Lincoln MoneyGuard solutions

Transcription

1 Lincoln MoneyGuard solutions Your presubmission underwriting tool To determine if you are a good candidate for Lincoln MoneyGuard solutions: 1 Review the presubmission underwriting 2 Review the auto-decline medication list. 3 considerations below. Review the height and weight guidelines (confirm BMI is acceptable). Presubmission underwriting considerations POSTPONE submitting a Lincoln MoneyGuard application if you are currently receiving medical treatment or medical treatment is pending. For example: If you: Received any joint injections with a cortisone or other steroid medication in the last 6 months Are currently receiving or scheduled for physical therapy or receiving more than twice monthly maintenance chiropractic care Have surgery scheduled in the next 6 months Have been advised to have surgery that is not yet completed Are currently being evaluated for an undiagnosed medical condition You should wait to submit your application until: 6 12 months (depending on reason for injection and if there were multiple injections discuss with your advisor) At least 30 days after the date of your last physical therapy treatment and you have been released from care (You must be back to 100% activity without limitations.) At least 3 months post-operative Fully recovered Back to 100% activity and released from all medical and doctor s care Until all evaluations have been completed and a diagnosis has been made DISQUALIFYING conditions for Lincoln MoneyGuard solutions are noted below: Alzheimer s disease, dementia, or taking medication for memory loss Congestive heart failure Heart attack, heart or carotid artery surgery within the past 6 months An implantable defibrillator Osteoporosis with a compression fracture or height loss of two or more inches Rheumatoid arthritis taking Prednisone or a biologic agent (Enbrel, Humira, Remicade, Rituxan, Kineret, Actemra, Orencia, Cimzia, etc.) Type 1 diabetes Dialysis treatment or chronic kidney disease Organ transplant recipient Moderate to severe emphysema or moderate to severe chronic obstructive pulmonary disease (COPD) Oxygen use for any reason Cancer certain breast, colon, prostate and lung cancers may qualify within 6 12 months of completion of treatment depending on the pathological staging of the tumor, treatment type, and time from completion of treatment. All other cancer types and recurrent cancer conditions are not considered until at least 3 years from completion of successful treatment, depending on the pathology of tumor, treatment type and type of cancer. Nonmelanoma skin cancers can qualify without any wait period. Transient ischemic attack (TIA) within the past 6 months or two or more TIAs Stroke within the past 12 months, multiple stroke history, or stroke with significant cardiac disease history Parkinson s disease, multiple sclerosis or muscular dystrophy Use of any narcotic drug or prescription pain medication currently or within the last 3 months (dental work narcotic pain prescription medications are excluded) Height and weight: if your BMI (body mass index) is less than 17 or greater than 42. To calculate BMI visit: lose_wt/bmi/bmicalc.htm. Use of a cane of any variety, walker or wheelchair currently or within the last 12 months Issuance of or requirement and use of a handicap parking permit due to physical limitations or medical conditions Currently collecting any type of disability payments Cardiomyopathy within the past 3 years Use of any medication on the Lincoln Medication Decline List History of falls due to gait disturbance or dizziness, or two or more falls in the last 36 months Severe sleep apnea with no treatment Bipolar disorder, mania, recurrent major depression, or schizophrenia Any medical condition that has restricted your mobility or has impacted ADLs in any way Page 1 of 2

2 The guidelines listed are not meant to be all inclusive. Due to the complexity of individual case medical histories, multiple comorbid medical conditions could result in a decline or postpone decision even if not listed here. Underwriting will decide based on the information provided in the interview. If you have any questions about qualification based on your medical history, contact your advisor for guidance. If you are going to proceed with submitting an application, please review the Personal History Interview instructions. This document will help you prepare for the Personal History Interview. Important information: Lincoln MoneyGuard Reserve, Lincoln MoneyGuard Reserve Plus, and Lincoln MoneyGuard II are universal life insurance policies with a rider that accelerates the specified amount of death benefit to pay for covered longterm care expenses. An Extension of Benefits Rider (EOBR), or Long-Term Care Extension of Benefits Rider (LEBR) on Lincoln MoneyGuard II, is available to continue long-term care benefit payments after the entire specified amount of death benefit has been paid. The Return of Premium Rider (ROPR) may be included at issue on onetime payment policies for issue ages on Lincoln MoneyGuard Reserve policies. The Enhanced Surrender Value Endorsement (ESVE) is included in Lincoln MoneyGuard Reserve Plus policy cost for all single premium policies and for flexible premium policies for issue ages On Lincoln MoneyGuard II policies, the return of premium options are offered through the Value Protection Rider (VPR) available at issue; Base option (1) is included in the policy cost; Graded option (2) is available at an additional cost. Any additional surrender benefit provided will be adjusted by any loans/loan interest/loan repayments, withdrawals taken, and claim payments made, and it will have tax implications. The cost of riders will be deducted monthly from the policy cash value. The insurance policy and riders have limitations, exclusions, and/or reductions. Long-term care benefit riders may not cover all costs associated with long-term care costs incurred by the insured during the coverage period. All contract provisions, including limitations and exclusions, should be carefully reviewed by the owner. For costs and complete coverage details, contact your agent or producer. Not a deposit Not FDIC-insured Not insured by any federal government agency Not guaranteed by any bank or savings association May go down in value 2015 Lincoln National Corporation LincolnFinancial.com Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. LCN ECG 6/15 Z01 Order code: MGR-QUA2-FLI007 Lincoln MoneyGuard Reserve policies are issued by Lincoln Life & Annuity Company of New York, Syracuse, NY, on Policy Form LN850 (8/05) with a Convalescent Care Benefits Rider on Rider Form LR851 (8/05), an Extension of Benefits Rider on Rider Form LR852 (8/05), a Return of Premium Rider on Rider Form LR850 (10/07), a Terminal Illness Accelerated Death Benefit Rider on Rider Form LR853 (8/05), a Right to Purchase a Long-Term Care Policy on Endorsement Form LR856 (8/05), and a Nonforfeiture Benefit Rider on Rider Form LR855 (8/05). Lincoln MoneyGuard Reserve is only available in the state of New York. Lincoln MoneyGuard Reserve Plus policies are issued by The Lincoln National Life Insurance Company, Fort Wayne, IN, on Policy Form LN870 with a Comprehensive Long-Term Care Benefits Rider (CCBR) on Rider Form LR870, an optional Enhanced Surrender Value Endorsement (ESVE) on Endorsement Form B10465F, an optional Extension of Benefits Rider (EOBR) on Rider Form LR871, and an optional Nonforfeiture Benefit Rider (NFO) on Rider Form LR872. The Lincoln National Life Insurance Company does not solicit business in the state of New York, nor is it authorized to do so. Lincoln MoneyGuard Reserve Plus is only available in the state of California. Lincoln MoneyGuard II policies are issued by The Lincoln National Life Insurance Company, Fort Wayne, IN, on Policy Form LN880/ICC13LN880 with the following riders: Value Protection Rider (VPR) on form LR880 and state variations/icc15lr880 Rev; Long-Term Care Acceleration of Benefits Rider (LABR) on form LR881/ICC13LR881; optional Long-Term Care Extension of Benefits Rider (LEBR) on form LR882/ICC13LR882. Lincoln MoneyGuard II is not available in the states of California or New York. All guarantees and benefits of the insurance policy are subject to the claims-paying ability of the issuing insurance company. They are not backed by the broker-dealer and/or insurance agency selling the policy, or any affiliates of those entities other than the issuing company affiliates, and none makes any representations or guarantees regarding the claims-paying ability of the issuing insurance company. Products and features, including benefits, exclusions, limitations, terms, and definitions, may vary by state. Page 2 of 2

3 FOR LIFE Universal Life Insurance Lincoln MoneyGuard solutions underwriting at a glance The final underwriting decision is based on the details provided in the Personal History Interview. Please contact the Lincoln MoneyGuard Underwriting department to discuss medical history not identified below. Uninsurable conditions Activity of daily living deficit(s) AIDS/HIV positive Alcoholism, active Amyotrophic lateral sclerosis (ALS), Lou Gehrig s disease Alzheimer s disease/dementia Aneurysm not surgically repaired Ataxia Balance disorders Cane, walker, wheelchair use Cardiomyopathy Chronic obstructive pulmonary disease Chronic pain (regular use prescription pain medication) Cirrhosis Congestive heart failure Cystic fibrosis Defibrillator (implantable) Diabetes mellitus (Type I) Dialysis/kidney failure Esophageal varices Falls (2+ in past 36 months) Handicap parking permit due to limitations or medical condition Hemophilia Hepatitis (chronic or active) Hydrocephalus Kidney disease (chronic) Lupus (systemic) Macular degeneration (progressive) Memory loss Mental impairment or retardation Multiple myeloma Multiple sclerosis Muscular dystrophy Myasthenia gravis Organ transplant Oxygen use Pancreatitis (chronic or multiple episodes) Paralysis of one or more limbs Paraplegia, quadriplegia, or hemiplegia Parkinson s disease Polycystic kidney disease Post polio syndrome (PPS) Primary billiary sclerosis Receiving Social Security or any other disability benefits Schizophenia Scleroderma Sclerosing cholangitis Wegener s granulomatosis Not a deposit Not FDIC-insured Not insured by any federal government agency Not guaranteed by any bank or savings association May go down in value Products issued by: The Lincoln National Life Insurance Company Lincoln Life & Annuity Company of New York For agent or broker use only. Not for use with the public. Page 1 of 4

4 Submission postponement periods Do not submit until appropriate time has elapsed and client is fully recovered and released from all medical care. Incident Postponement Incident Postponement Stroke 12 months Heart attack 6 months Transient ischemic attack (TIA) 6 months Heart valve replacement surgery 6 months Pacemaker implant 3 months Joint replacements 6 months Coronary artery disease, bypass surgery, or angioplasty Cardioversion No complete physical exam within past 12 months 6 months Pending surgery After completion of surgery and appropriate recovery 6 months period has passed Postpone until exam completed and results known Physical therapy treatment Single joint injection 6 months Multiple joint injections 12 months Bone marrow transplant 10 years Gastric bypass surgery 6 months Carotid artery surgery 6 months After release from all care and client is back to full activity without limitations Medical conditions with tobacco use Tobacco use in the past 24 months with any of the following medical conditions is uninsurable. Asthma Heart attack Carotid artery disease Peripheral vascular disease Coronary artery disease Sarcoidosis Diabetes (Type II) Sleep apnea Emphysema Stroke or transient ischemic attack (TIA) Streamlined underwriting guidelines for common conditions The following conditions may be acceptable for Lincoln MoneyGuard products. The final underwriting decision is based on details or overall medical history provided by the client in the Personal History Interview. Alcoholism Angina Anxiety Arthritis Asthma Atrial fibrillation Carotid artery disease Chronic fatigue syndrome/ fibromyalgia Coronary artery disease Crohn s disease/colitis Degenerative disc disease Recovered for 48 months Past history only; no current symptoms; favorable build, blood pressure, and lipids Mild or stable on medications; no hospitalization in past 48 months Symptoms do not limit activities; no chronic pain; no narcotic, immunosuppressant, or steroid medication use; no TENS (transcutaneous electrical nerve stimulator) unit use; not treated with four or more medications Mild symptoms; no oral steroids No complications; stable; no coexisting history of heart condition, stroke, carotid artery disease, circulatory problems, or diabetes No tobacco use in past 24 months; no coexisting history of stroke or TIA Not treated with three or more medications; symptoms do not limit activities; no coexisting history of major depression; no narcotic medications No tobacco use in the past 24 months; onset of symptoms or diagnosis must have occurred after age 45; no coexisting history of diabetes, stroke, TIA, or COPD; no ongoing symptoms; favorable build, blood pressure, and lipids Stable with mild symptoms; no weight loss; no hospitalization in past 12 months; no oral steroids or immunosuppressant medications Symptoms do not limit activities; no chronic pain; no narcotic or steroid medication use; no TENS (transcutaneous electrical nerve stimulator) unit use; not treated with four or more medications; not treated with three or more intraverterbral injections in past 12 months; no history of vertebroplasty Page 2 of 4

5 Streamlined underwriting guidelines for common conditions, cont d. Depression Diabetes Dizziness/vertigo Epilepsy/seizure disorder Mild symptoms; stable on medications; no hospitalization in past 24 months; no coexisting history of chronic fatigue syndrome/fibromyalgia; treated with less than three medications Adult onset (Type II); good control; favorable build, blood pressure, and lipids; no tobacco use in past 24 months; not treated with more than 80 units of insulin per day; no coexisting conditions of coronary artery disease No frequent symptoms; no falls in past 12 months No seizure activity in past 12 months; not treated with three or more medications Heart attack No tobacco use in past 24 months; onset of symptoms or diagnosis must have occurred after age 50; no coexisting history of diabetes, stroke, TIA, or COPD; no ongoing symptoms; favorable build, blood pressure, and lipids Heart valve replacement Hypertension (high blood pressure) Incontinence Lyme disease Mitral valve disease/prolapse Osteoporosis Paget s disease Psoriasis Polymyalgia rheumatica Resident of continued care retirement community Sarcoidosis Sleep apnea Spinal stenosis/spondylosis Stroke Transient ischemic attack (TIA) Onset of symptoms or diagnosis must have occurred after age 50; no ongoing symptoms; no coexisting history of atrial fibrillation or arrhythmia Treated with stable and good control Minor problem; symptoms do not limit activities Symptoms do not limit activities; no treatment in past six months Stable with no symptoms; no coexisting history of atrial fibrillation or coronary artery disease Stable; no height loss of two or more inches; no history of compression fractures; symptoms do not limit activities; dependent on bone density T-score and treatment received; no coexisting history of spinal stenosis, scoliosis, kyphosis, or vertebroplasty Mild symptoms; symptoms do not limit activities Mild symptoms; no evidence of joint involvement Symptoms do not limit activities; no chronic pain; no narcotic, immunosuppressant, or steroid medication use; no TENS (transcutaneous electrical nerve stimulator) unit use; not treated with four or more medications Not receiving any services; no fees are paying for future care No tobacco use in past 24 months; no ongoing symptoms or current treatment Mild, stable, and controlled with or without CPAP; compliant with CPAP use, if recommended; no tobacco use in past 24 months Symptoms do not limit activities; no chronic pain; no narcotic or steroid medication use; not treated with four or more medications; no coexisting history of osteoporosis, scoliosis, or kyphosis Single episode, must have occurred more than 12 months ago; no residual impairments; fully recovered; no tobacco use in past 24 months; no coexisting history of TIA, coronary artery disease, congestive heart failure, cardiomyopathy, atrial fibrillation, or diabetes Single episode, must have occurred more than 12 months ago; no residual impairments; fully recovered; no tobacco use in past 24 months; no coexisting history of stroke, coronary artery disease, congestive heart failure, cardiomyopathy, atrial fibrillation, or diabetes Page 3 of 4

6 Streamlined underwriting guidelines for cancer The following conditions may be acceptable. The final underwriting decision is based on the details or overall medical history provided by the client in the Personal History Interview. The submission postponement periods specified below are required minimum time frames. These may be longer, depending on the details of the medical history. Clients must have completed all treatment (including surgery, radiation, or chemotherapy). Clients with recurrent or metastatic cancer are not insurable for Lincoln MoneyGuard products. Cancer Submission postponement period from date of last treatment Uninsurable Possible considerations Breast 6 months With lymph node involvement and treated within the past 10 years Colon 6 months With lymph node involvement and treated within the past 5 years Stage, grade, and size of tumor; and type of treatment Stage, grade, and size of tumor; and type of treatment Leukemia 10 years Stage, type, and treatment Lung 3 years Tobacco use within past 24 months Stage and type of treatment Lymphoma 10 years Stage, type, and treatment (includes both Hodgkin s and non-hodgkin s disease) Prostate 6 months With lymph node involvement and treated within the past 5 years Stage, type of treatment (surgery or radiation), PSA level, and follow-up care Skin cancer (melanoma) 3 years More than one malignant melanoma Stage, Clark level, and type of treatment Skin cancer (nonmelanoma) 3 months Type, stage, and number of lesions Not a deposit Not FDIC-insured Not insured by any federal government agency Not guaranteed by any bank or savings association May go down in value 2014 Lincoln National Corporation LincolnFinancial.com Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. LCN MOS 4/14 Z01 Order code: MGR-QUI2-BRC001 All other types of cancer Treated within the past 3 years Issuers: The Lincoln National Life Insurance Company, Fort Wayne, IN Lincoln Life & Annuity Company of New York, Syracuse, NY The Lincoln National Life Insurance Company does not solicit business in the state of New York, nor is it authorized to do so. All guarantees and benefits of the insurance policy are subject to the claims-paying ability of the issuing insurance company. They are not backed by the broker-dealer and/or insurance agency selling the policy, or any affiliates of those entities other than the issuing company affiliates, and none makes any representations or guarantees regarding the claims-paying ability of the issuer. Distributor: Lincoln Financial Distributors, Inc., abroker-dealer Policies: Lincoln MoneyGuard Reserve, universal life insurance policy form LN850 (8/05) with a Convalescent Care Benefits Rider (CCBR) on Rider Form LR851 (8/05), a Return of Premium Rider on Rider Form LR850 (10/07), a Terminal Illness Stage, grade size of tumor, and type of treatment Accelerated Death Benefit Rider on Rider Form LR853 (8/05), and a Right to Purchase a Long-Term Care Policy on Endorsement Form LR856 (8/05). Only available in the state of New York. Lincoln MoneyGuard Reserve Plus, universal life insurance policy form LN870 with a Convalescent Care Benefits Rider* (CCBR) on Rider Form LR870 and an optional Enhanced Surrender Value Endorsement (ESVE) on Endorsement Form B10465F. Not available in the state of New York. Lincoln MoneyGuard II, universal life insurance policy form LN880/ICC13LN880 with the following riders: Value Protection Rider (VPR) on form LR880/ ICC13LR880; Long-Term Care Acceleration of Benefits Rider (LABR) on form LR881/ICC13LR881; and optional Long-Term Care Extension of Benefits Rider (LEBR) on form LR882/ICC13LR882. Not available in the state of New York. *State variations apply. For agent or broker use only. Not for use with the public. Page 4 of 4

7 LIFE SOLUTIONS Lincoln MoneyGuard solutions Personal History Interview Instructions Dear valued prospective Lincoln MoneyGuard client: Please complete the worksheet below prior to your Personal History Interview. Preparing for your interview helps ensure it will go smoothly. The worksheet is for your use only and should not be returned to Lincoln. What you need to do The actual phone interview will take about 60 minutes. You may want to be in a place free of distractions. Be ready to provide the following details: Your name, gender, birth date, address, Social Security number (SSN), and the Social Security numbers or tax I.D. numbers (TIN) of the individuals/entities that will be the owner and beneficiary(ies). We will also ask about your source of premium, citizenship and marital status. Your existing life insurance policy, annuity and long-term care contract information. We ll verify company names, coverage amounts, issue dates, and if you re replacing the policies, the policy numbers. This includes any previous coverage for which you applied and may have been declined, rated, postponed or offered. Your medical history including diagnoses, symptoms and conditions for which you are or have been treated in the last 10 years. Be sure you are prepared to give detailed information about your health and recent physician visits. We will want to know about any symptoms, treatments, and any testing or follow up that occurred. Be ready to provide your doctor s name, address, phone number, specialty, date and reason for last visit, and any testing or treatment performed. We ll also perform a prescription drug check prior to your Personal History Interview, and you may be asked about any medications identified as a part of that search. The names and dosages of any medications you are currently taking. Have prescription bottles handy to make it easier. This interview may require you to participate in a short memory exercise. The outcome of your application will be based on the information given during this interview only. Be sure you take your time and give it your full attention. Thank you for applying for Lincoln MoneyGuard solutions. We look forward to talking to you. Preinterview worksheet Important numbers Your Social Security number Existing insurance information List every life insurance policy, annuity contract or long-term care policy you currently have in-force AND any life insurance or annuity you ve applied for, but have not yet been issued. Use a separate sheet of paper if there is not enough room in the space provided. Company name Policy number (if available) Issue date Face amount Replacing Yes Yes Yes No No No Products issued by: The Lincoln National Life Insurance Company Lincoln Life & Annuity Company of New York Page 1 of 4

8 Owner information If you are not the owner of this policy, you need to provide the following information for the owner: Owner s name Date of birth Relationship to insured SSN or TIN Address If trust owned, you need to provide the following information: Trust name Date of trust Trustee(s) Trust TIN Beneficiary(ies) Use a separate sheet of paper if there is not enough room in the space provided. Name Date of birth Address Phone number SSN or TIN Relationship Trust name Trustee name Date of trust Share percentage Primary beneficiary (1) Primary beneficiary (2) Contingent beneficiary Third party designation (to receive grace period of lapse notices) Name Address Phone number Height Weight Page 2 of 4

9 Doctors visits Please provide the following information about any doctors you ve seen in the last five years for a medical condition, routine physical exam, or follow up. Use a separate sheet of paper if there is not enough room in the space provided. Doctor s name City and state Specialty Date of visit Reason for last visit Testing or treatment received Doctor s name City and state Specialty Date of visit Reason for last visit Testing or treatment received Disability benefits In the last 12 months have you collected any of the following disability benefits: worker s compensation, Social Security disability, disability insurance or handicap sticker? Yes No Have you had to alter any of your daily activities? Yes No Social history Marital status Tobacco use Alcohol use Medical history List any medical conditions you have or have ever been diagnosed with. Use a separate sheet of paper if there is not enough room in the space provided. Condition Date of diagnosis Symptoms Type and date of treatment Tests done and results Medications Provide the following information about the prescription medication or aspirin you are currently taking. Date of last doctor visit Prescription name Dosage and frequency Reason for usage Length taken Date last used Page 3 of 4

10 If you have any of the following conditions, please be ready to provide the following information, and check with your doctor to make sure the pathology staging, tumor size and treatment information are accurate for the call. Breast cancer Age at diagnosis Size of tumor Stage Lymph node involvement Type of treatment Prostate cancer Age at diagnosis and pretreatment PSA Gleason score Stage Type of treatment Post-treatment PSA Colon cancer Age at diagnosis Dukes staging Lymph node involvement Type of treatment Diabetes Age at diagnosis Fasting blood glucose Blood HgA1C Type of treatment Coronary heart disease Age at diagnosis Bypass surgery Yes No If yes, how many vessels? Angioplasty with or without stent Yes No Heart attack Yes No Last stress test and results Not a deposit Not FDIC-insured Not insured by any federal government agency Not guaranteed by any bank or savings association May go down in value 2014 Lincoln National Corporation LincolnFinancial.com Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. LCN POD 7/14 Z01 Order code: MGR-PHI2-FLI001 Issuers: The Lincoln National Life Insurance Company, Fort Wayne, IN Lincoln Life & Annuity Company of New York, Syracuse, NY The Lincoln National Life Insurance Company does not solicit business in the state of New York, nor is it authorized to do so. All guarantees and benefits of the insurance policy are subject to the claims-paying ability of the issuing insurance company. They are not backed by the broker-dealer and/or insurance agency selling the policy, or any affiliates of those entities other than the issuing company affiliates, and none makes any representations or guarantees regarding the claims-paying ability of the issuer. Products, riders and features are subject to state availability. The insurance policy and riders have limitations, exclusions, and/or reductions. Check state availability. Additionally, long-term care benefit riders may not cover all costs associated with longterm care costs incurred by the insured during the coverage period. Distributor: Lincoln Financial Distributors, Inc., a broker-dealer Policies: Lincoln MoneyGuard II, universal life insurance policy form LN880/ICC13LN880 with the Value Protection Rider (VPR) on form LR880/ICC13LR880, Long-Term Care Acceleration of Benefits Rider (LABR) on form LR881/ICC13LR881, and optional Long-Term Care Extension of Benefits Rider (LEBR) on form LR882/ICC13LR882 (not available in NY). Lincoln MoneyGuard Reserve, universal life insurance policy form LN850 (8/05) with a Convalescent Care Benefits Rider (CCBR) on Rider Form LR851 (8/05), a Return of Premium Rider on Rider Form LR850 (10/07), a Terminal Illness Accelerated Death Benefit Rider on Rider Form LR853 (8/05), and a Right to Purchase a Long-Term Care Policy on Endorsement Form LR856 (8/05) (only available in NY). Lincoln MoneyGuard Reserve Plus, universal life insurance policy form LN870/ICC11LN870 with a Convalescent Care Benefits Rider* (CCBR) on Rider Form LR870/ICC11LR870 and an optional Enhanced Surrender Value Endorsement (ESVE) on Endorsement Form B10465F/ICC11B10465F (not available in NY). *State variations apply. Page 4 of 4