
with dystrophy of bones and soft tissue, due to congenital lack of thyroid function.

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Cyst – a closed cavity or sac, normal or abnormal. Cystitis – inflammation or infection in the urinary bladder. Deductible - An amount of expense or loss to be paid by
the insured before an insurance policy starts paying benefits.

Dysuria – painful or difficult urination. Earache – pain in the ear or the surrounding area. Ear tubes – a tube inserted into the eardrum to allow
ventilation of middle ear.

Depressant – agent or chemical that reduces functional activities and vital energies.

Eczema – a pruritic type of skin disorder caused by
reaction to certain agents or body reactions and may be acute or chronic.

Depression – a lowing or decrease in functional activity,
feeling of sadness and despair.

Edema – presence of abnormally large amounts of fluid
in the tissues of the body.

Dermatitis – inflammation or infection of the skin. Developmental Delay – retarded growth both mentally
and physically that causes late mental and physical achievement.

EKG/ECG (Electrocardiogram) – graphic tracing that
measures heart activity.

Elevated Blood Glucose – blood sugar higher than normal.

Diabetes Mellitus – a chronic syndrome of carbohydrate, fat, and protein metabolism due to insufficent secretion of insulin by the pancreas.

Emotional Problems – inability to cope with mood and
affect (excitement, distress, happiness, sadness, love, hate, etc.).

Diagnosis - The determination of the nature of a case of
disease.

Emphysema – accumulation of air in lung tissue causing over distention with loss of elasticity and function.

Diarrhea – abnormal frequency and liquidity of fecal material.

Endometriosis – a state of endometrial tissue abnormally migrating to various parts of the abdomen and pelvis.

Disease - Any deviation from or interruption of the nomal
structure or function any part, organ or system (of combination thereof) of the body that is manifest by a characteristic set of symptoms and signs and whose etiology, pathology and prognosis may be known or unknow.

Enlarged Lymph Nodes – glands that are larger than
what is considered normal.

Enuresis – involuntary voiding of urine, especially during
sleep, bed wetting.

Disorder - A derangement or abnormality of function. Diverticulum – a small pouch or sac lined by mucous
membrane which herniates through the muscular wall of a tubular organ.

Epilepsy – central nervous system disorder characterized by transient disturbances of brain function leading to episodic movement.

Epistaxis – nosebleed. Esophageal Reflux – return or backward flow of stomach or duodenal contents into the esophagus.

Dizziness – dysequilibrium, sense of unsteadiness, giddiness. Drug Abuse – misuse, overuse, or wrongful use of a
drug.

Euthyroid – normally functioning thyroid gland or normal
thyroid hormone level.

Drug Reaction – abnormal response to a drug or medication.

Excessive Menstruation – heavy abnormal menstrual
bleeding.

Dysmenorrhea – painful menstruation; from any of a
wide variety of causes.

Facial Bone Disorder – abnormal condition, disease or
impairment of any facial bones.

Dysphagia – pain or difficulty in swallowing. Dyspnea – difficult or distressed breathing.

Fainting Spells – loss of consciousness, passing out,
light headed, syncope.

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Febrile – having a fever or feverish. Female Reproductive Organs Disorder – abnormality
within the female reproductive system or organs.

Types of HMO include Prepaid Group Practice and Individual Practice Association (IPA) models. a) A prepaid Group Practice employees physician groups that contract with HMO, who share facilities and draw s a l a ries. b) An Individual Practice Association provides medical services out of its own offices and are compensated on a fee-for-service basis. An IPA is usually sponsored by a medical care foundation or a medical society

Fibromyalgia – group of nonarticular rheumatic disorders, characterized by tenderness, muscle, tendon pain, soft tissue pain, with multiple somatic complaints.

Fibrocystic Breast Disease – cystic spaces accompanied by an over growth of breast tissue.

Fixation Device – substance, agent, object used for a
specific purpose to repair or mend a part of the body.

Hearing Disorder – abnormal perception/reception of sound. Heart Attack – circulation to a region within the heart is
obstructed causing necrosis and destroying cardiac tissue.

Foot Disorder – abnormal condition, disease, or impairment
of the feet.

Gallbladder Disease – abnormal conditions affecting
the gallbladder.

Heart Valve Disease – disorder or abnormal findings
within a heart valve.

Gallstone – calculus or stone formed in the gallbladder. Glandular Disorder – abnormal condition, disease or impairment of the exorcrine or endocrine glands. Glucose Intolerance – inability to withstand normal
metabolism of glucose in blood sugar.

Hematoma – a mass or collection of blood which escaped from the vascular system into the soft tissues.

Hepatitis – inflammation or infection of the liver. HIV – human immunodeficiency virus. HIV related test – test performed on a body fluid to detect presence of HIV.

Glycosuria – presence of glucose in the urine. Gout – joint pain caused by metabolic disorder resulting
in crystal deposits and joint destruction.

Hiatal Hernia – protrusion of the stomach through the
esophageal opening of the diaphragm.

Hallucinations – perception of external stimulus objects in the absence of such objects.

Hip Disorder – abnormal condition, disease, or impairment of either hip.

Head Injury – cranial damage affecting skull, brain, blood
vessels, conscientiousness, etc.

Hospital Confined – placed, kept in, or admitted to a medical institution.

Health Care Services – assistance provided through
various entities that offer treatment and consultation.

Hospital Expense Insurance- health insurance protection against the cost of hospital care resulting from the illness or injury of the insured person.

Health Conditions – an impairment that causes a
defective state in one’s wellbeing.

Hospital Indemnity Insurance- a form of health insurance which provides a stipulated daily, weekly or monthly indemnity during hospital confinement. The indemnity is payable on an unallocated basis without regard to the actual expense of hospital confinement.

Health Maintenance Organization (HMO) - an HMO
provides a wide range of comprehensive health care services for members who are enrolled on a group basis and who pay a fixed periodic premium in advance for the services of participating physicians and cooperating hospitals. They emphasize preventive medicine and early treatment through prepaid routine physical examination and diagnostic screening techniques.

Hospitalization – confinement to a medical facility. Hyperthryoidism – deficiency of the thyroid activity Hypoglycemia – abnormally low amount of sugar found
in blood serum.

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Hypothyroidism – under production of sugar or glucose found in thyroid hormones causing underactivity of the thyroid gland.

Lymphadenopathy Syndrome – presence of unexplained enlarged lymph nodes for three or more consecutive months in extra inguinal sites.

Immune System - complex system of various components that defend the body against foreign organisms and substances.

Male Reproductive Disorder – abnormality of or within
the male reproductive organs.

Mammoplasty – plastic reconstruction of the breast to Impaired Sight - lack of or impaired vision Implants – material grafted or inserted into the body for
prosthetic, theraputic, or cosmetic and diagnostic uses. augment or reduce.

Manipulation Therapy – skillful or dexeterous treatment
as with the hands such as massage or chiropractic treatment.

Impotence – inability to copulate or initiate an erection. Major Medical Expense - A form of health insurance Inflammatory Bowel Disease – chronic disease of
the bowel of unknown etiology such as Crohn’s Disease, ilietis, and ulcerative colitis. that provides benefits for most types of medical expense up to a high maximum benefit. Such contracts may contain internal limits and usually are subject to deductibles and coinsurance.

Indication - That which serves as a guide or warning. Material Misrepresentation - A false or misleading Infertility – diminished or lack of capacity to produce
offspring. statement of fact on a application for an insurance policy that influences the insured’s insurability; such statements may serve as a basis for voiding the policy.

Injury – damage inflicted to the body by an external or
internal force.

Managed Care - The integration of both the financing
and the delivery of health care within a system that seeks to manage the accessibility, cost and quality of that care.

Intestinal Disorder – abnormal condition, disease, or
impairment of the intestines.

Medicare - The hospital insurance system and the Irregular Heartbeat – abnormal electrical conduction
through the hearts specialized pathways causing irregular beats. supplementary medical insurance for the aged created by the 1965 amendments to the Social Security Act and operated under the provisions of the Act.

Jaw Disorder – abnormal condition, disease or impairment
of the jaw.

Medication – an agent used in treatment of disease
or maintenance of health.

Joint Pain – pain arising where two bones unite Kidney Stones – calculi formed in the kidney.

Medical Advise – recommendation to explain, improve,
or heal a medical condition.

Mental Disorder – abnormality of the mind or psyche. Liver Disease – abnormal condition, disease, or impairment
affecting the liver.

Migraine Headache – pain in or to the head persisting
over a long period of time.

Leukemia – progressive, malignant disease of blood forming
organs with excessive increase in number of leukocytes.

Mild – not being or involving what is extreme; gentle in nature
or behavior.

Lung Disorder – abnormal condition, disease or impairment
of the lungs.

Moderate – tending toward the mean or average of
dimension – avoiding extremes of behavior – limited in scope and effect.

Lupus Erythematosis – chronic, relapsing, inflammatory disorder of connective tissue and immune system that destroys function of necessary organs.

Morbidity – the incidence, prevalence of a disease Motor Skill Delay – late or retarded development in ability to execute learned physical tasks.

Lymphoma – a neoplastic, malignant disease of the
lymphoid tissue.

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Musculoskeletal System – all muscles of the body collectively and the ligaments, tendons, or bones that interconnect.

Paraplegia – paralysis of both legs and the lower part of
the body.

Parathyroid Disorder – abnormal condition, disease, Musculoskeletal Disorder – abnormal condition, disease, or impairment of the musculoskeletal system. or impairment of the parathyroid gland.

Myalgias – pain in a muscle or muscles. Myositis – inflammation of a voluntary muscle. Narcolepsy – recurrent, uncontrollable episodes of sleep. Necrosis – death of a tissue. Nervous Disorder – abnormality of the brain or spinal
cord and all elements of each.

Persistent Cough – symptoms of cough existing longer than usual time or continually. Persistent Fever – elevated body temperature lasting
longer than usual or continually.

Pes Planus – flat foot. Phlebitis – inflammation or infection in a vein. Physician – authorized practitioner of medicine or
osteopathy and licensed by the appropriate board.

Nervous System – comprised of the brain, spinal cord,
and neural elements.

Pins – (see screw) Pituitary Disorder – abnormal condition, disease, or
impairment of the pituitary gland.

Neuritis – inflammation of a nerve with pain and tenderness,
parasthesias and lack of reflexes.

Nocturia – excessive urination at night. Operation – manual or surgical procedure to improve or
cure a condition.

Plantar – pertaining to the sole of the foot. Plate – an artificial object used to repair, mend, or restore a body part.

Opiate – any remedy, drug, or concoction that contains
opium.

Polydipsia – excessive thirst. Preferred Provider Organization (PPO) or Preferred Provider Arrangements (PPA) PPOs/PPAs
are a compromise between the traditional fee-for service system and HMO’s. Under the usual PPO/PPA arrangement, and employer, union, or insurer obtains price discounts or special services from health care providers in return for channeling employee’s or members to them.

Orthotics – application or device used to protect, restore,
or improve function.

Otitis Externa – inflammation or infection in the external
ear canal

Otitis Media – inflammation or infection of the middle
ear.

Pregnancy Complications – disease or abnormality affecting a pregnancy rendering it less than normal.

Pacemaker – device that uses electrical impulses to regulate
or control heart rhythms.

Prosthetic Device – an object or agent that serves as a
substitute for various body parts.

Palsy – paralysis of varying degrees. Pancreatic Disorder – abnormal condition, disease,
or impairment of the pancreas.

Prostate Disorder – abnormal condition, disease or impairment of the prostate gland.

Pancreatitis – acute or chronic infection or an inflammation
of the pancreas.

Prostatitis – inflammation or infection of the prostate Psoriasis – chronic inflammation or infection of the skin

Paralysis – loss of impairment of motor functions. Psychological Treatment – assistance rendered by Paranoia – a mental disorder characterized by delusions
or persecutions. mental health care services.

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Psychologist – qualified specialist in psychology (mind
and mental process).

Sexually Transmitted Disease (STD) – group of infections caused by certain organisms transmitted by sexual contact.

Psychosis – disorder characterized by loss of reality as evidenced by delusion, hallucinations and incoherency. Quadriplegia – paralysis of all four extremities.

Seizures – convulsion, fit, abnormal movement with complete or partial loss of consciousness.

Severe – inflicting physical discomfort and hardship – of Reactive Airway Disease – acute constrictive breathing disorder caused by the hypersensitivity to external agent. a great degree.

Shunts – surgically created union, a bypass created manuReasonable and Customary Charge - a charge for
health care which is consistent with the average rate or charge in a certain geographic area for identical or similar services. ally.

Skin Disorder – abnormal condition, disease or impairment affecting the skin.

Recent – having lately come into existence – relating to a
time not long past.

Sleep Apnea – transient attacks of failure to automatically control one’s breathing with decreased respiration (may be central or obstructive)

Reconstructive Surgery – treatment, correction, or reformation by surgery from constituent parts.

Speech Disorder – abnormality in ability to speak in normal fashion such as stutter.

Recurrent – returning after remission – returning or happening time after time.

Spinal Cord Disorder – abnormal condition, disease,
or impairment affecting any portion of the spine.

Recurrent Fever – return of elevated temperature after
remission.

Spleen Disorder – abnormal condition, disease, or
impairment of the spleen.

Recurrent Skin Rash – return of skin condition after
remission.

Stenosis – a narrowing or contraction of a duct, canal,
vessel or heart valve.

Relapse – the return of a disease after its apparent cessation.

Remission – a lessening or abatement of manifestations of
disease which often have recurrences.

Stent- artificial device inserted into an organ, vein, or artery to promote/allow continued function or treat disorder within same Stimulant – an agent or chemical that causes central nervous
system excitation, increases functional activities.

Respiratory System – organ, structures such as the
lungs and bronchi whose purpose is to assist in air exchange in the ventilation process.

Stomach Disorder – abnormal condition, disease,
or impairment of the stomach.

Rheumatism – multiple disorders with marked inflammation, degeneration or metabolic derangement of connective tissue structure, especially in the joints.

Stroke – infarct of the vasculature and tissue primarily
of the brain either by blood clot or athromatous plague.

Rosacea – chronic skin disease (usually of the face) characterized by persistent erythema and acute episodes of edema, papules, and pustules. Sciatica – pain radiating from the back into the buttocks and
lower extremities usually caused by protrusion of a lumbar disc.

Surgery – a method of treatment where by disease
or impairments are corrected by manual or operative means.

Surgical Advise – recommendation related to improving
or healing through an operation.

Screw – a special implement used to repair, mend, restore a broken malfunctioning body part.

Swollen Glands – abnormally enlarged nodes. Syncope – a sudden temporary loss of consciousness;
a faint.

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Temporomandibular Joint Disease (TMJ) – abnormal
condition, disease or impairment of the temporomandibular joint.

Waiting period - a period of the time that must pass
after a new employee is hired before he or she becomes eligible to enroll in the group health insurance plan.

Testicular Disorder – abnormal condition, disease or
impairment of the testicles.

Weight Gain – unintentional increase of 10% of body
weight over standard build.

Therapist – one skilled in the treatment of disease, often
dedicated to one specific disorder.

Weight Loss – unintentional loss of more than 10% of
usual body weight.

Thrombosis – the formation or presence of a blood clot
(thrombus) in the circulatory system.

Thyroid Disorder – abnormal condition, disease or impairment of the thyroid gland.

Tonsillitis – inflammation or infection of the tonsils. Treatment – management, consulation and care for
the purpose of combating or controlling a disease or disorder.

Tremors – involuntary trembling or quivering. Tumor – abnormal growth of tissue with multiplication
of abnormal cells.

Tuberculosis - infectious and contagious disease primarily
of the lung, that forms tubercules and causes necrosis in lung tissue or any tissue it invades.

Ulcer – a defect or excavation on the surface of an organ or
tissue created by an inflammatory process that destroys tissue.

Ureteral Reflux – abnormal passage of urine from the
bladder neck back into the ureter.

Urinary System – organs concerned in secretions of urine including kidneys, ureters, bladder, urethra, etc. Urinary Tract Infection – infectious process affecting the
organs of the urinary tract.

Utilization Review - a program designed to reduce
unnecessary hospital admissions and to control the stay of in-patients, through preliminary evaluations, concurrent inpatient evaluations or the use of discharge pre-planning.

Valve Prosthesis – artificial agent used to replace a diseased
or nonfunctioning heart, or other valve.

Varicose Veins – dilated, tortuous, incompetent veins. Viral Infections – disease caused by a virus.

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Claim Submission
Claims are submitted on a claim form to: American National Life Insurance Company of Texas P O Box 1520 Galveston, Texas 77553-1520 Toll-Free Claim Telephone Number: 1-800-899-6805

Provide the Company written notice of claim within 30 days after the occurrence of any loss covered by the policy. When the Company is notified, the necessary instructions and claim forms will be mailed promptly to the Insured. When policyholders notify the agent, give the proper forms to them. Instruct them to show the policy number on all items submitted. Claim forms, along with bills, must be submitted within 90 days after the date of loss. A separate claim form should be furnished for each illness or accident. If possible, all forms should be sent to the Health Claims Department at the same time, rather than sending them in one at a time. At no time should you verify or confirm benefits. The Insured's identification card provides instructions to the hospital or doctor to call the Home Office for verification of benefits.

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