Disability Income Choice Portfolio

Transcription

1 Mutual of Omaha Isurace Compay Disability Icome Choice Portfolio SM Product ad Uderwritig Guide M25981

2 Table of Cotets Product Guidelies Sectio 1 Short-Term Accidet Oly Beefits ad Riders Short-Term Accidet ad Sickess Beefits ad Riders Log-Term Accidet ad Sickess Beefits ad Riders Busiess Operatig Expese Examples of Qualified Applicats Geeral Uderwritig Guidelies Sectio 2 Eligibility Requiremets Miimum Beefit Amouts Social Security umber Foreig Travel o-eglish Speakig Applicats Preferetial Rates State Sposored Compulsory Disability Isurace Tobacco Use Hazardous Avocatios Medical Uderwritig Guidelies Sectio 3 Possible Uderwritig Outcomes Pre-Existig Medical Coditios Schedulig Paramedical Facilities Blood Profile, Urialysis ad HIV Coset Cliet Iterview (PHI) Attedig Physicia s Statemets (APS) otice of Uderwritig Actio (Pedig Report) Body Build Chart Fiacial Uderwritig Guidelies Sectio 4 Defiitios Salary Eared Icome Ueared Icome Overtime Icome Self-Employed et Worth Bakruptcy Depreciatio Future Isurability Optio Icome Documetatio Icome Qualificatio Table M25981_1007

3 Occupatioal Uderwritig Sectio 5 Geeral Descriptio of Occupatioal Classes Multiple Occupatios Maximum Beefit Amouts Beefit ad Elimiatio Periods Special Restrictios Home-Based Occupatios Preferetial Rates Uisurable Occupatios Occupatioal Classificatio Maual Busiess Submissio Process Sectio 6 Trial Iquiries Applicatio Processig Applicatio Completio Applicatio Sectios HIPAA Compliace Replacemets Premium Processig Policy Issue ad Delivery Sample Applicatio

4 Product Guidelies Short-Term Accidet Oly Beefit Period Elimiatio (Moths) Period (Days) Issue Ages Occupatioal Classes 3 14, 30, 60, All 6 14, 30, 60, All 12 14, 30, 60, All 24 14, 30, 60, All Premium Structure Iitial premiums will be based o issue age, occupatio, beefit period, elimiatio period, mothly beefit amout ad ay optioal coverage selected. Preferetial Rates If your cliet is a member of a qualifyig associatio or is selfemployed, they may qualify for a preferetial premium. Uderwritig This product may qualify for Express Uderwritig depedig o age, occupatio ad icome. Reewability This product guaratees the right to cotiue the coverage util age 67. Durig that time, we caot cacel the policy as log as the required premiums are paid whe due. Maximum Beefit Amouts The maximum mothly beefit amout available is $5,000. Total Disability Icome Beefit If a ijury, ot covered by workme s compesatio, prevets your cliet from performig the material ad substatial duties of their regular occupatio, ad they are t gaifully employed i aother occupatio, we will pay a mothly beefit oce the elimiatio period has bee met. Partial Disability Beefit If a ijury prevets your cliet from performig the material ad substatial duties of their regular occupatio for more tha 50 percet of the time usually spet i the daily performace of such duties, we will pay 50 percet of the total disability mothly beefit. These beefits commece after the elimiatio period has bee satisfied ad are payable for up to six moths. Survivor Beefit If your cliet dies while they are disabled, we will pay their beeficiaries a lump sum amout equal to three times the total disability mothly beefit payable at the time of their death. Recurret Disability If a related disability occurs withi six moths of returig to full-time employmet, we will cosider it a recurret disability. A ew elimiatio period will ot eed to be satisfied ad the same beefit period will cotiue. Presumptive Total Disability We will presume your cliet to be totally ad permaetly disabled if a ijury results i their complete ad irrecoverable loss of hearig, speech, sight or use of both hads, both feet or oe had ad oe foot. We will pay your cliet total disability beefits for the full legth of the beefit period eve if they retur to work i aother occupatio. We also will waive the elimiatio period. Waiver of Premium We will waive premium for the coverage ad all optioal riders after your cliet is disabled for 90 days. We also will refud ay premiums paid durig this 90-day period. OPTIOAL RIDER (Available oly at issue) Accidet Hospital Cofiemet Idemity Beefits Rider This optioal rider pays a daily room beefit of $125, $250, $350, or $500 (x2 ICU) for each day of hospital cofiemet due to a accidet. Beefits are payable for a maximum of 45 days for ay period of cofiemet. Uderwritig of the rider will be subject to the Uderwritig Rules for the Policy Form, Health Maual ad Occupatioal Guide Issue ages Oly oe Accidet Hospital Cofiemet Idemity Beefits rider may be attached to a give policy. The rider termiates o whichever of the followig occurs first: The first reewal date followig age 67 The date the policy termiates either the Associatio Group Discout or the Self- Employed Discout applies to this rider Sectio 1 *.Features ad riders may ot be available with all policies or approved i all states. 1

5 Product Guidelies Short-Term Accidet ad Sickess Beefit Period Elimiatio (Moths) Period (Days) Issue Ages Occupatioal Classes 3 14, 30, 60, All 6 14, 30, 60, All 12 14, 30, 60, All 24 14, 30, 60, All Premium Structure Iitial premium will be based o issue age, tobacco status, geder, occupatio, beefit period, elimiatio period, mothly beefit amout ad ay optioal coverage selected. Before age 67, premiums may be chaged, but oly if the same chage is made to all policies i the same class. After age 67, premiums will icrease aually util policy termiates, ad may also be chaged o a class basis. I o evet will premiums icrease durig the first 12 moths. Preferetial Rates If your cliet is a member of a qualifyig associatio, or selfemployed, they may qualify for a preferetial premium. Uderwritig This product may qualify for Express or Simplified Uderwritig depedig o age, icome ad beefit amout. Reewability This product guaratees the right to cotiue coverage util age 67. Durig that time, we caot cacel the policy as log as the required premiums are paid whe due. After age 67, coverage may cotiue to age 75 if full-time employmet ad the ecessary premiums are paid whe due. Maximum Mothly Beefit Amouts The maximum mothly beefit amout available is $5,000. Total Disability Beefits If your cliet is uable to perform the material ad substatial duties of their regular occupatio due to ijury or illess, ot covered by workme s compesatio, ad is ot gaifully employed i aother occupatio, we will pay a mothly beefit oce the elimiatio period has bee met. Partial Disability Beefit If your cliet is able to perform the material ad substatial duties of their regular occupatio due to ijury or illess for o more tha 50 percet of the time usually spet i the daily performace of such duties, we will pay 50 percet of the total disability mothly beefit. These beefits commece after the elimiatio period has bee satisfied ad are payable for up to six moths. Survivor Beefit If your cliet dies while they are disabled, we will pay their beeficiaries a lump sum amout equal to three times the total disability mothly beefit payable at the time of their death. Termial Illess Beefit Your cliet has the optio to accelerate up to 12 moths of disability beefits if diagosed with a termial illess. Recurret Disability If a related disability occurs withi six moths of returig to full-time employmet, we will cosider it a recurret disability. A ew elimiatio period will ot eed to be satisfied ad the same beefit period will cotiue. Presumptive Total Disability We will presume your cliet to be totally ad permaetly disabled if sickess or ijury results i their complete ad irrecoverable loss of hearig, speech, sight, or use of both hads, both feet or oe had ad oe foot. We will pay total disability beefits for the full legth of the beefit period eve if they retur to work i aother occupatio. We also will waive the elimiatio period. Waiver of Premium We will waive premium for the coverage ad all optioal riders after your cliet is disabled for 90 days. We also will refud ay premiums paid durig this 90-day period. Trasplat Door Beefits We will pay beefits o the same basis as ay other sickess if your cliet becomes disabled as the result of a trasplat of part of their body to the body of aother perso. Rehabilitatio Beefit If your cliet is disabled ad receivig disability beefits, they may be eligible to receive vocatioal rehabilitatio services at our expese. OPTIOAL RIDERS (Available oly at issue) Hospital Cofiemet Idemity Beefits Rider This optioal rider pays a daily room beefit of $125, $250, $350, or $500 (x2 ICU) for each day of hospital cofiemet due to a accidet or sickess, subject to a oe-day elimiatio period. Beefits are payable for a maximum of 45 days for ay period of cofiemet. Uderwritig of the rider will be subject to the Uderwritig Rules for the Policy Form, Health Maual ad Occupatioal Guide Issue ages Oly oe Hospital Cofiemet Idemity Beefits rider may be attached to a give policy The rider termiates o whichever of the followig occurs first: The first reewal date followig age 67 The date the policy termiates either the Associatio Group Discout or the Self- Employed Discout applies to this rider 2

6 Critical Illess Beefits Rider This optioal rider pays a lump-sum beefit of $5,000, $10,000, $15,000 or $25,000 upo diagosis of certai specified diseases. The combied beefits of this rider plus ay stad-aloe Mutual of Omaha critical illess policies may ot exceed $250,000. Uderwritig of the rider will be subject to the Uderwritig Rules for the Policy Form, Health Maual ad Occupatioal Guide Adverse family history may affect rider availability Issue ages Oly oe Critical Illess Beefits rider may be attached to a give policy The rider termiates o whichever of the followig occurs first: The first reewal date followig age 67 The date the policy termiates either the Associatio Group Discout or the Self- Employed Discout applies to this rider Retur of Premium Rider This optioal rider provides for the retur of a specified percetage of premiums paid (80 percet or 50 percet). less ay claims paid at the ed of each term period (usually 10 years). Premium ad claims for the Critical Illess Beefits rider, Hospital Cofiemet Idemity Beefits rider, ad Accidet Hospital Cofiemet Idemity Beefits rider are excluded from the retur of premium calculatio. The uderwritig for this rider is the same as the policy to which it is attached Elimiatio Periods 30, 60, 90, 180, ad 365 days oly The rider termiates o whichever of the followig occurs first: The first reewal date followig age 67 The date the policy termiates The Associatio Group Discout ad Self-Employed Discout apply to this rider Critical Illess Isured Coditios Alzheimer s Disease Blidess Deafess Heart Attack (Myocardial Ifarctio) Life-Threateig Cacer (whe first symptoms appear ad first Diagosis occurs more tha 30 days after the Rider Date or rider reistatemet date) Major Orga Trasplat Paralysis Real Failure or Stroke *.Features ad riders may ot be available with all policies or approved i all states. 3

7 Product Guidelies Log-Term Accidet ad Sickess Beefit Period (Years) Elimiatio Period (Days) Issue Ages Occupatioal Classes 2 60, 90, 180, All 5 60, 90, 180, All 10 60, 90, 180, A, 5A,,, To Age 67 60, 90, 180, A, 5A,, Applicats may ot apply for combiatios of Elimiatio Periods ad Beefit Periods usig multiple accidet ad sickess policies with the itet to create total beefits where the Elimiatio Period is less tha the miimum allowed for a particular Beefit Period. Example: Applyig for a 30-day Elimiatio Period with a 1-year Beefit Period o oe applicatio ad applyig for a. 365-day Elimiatio Period with a To Age 67 Beefit. Period o aother applicatio Premium Structure Iitial premium will be based o issue age, tobacco status, geder, occupatio, beefit period, elimiatio period, mothly beefit amout ad where both plas cover accidets ad sickesses. Before age 67, premiums may be chaged, but oly if the same chage is made to all policies i the same class. After age 67, premiums will icrease aually util policy termiates, ad may also be chaged o a class basis. I o evet will premiums icrease durig the first 12 moths. Preferetial Rates If your cliet is a member of a qualifyig associatio, or selfemployed, they may qualify for a preferetial premium. Uderwritig This product is fully uderwritte. Reewability This product is guarateed reewable util age 67. Durig that time, the policy caot be cacelled as log as required premiums are paid whe due. After age 67 coverage may be cotiued to age 75 if workig full time ad the ecessary premiums are paid whe due. Maximum Mothly Beefit Amouts The maximum mothly base beefit amout available is $10,000, or $12,000 if the Social Isurace Supplemet Beefits Rider is added. This amout may vary accordig to icome ad occupatio. Total Disability Beefits If a ijury or illess prevets your cliet from performig the material ad substatial duties of their regular occupatio, ad they are ot gaifully employed i aother occupatio, we will pay a mothly beefit oce the elimiatio period has bee met. After the first 24 moths followig the elimiatio period, if the maximum beefit period has ot bee met, we will cotiue to pay a mothly beefit as log as they are uable to perform the material ad substatial duties of ay occupatio for which they are reasoably suited because of educatio, traiig or experiece. Proportioate Disability Beefit If a ijury or illess prevets your cliet from performig oe or more of the material ad substatial duties of their regular occupatio, or is uable to perform such duties for as much time as it would ormally take to do them, ad the loss of mothly icome is at least 20 percet, we will pay a percetage of the total disability mothly beefit that is proportioate to their loss of icome oce the elimiatio period has bee met. These beefits are payable for up to 24 moths. Survivor Beefit If your cliet dies while disabled, we will pay their beeficiaries a lump sum amout equal to three times the total disability mothly beefit payable at the time of their death. Termial Illess Beefit Your cliet has the optio to accelerate up to 12 moths of disability beefits if diagosed with a termial illess. Recurret Disability If a related disability occurs withi six moths of a retur to full-time employmet, we will cosider it a recurret disability. A ew elimiatio period wo t eed to be satisfied ad the same beefit period will cotiue. Presumptive Total Disability We will presume your cliet to be totally ad permaetly disabled if sickess or ijury results i their complete ad irrecoverable loss of hearig, speech, sight, or use of both hads, both feet or oe had ad oe foot. We will pay total disability beefits for the full legth of the beefit period eve if they retur to work i aother occupatio. We also will waive the elimiatio period. Waiver of Premium We will waive premium for the coverage ad all optioal riders after your cliet is disabled for 90 days. We also will refud ay premiums paid durig this 90-day period. 4

8 Trasplat Door Beefits We will pay your cliet beefits o the same basis as ay other sickess if your cliet becomes disabled as the result of a trasplat of part of their body to the body of aother perso. Rehabilitatio Beefit If your cliet is disabled ad receivig disability beefits, they may be eligible to receive vocatioal rehabilitatio services at our expese. OPTIOAL RIDERS (Available oly at issue) Hospital Cofiemet Idemity Beefits Rider This optioal rider pays a daily room beefit of $125, $250, $350, or $500 (x2 ICU) for each day of hospital cofiemet due to a accidet or sickess, subject to a oe-day elimiatio period. Beefits are payable for a maximum of 45 days for ay period of cofiemet. Uderwritig of the rider will be subject to the Uderwritig Rules for the Policy Form, Health Maual ad Occupatioal Guide Issue ages Oly oe Hospital Cofiemet Idemity Beefits rider may be attached to a give policy The rider termiates o whichever of the followig occurs first: The first reewal date followig age 67 The date the policy termiates either the Associatio Group Discout or the Self- Employed Discout applies Critical Illess Beefits Rider This optioal rider pays a lump-sum beefit of $5,000, $10,000, $15,000 or $25,000 upo diagosis of certai specified diseases. The combied beefits of this rider plus ay stad-aloe Mutual of Omaha critical illess policies may ot exceed $250,000. Uderwritig of the rider will be subject to the Uderwritig Rules for the Policy Form, Health Maual ad Occupatioal Guide Adverse family history may affect rider availability Issue ages Oly oe Critical Illess Beefits rider may be attached to a give policy The rider termiates o whichever of the followig occurs first: The first reewal date followig age 67 The date the policy termiates either the Associatio Group Discout or the Self- Employed Discout applies to this rider Life-Threateig Cacer (whe first symptoms appear ad first Diagosis occurs more tha 30 days after the Rider Date or rider reistatemet date) Major Orga Trasplat Paralysis Real Failure or Stroke Retur of Premium Rider This optioal rider provides for the retur of a specified percetage of premiums paid (80 percet or 50 percet). less ay beefits paid at the ed of each term period (usually 10 years). Premium ad claims for the Critical Illess Beefits rider, Hospital Cofiemet Idemity Beefits rider, ad Accidet Hospital Cofiemet Idemity Beefits rider are excluded from the retur of premium calculatio. The uderwritig for this rider is the same as the policy to which it is attached Elimiatio Periods 30, 60, 90, 180, ad 365 days oly The rider termiates o whichever of the followig occurs first: The first reewal date followig age 67 The date the policy termiates The Associatio Group Discout ad Self-Employed Discout apply to this rider Social Isurace Supplemet Rider This optioal rider offers disability icome isurace at more affordable premiums tha base coverage sice disability beefits payable uder this rider are offset dollar-for-dollar by other forms of social isurace. Uderwritig rules for the rider will be subject to the uderwritig rules for the Policy Form, Health Sectio, Occupatioal Sectio ad Icome Qualificatio Table The same Beefit Period/Elimiatio Period optios ad Issue Age/Occupatioal restrictios that apply to the base coverage also apply to the Social Isurace Supplemet rider The Elimiatio Period ad the Beefit Period must be the same for the base pla ad the SIS rider Oly oe Social Isurace Supplemet rider may be attached to a give policy The rider termiates o whichever of the followig occurs first: The first reewal date followig age 67 The date the policy termiates The Associatio Group Discout ad Self-Employed Discout apply to this rider Critical Illess Isured Coditios Alzheimer s Disease Blidess Deafess Heart Attack (Myocardial Ifarctio) 5

9 Exteded Ow Occupatio Disability Defiitio Amedmet Rider This optioal rider exteds the ow occupatio defiitio of disability applicable to the base ad SIS rider past two years, to the duratio of the Beefit Period. The uderwritig for this rider is the same as the policy to which it is attached Issue ages Beefit Periods 5-Year, 10-Year, ad To Age 67 Occupatioal Classes 6A, 5A,, ad (health care occupatios ad govermet employees are ot eligible) Oly oe Exteded Ow Occupatio Disability Defiitio Amedmet rider may be attached to a give policy The rider termiates o whichever of the followig occurs first: The first reewal date followig age 67 The date the policy termiates The Associatio Group Discout ad Self-Employed Discout apply to this rider Future Isurability Optio Rider (FIO) This optioal rider allows the policyholder to icrease their base mothly beefit, at the policy s aual reewal date, subject oly to proof of fiacial isurability. The maximum icrease amout is two times the base beefit, but the total base plus FIO mothly beefit may ever exceed the maximum base mothly beefit. The maximum allowable icrease o ay give otice date is 25 percet of the total disability mothly beefit (base oly) at policy issue. The uderwritig for this rider is the same as the policy to which it is attached Issue ages Beefit Periods 2, 5, ad 10-Year ad To Age 67 Occupatioal Classes 6A, 5A,,, ad (govermet employees are ot eligible) Health Risk Classes Stadard, Stadard with Exclusio, L or 7 ad M or 8 Oly oe Future Isurability Optio rider may be attached to a give policy The rider termiates o whichever of the followig occurs first: The first reewal date followig age 57 The date beefits have bee icreased to the maximum allowable The date the policy termiates The Associatio Group Discout ad Self-Employed Discout apply to this rider Exteded Proportioate Disability Beefits Rider This optioal rider exteds the maximum duratio Proportioate Disability beefits ca be received past. 24 moths, to the duratio of the Beefit Period. The uderwritig for this rider is the same as the policy to which it is attached Issue ages Beefit Periods 5-Year, 10-Year, ad To Age 67 Oly oe Exteded Proportioate Disability Beefits rider may be attached to a give policy The rider termiates o whichever of the followig occurs first: The first reewal date followig age 67 The date the policy termiates The Associatio Group Discout ad Self-Employed Discout apply to this rider. Cost-of-Livig Adjustmet Rider This optioal rider icreases the disability beefits payable uder the base policy ad SIS rider by the lesser of: The CPI-U (Cosumer Price Idex All Urba Cosumers) 5.0 percet compouded aually The uderwritig for this rider is the same as the policy to which it is attached Issue ages Beefit Periods 2, 5, ad 10-Year ad To Age 67 Oly oe Cost-of-Livig Adjustmet rider may be attached to a give policy The rider termiates o whichever of the followig occurs first: The first reewal date followig age 67 The date the policy termiates The Associatio Group Discout ad Self-Employed Discout apply to this rider *.Features ad riders may ot be available with all policies or approved i all states. 6

10 Product Guidelies Busiess Operatig Expese Beefit Period (Years) Elimiatio Period (Moths) 30, 60, 90, 180 ad 365 days 30, 60, 90, 180 ad 365 days Issue Ages Occupatioal Classes All All Premium Structure Iitial premiums will remai level util age 65 ad are based o issue age, geder, occupatio, beefit period, elimiatio period ad mothly beefit amout. Uderwritig This product may qualify for Express or Simplified Uderwritig depedig o age, occupatio, icome ad beefit amout. Reewability This product guaratees the right to cotiue the coverage util your cliet retires, sells their busiess or otherwise discotiues their busiess or professio util age 65. Durig that time, we caot cacel the policy as log as the required premiums are paid whe due. Maximum Beefit Amout The maximum mothly beefit amout available is $15,000. This amout may vary by icome ad occupatioal classificatio. Total Loss of Time Beefit If your cliet is completely uable to egage i their occupatio ad is ot gaifully employed i aother occupatio, we will pay beefits for operatig expeses icurred durig this total loss of time. Recurret Total Loss of Time Beefit If further loss of time results from ijury or sickess for which beefits have already bee paid, the maximum operatig expese beefit ad deductible period will be restored after retur to full-time work for a period of six cosecutive moths. Waiver of Premium Premiums will be waived for the coverage after total loss of time beefits have bee paid cotiuously for 90 days. Eligibility Requiremets May be issued to qualified professioal ad busiess persos i Occupatio Class 6A, 5A,,,, or who icur operatig expeses covered by this policy ad have bee i busiess for a miimum of two years. Persos operatig busiesses out of their ow home are ot eligible for this coverage. Examples of qualified applicats are: Idividuals, joit occupats, ad members of a partership. I the case of joit occupats ad parters, the mothly beefit may ot exceed the applicat s share of mothly operatig expeses Professioal idividuals who have icorporated solely for tax purposes ad who, except for icorporatio, would qualify uder Rule 1 above Officers of close corporatios with ot more tha five employees icludig corporatio officers, subject to the followig: Each officer isured must be a active full-time, salaried employee of the corporatio The maximum mothly beefit may ot iclude salaries paid to officers or stockholders of the corporatio Coverage issued to ay oe officer may ot exceed a share of expeses proportioate to that officer s share of out-stadig stock Citizeship/Residecy Requiremets: Uited States citizes permaetly residig withi the Uited States or its territories, or Foreig atioals who have a Permaet Residet Visa ad have lived cotiuously i the Uited States or its territories for at least three (3) years [Proof of status will be required by submittig a copy of the permaet residet visa card, ad completig the Foreig atioal/travel Questioaire (Form L5719_0107)] Mothly Beefit Limits Miimum: $500 Maximum: Occupatio Class 6A, 5A, $15,000 Occupatio Class $12,000 Occupatio Class $ 6,000 Occupatio Class $ 5,000 The Maximum mothly beefit may ot exceed the average mothly operatig expeses for the 12-moth period proceedig the date of the applicatio The product may be sold aual, semiaual, quarterly, BSP or PRD (PRD requires siged Ackowledgmet Form) 7

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12 Geeral Uderwritig Guidelies This sectio is desiged to provide you with comprehesive iformatio regardig our eligibility ad employmet requiremets ad medical guidelies. For specific product iformatio, please see the associated product sectio. I additio, you ca talk directly to the uderwritig staff. Cotact your DI uderwritig team. for uderwritig questios or pedig case status at Eligibility Requiremets Log-Term Accidet ad Sickess D81 Short-Term Accidet ad Sickess D82 Short-Term Accidet Oly D83 Workig at least 30 hours per week i Occupatio Classes 6A, 5A,,,, or Age Aual icome of at least $15,000 Citizeship/Residecy Requiremets: Uited States citizes permaetly residig withi the Uited States or its territories, or Foreig atioals who have a Permaet Residet Visa ad have lived cotiuously i the Uited States or its territories for at least three (3) years [Proof of status will be required by submittig a copy of the permaet residet visa card, ad completig the Foreig atioal/travel Questioaire (Form L5719_0107)] o-residet Foreig atioals or those persos aticipatig residece i a foreig coutry, eve temporarily, are ieligible for disability icome isurace Self-employed idividuals must be self-employed At least 6 moths, if egaged i the same occupatio as they were prior to becomig self-employed, or At least 12 moths, if ewly worked or egaged i a differet occupatio tha they were prior to becomig self-employed Busiess Operatig Expese (BOE) 150BE Workig at least 30 hours per week i Occupatio Classes 6A, 5A,,,, or Ages Busiess must have bee i cotiuous operatio for at least two years. Persos operatig busiesses out of their ow home are ot eligible for this coverage. Citizeship/Residecy Requiremets: Uited States citizes permaetly residig withi the Uited States or its territories, or Foreig atioals who have a Permaet Residet Visa ad have lived cotiuously i the Uited States or its territories for at least three (3) years [Proof of status will be required by submittig a copy of the permaet residet visa card, ad completig the Foreig atioal/travel Questioaire (Form L5719_0305)] Self-employed idividuals must be self-employed At least 6 moths, if egaged i the same occupatio as they were prior to becomig self-employed, or At least 12 moths, if ewly worked or egaged i a differet occupatio tha they were prior to becomig self-employed Miimum Beefit Amouts The miimum mothly beefit amouts required are show i the table below. These miimums may be satisfied with a combiatio of base ad SIS coverage. Miimum Mothly Beefit Amouts/Icremets Miimum Beefit Miimum Icremet Short- Term Accidet Oly Short- Term Accidet ad Sickess Log- Term Accidet ad Sickess Busiess Operatig Expese $300 $300 $300 $500 $100 $100 $100 $50 Social Security umber Applicats are cosidered for isurace by providig a valid Social Security umber issued by the Uited States Social Security Admiistratio. Foreig Travel Applicats who travel to foreig coutries frequetly, those who visit for a legthy period of time, or those who travel to areas with political urest, poor ecoomic coditios, lack of moder livig stadards or moder medical facilities, are ieligible for disability icome coverage. o-eglish Speakig Applicats Applicats who do ot speak the Eglish laguage are cosidered for isurace provided the Aget serves as a 3rd- Party traslator ad completes Form MLU25947, Aget s Certificatio for o-eglish Speakig Applicats. Reasoable efforts will be made to assist o-eglish speakig applicats i completig the telephoe iterview ad other uderwritig requiremets. Sectio 2 9

13 Preferetial Rates for Members of Qualifyig Associatio Groups (Short-Term Accidet Oly, Short-Term Accidet ad Sickess ad Log-Term Accidet ad Sickess oly) Members of associatios may qualify for preferetial rates. that are 15 percet below ormal idividual rates. Please call to fid out if your cliet qualifies for a discout. State Sposored Compulsory Disability Isurace I some states residets are eligible for compulsory disability isurace programs with beefit periods ragig from 26 to. 52 weeks. The beefits vary by state ad will be cosidered whe determiig beefit amout eligibility. Tobacco Use (Short-Term Accidet ad Sickess ad Log-Term Accidet ad Sickess oly) Idividuals who have used tobacco products withi 12 moths of applicatio completio or those with positive icotie (cotiie) urialysis test results require tobacco user rates. Tobacco products iclude cigarettes, cigars, pipes, chewig tobacco, ad icotie gum ad patches. Tobacco user rates are 25 percet higher tha otobacco rates. Tobacco users who stop usig tobacco products for 12 cosecutive moths will qualify for a rate reductio. A otobacco questioaire ad oral fluid or urialysis will eed to be completed. Hazardous Avocatios Persos who egage i hazardous avocatios o a amateur basis may still be eligible for disability icome coverage. Avocatios such as automobile/motorcycle/boat racig, hag glidig, skydivig/parachutig, scuba divig, rock climbig, or similar activities should be idetified durig the applicatio process ad a Avocatio Questioaire (icluded i the applicatio kit) must be completed. Typically, a amedmet rider excludig the avocatio will be attached to the policy if the applicatio is approved. 10

14 Medical Uderwritig Guidelies Base Mothly Beefit Amout Short-Term Accidet Oly Short-Term Accidet ad Sickess Express. $300-$3,000 Uderwritig¹ Express. Uderwritig¹ $3,100-$5,000 Iterview $5,100-$8,000 $8,100 ad Above 2-Year ad 5-Year Beefit Period Iterview Iterview,. Oral Fluid Test Iterview,. Physical Data,. Blood ad Urie Iterview,. Log Form Paramed, Blood. ad Urie, EKG² Log-Term Pla 10-Year ad To Age 67 Beefit Period Iterview,. Oral Fluid Test Iterview,. Physical Data,. Blood ad Urie Iterview,. Log Form Paramed, Blood. ad Urie Iterview,. Log Form Paramed, Blood. ad Urie, EKG² Busiess Operatig Expese Express. Uderwritig¹ Iterview Iterview,. Physical Data,. Blood ad Urie Iterview,. Log Form Paramed, Blood. ad Urie, EKG² ¹Uderwritig decisios withi 48 hours of iitial uderwritig review provided the followig coditios are met: Applicat is i occupatio class 6A, 5A,,, or For Accidet Oly coverage: Applicat is age 55 or youger ad medically stadard For Accidet ad Sickess coverage: Applicat is otobacco, age 45 or youger, ad medically stadard o adverse iformatio from the Medical Iformatio Bureau All applicatio questios have bee clearly ad completely aswered ad required forms ad fiacial documets have bee submitted with the applicatio ²Age 45 ad over oly Sectio 3 Possible Uderwritig Outcomes Stadard Impairmet Rate-Up of L (25 percet), M (50 percet),. (75 percet) ad/or a BL (Beefit Limitatio) for a specific coditio which will exclude such coditio from coverage uless the loss begis at least 12 moths after the policy effective date Impairmet Rate-Up of 7 (25 percet), 8 (50 percet),. 9 (75 percet) ad a # (Disease Elimiatio Rider) for a specific coditio which will exclude such coditio from coverage for as log as the rider is o the policy BL (Beefit Limitatio) for a specific coditio, which will exclude such coditio from coverage uless loss begis. 12 moths after the policy effective date # (Disease Elimiatio Rider) for a specific coditio which will exclude such coditio from coverage for as log as the rider is o the policy Reject o coverage available Pre-Existig Medical Coditios Applicats who are acutely ill, curretly disabled, have surgery pedig, or are recuperatig from a illess or ijury are geerally ot eligible for coverage. The uderwriter will evaluate applicats with residual illesses or ijuries. Applicats with cotrolled, chroic coditios with appropriate medical maagemet may be eligible for coverage. Below is a list of some of the coditios that will result i automatic rejectio of a applicatio for disability icome coverage. AIDS/HIV/AIDS Related Complex (ARC) Alcohol or Drug Abuse/Depedece treatmet withi the past 5 years Bipolar or Maic Depressio Cardiomyopathy *Chroic Fatigue Sydrome Coective Tissue Disorders Scleroderma ad Polymyositis *Coroary Artery Bypass or Agioplasty *Coroary Artery Disease ACC after 6 moths *Diabetes Type I, isuli-depedet, or juveile *Gastric By-pass *Hepatitis Preset ad/or chroic Multiple Sclerosis Muscular Dystrophy *Myocardial Ifarctio/Heart Attack arcolepsy Parkiso s Disease Pedig evaluatio or Ucofirmed diagosis *Polycystic Kidey Disease *Pregacy *Rheumatoid Arthritis * Persos with these coditios may be cosidered for accidet oly coverage. 11

15 Coverage may be available for applicats with the followig pre-existig medical coditios, however, their beefits may be limited. Medical records will be required i order to make the fial uderwritig determiatio. Diabetes Type II, o-isuli depedet Coverage will be limited to a maximum mothly beefit of $2,000 with a 90-day waitig period, ad a 2- year beefit period. Policy will have a exclusio rider for Diabetes Mellitus ad/or Complicatios Metal/ervous Coditios (Axiety, Depressio, Stress, etc.) Coverage will be limited to a maximum mothly beefit of $3,000 with a 90-day waitig period, ad a 5- year beefit period. Policy will have a exclusio rider for eurosis, Psychoeurosis, Metal or Emotioal, Persoality or Psychotic Disorder of Ay Kid Schedulig After the applicatio is completed, please schedule all required examiatios with approved paramedical examiatio facilities. Paramedical facilities complete blood profile, urialysis ad log-form examiatios. Oral fluid swabs eed to be completed by the aget. To order oral fluid kits: Mutual of Omaha. Career aget: Cotact Divisio Office All other agets: Call (optio #2) Paramedical Facilities Mutual of Omaha s approved paramedical facilities have blood kits ad the expertise to complete our blood profile requiremets. All blood specimes must be draw usig Portamedic or APPS blood kits ad mailig istructios. Oe of these paramedical facilities must be used whe a blood profile is required or requested. All specimes are set to the Cliical Referece Laboratory (CRL) for testig. Blood Profile, Urialysis ad HIV Coset Mutual of Omaha may require a blood profile, urialysis or a fluid swab. See the Uderwritig Requiremets Chart for specific guidelies. Laboratory tests may be requested for lesser amouts. A HIV coset form may be required i some states, coset forms will be icluded i the applicatio packet. Cliet Iterview (PHI) A cliet iterview will be required for certai beefit amout/ beefit period combiatios. They may also be ordered at the uderwriter s discretio. The iterview should be completed at the time of the applicatio or shortly thereafter. Please call ad follow the prompts to complete a disability iterview. The iterviews are recorded ad geerally take oly 10 to 20 miutes, depedig o the applicat s health history. Cliets should be prepared to provide physicia ad medicatio iformatio. Attedig Physicia s Statemets (APS) I order to reder the most favorable decisio possible, a APS may be required. The home office will iitiate the request by cotactig the doctor s office or medical facility i advace to cofirm the availability of the medical records, cost ad requiremets for release. The home office will advise you of our request ad periodically follow-up with the medical facility. Timely release of the requested APS depeds o the quality of the cotact iformatio ad the degree of cooperatio afforded by the medical facility. The aget ad applicat ca play a crucial role i securig the APS by cotactig the medical facility to reiterate the urgecy ad sigificace of obtaiig the ecessary iformatio. otice of Uderwritig Actio (Pedig Report) otice of Uderwritig Actio correspodece is available o SPA to cofirm the uderwritig requiremets that are ecessary to uderwrite the applicatio. For assistace i viewig this report, please cotact our sales support team. If you are a Mutual of Omaha career aget, please call All other agets, please call Portamedic APPS

16 Build Chart The build chart used for disability icome isurace categorizes applicats ito differet risk classes accordig to their Body Mass Idex (BMI). The BMI is a umber calculated from a perso s weight ad height. BMI provides a reliable idicator of body fatess for most people ad is used to scree for weight categories that may lead to health problems. Use the Build Chart by first fidig the applicat s height i the left-had colum ad the lookig across the row to fid the applicat s weight i pouds. The colum headig above their weight will determie their appropriate risk class. BMI Substadard Ratig Height Declie Stadard 25% 50% 75% Declie 4'8" < '9" < '10" < '11" < '0" < '1" < '2" < '3" < '4" < '5" < '6" < '7" < '8" < '9" < '10" < '11" < '0" < '1" < '2" < '3" < '4" < '5" < '6" < '7" < '8" < '9" < '10" < '11" < M

17

18 Fiacial Uderwritig Guidelies DEFIITIOS Salary Salary (wage) is defied as compesatio received by a employee for services performed. A salary is a fixed sum paid for a specific period of time worked, such as weekly or mothly. (Federal Tax Form W-2) Eared Icome Eared icome is icome eared from employmet, which would iclude wages, salary, tips, bouses ad other compesatio. Eared icome is reported o a gross, or beforetax basis. Sigificat chages or fluctuatio i eared icome may require clarificatio to determie the appropriate beefit amout available. Ueared Icome Ueared (passive) icome is defied as icome that does ot come from employmet. Sources of ueared icome might iclude icome from retal properties, divideds, iterest, royalties, ad capital gais. Oe-half of ay amout of ueared icome i excess of $1,500 a moth will be cosidered as other disability beefits at the time of uderwritig. Overtime Icome Overtime icome is defied as icome received for workig i excess of a 40-hour workweek. Overtime icome should ot be icluded whe calculatig mothly beefit amout eligibility. Icome Documetatio Self-Employed Self-employed is defied as a applicat who is operatig as a sole proprietor, idepedet cotractor, partership or closely held corporatio ad has 20 percet or more owership i a busiess. et Worth et Worth is defied as the value of a perso s assets, icludig cash, mius all liabilities. The amout by which the idividual s assets exceed their liabilities is cosidered the et worth of that perso. I order to determie et worth for uderwritig purposes, the primary persoal residece ad persoal belogigs may be igored. Beefits may be limited for idividuals with et worth i excess of $2.5 millio. Bakruptcy o coverage ca be offered util two years after a applicat s bakruptcy discharge. Depreciatio Depreciatio is defied as a o-cash expese that reduces the value of a asset as a result of wear ad tear, age, or obsolescece. Depreciatio of assets such as furiture ad equipmet ca be cosidered whe determiig the mothly beefit amout for a Busiess Operatig Expese (BOE) policy. Future Isurability Optio (Log-Term Accidet ad Sickess oly) Whe exercisig the Future Isurability Optio proof of icome must accompay the supplemetal applicatio. Sectio 4 Base Mothly Beefit Amout Employee o-ower Sole Proprietor Parter i Partership Corporatio Shareholder S-Corp Shareholder Last Year s 1120S, K1 ad W2 Form or Last Year s 1040 Form, Schedule E, ad W2 Form* First 2 Pages of. Last 2 Years Form, Both Pages of 1120S,. K1, ad W2 Form or Schedule E ad W2 Form Up to $5,000 Uderwriter Discretio Last Year s. Schedule C* Last Year s K1 or Schedule C* Last Year s 1120 Form (Pages 1. ad 2)* Over $5,000 First 2 Pages of. Last 2 Years Form ad. W2 Form First 2 Pages of. Last 2 Years Form ad Schedule C First 2 Pages of. Last 2 Years Form with K1 ad Schedule C First 2 Pages of. Last 2 Years Form with W2 ad Both Pages of 1120 Form *.Fiacials are geerally ot required if applyig for Short-Term Accidet Oly coverage up to $3,000. Idividual who have bee. self-employed less tha 12 moths must provide a Profit ad Loss/Expese Statemet. 15

19 Icome Qualificatio Table The icome qualificatio table shows the maximum beefit amouts available for a give icome level for Short-Term Accidet Oly, Short-Term Accidet ad Sickess ad Log-Term Accidet ad Sickess policy forms. The maximums are iteded to replace a sufficiet percetage of a policyholder s icome to allow them to sustai their stadard of livig durig a disability while ot completely removig the fiacial icetive to retur to work. The table is based o aual gross (before tax) eared icome. The maximum base ad maximum SIS beefits available do ot sum to equal the total maximum beefit available. This gives cliets the flexibility to maximize either base or SIS beefits i desigig the icome protectio pla that fits their eeds. Whe lookig up values i the table, move to the ext lower Aual Eared Icome value. (Example: $42,500 of eared icome would use the $41,000 table values) OTE:..For Short-Term Accidet Oly ad Short-Term Accidet ad Sickess plas, refer to the Total Maximum Mothly Beefit colum sice these coverages have o SIS beefits. Aual Eared Icome Maximum Base Mothly Beefit Maximum SIS Mothly Beefit with O Depedets Maximum SIS Mothly Beefit with Depedets Total Maximum Mothly Beefit $15,000 $600 $400 $400 $900 17, ,000 19, ,100 21, ,200 23, ,300 25, ,000 1,400 27, ,000 1,200 1,500 29, ,000 1,200 1,600 31, ,100 1,300 1,700 33, ,100 1,300 1,800 35,000 1,000 1,200 1,400 1,900 37,000 1,100 1,200 1,400 2,000 39,000 1,100 1,300 1,500 2,100 41,000 1,200 1,300 1,600 2,200 43,000 1,300 1,400 1,600 2,300 45,000 1,300 1,400 1,700 2,400 47,000 1,400 1,500 1,800 2,500 49,000 1,500 1,500 1,800 2,600 51,000 1,600 1,500 1,800 2,700 53,000 1,600 1,500 1,900 2,800 55,000 1,600 1,600 1,900 2,800 57,000 1,700 1,600 1,900 2,900 59,000 1,800 1,600 2,000 3,000 61,000 1,900 1,600 2,000 3,100 63,000 2,000 1,600 2,000 3,200 65,000 2,000 1,600 2,100 3,300 67,000 2,100 1,700 2,100 3,400 69,000 2,200 1,700 2,100 3,400 71,000 2,200 1,700 2,200 3,500 73,000 2,300 1,700 2,200 3,600 75,000 2,400 1,700 2,200 3,700 80,000 2,600 1,800 2,300 3,900 85,000 2,800 1,800 2,300 4,100 90,000 3,000 1,800 2,300 4,300 95,000 3,100 1,800 2,300 4, ,000 3,300 1,800 2,300 4, ,000 3,500 1,800 2,300 4, ,000 3,700 1,800 2,300 5, ,000 3,900 1,800 2,300 5, ,000 4,100 1,800 2,300 5, ,000 4,200 1,800 2,300 5, ,000 4,400 1,800 2,300 5, ,000 4,600 1,800 2,300 5, ,000 4,700 1,800 2,300 5, ,000 4,900 1,800 2,300 6, ,000 5,100 1,800 2,300 6, ,000 5,200 1,800 2,300 6, ,000 5,400 1,800 2,300 6,500 M26139_

20 Icome Qualificatio Table (cotiued) Aual Eared Icome Maximum Base Mothly Beefit Maximum SIS Mothly Beefit with O Depedets Maximum SIS Mothly Beefit with Depedets Total Maximum Mothly Beefit $165,000 $5,500 $1,800 $2,300 $6, ,000 5,600 1,800 2,300 6, ,000 5,800 1,800 2,300 6, ,000 5,900 1,800 2,300 7, ,000 6,000 1,800 2,300 7, ,000 6,200 1,800 2,300 7, ,000 6,400 1,800 2,300 7, ,000 6,500 1,800 2,300 7, ,000 6,700 1,800 2,300 7, ,000 7,000 1,800 2,300 8, ,000 7,200 1,800 2,300 8, ,000 7,400 1,800 2,300 8, ,000 7,700 1,800 2,300 8, ,000 8,000 1,800 2,300 8, ,000 8,200 1,800 2,300 9, ,000 8,400 1,800 2,300 9, ,000 8,600 1,800 2,300 9, ,000 8,800 1,800 2,300 9, ,000 9,000 1,800 2,300 9, ,000 9,200 1,800 2,300 10, ,000 9,300 1,800 2,300 10, ,000 9,600 1,800 2,300 10, ,000 9,800 1,800 2,300 10, ,000 10,000 1,800 2,300 10, ,000 10,000 1,800 2,300 10, ,000 10,000 1,800 2,300 11, ,000 10,000 1,800 2,300 11, ,000 10,000 1,800 2,300 11, ,000 10,000 1,800 2,300 11, ,000 10,000 1,800 2,300 11, ,000 10,000 1,800 2,300 11, ,000 10,000 1,800 2,300 11, ,000 10,000 1,800 2,300 12, ,000 10,000 1,800 2,300 12, ,000 10,000 1,800 2,300 12, ,000 10,000 1,800 2,300 12, ,000 10,000 1,800 2,300 12, ,000 10,000 1,800 2,300 12,300 Coordiatio with Group Log-Term Disability I order to determie the maximum beefit amout that ca be offered to cliets with group disability isurace, multiply the Total Maximum Mothly Beefit colum of the Icome Qualificatio Table by 1.20, the subtract the total group disability mothly beefit amouts they are eligible for. 17

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22 Occupatioal Uderwritig These occupatioal guidelies are desiged to assist i the proper occupatioal classificatio of applicats for disability icome isurace. The classificatios are based o factors such as degree of educatio, traiig, ad skill demaded by the occupatio, level of maual dexterity ad physical effort required, evirometal hazards to health ad safety preset i the workplace, employmet stability, ecoomic factors specific to the occupatio/idustry, ad past compay claims experiece Some occupatios are ot specifically listed i the Occupatioal Maual. I these cases, please refer to the Geeral Descriptio of Occupatioal Classes below or cotact the Uderwritig Support Uit at It is importat that applicats be classified accurately accordig to these guidelies sice occupatioal class determies the premium rate ad the amout of coverage that is available. As a result, each applicat s specific duties must be accurately described, as well as the percetage of time each of the duties is performed. This iformatio, more frequetly tha the job title, will be the basis for a fair occupatioal classificatio. The occupatioal classes cotaied i the maual are guidelies oly ad Uderwritig reserves the right to adjust these classificatios if specific job duties or circumstaces suggest such actio is warrated. I certai cases, additioal requiremets are icluded i the job descriptio, such as miimum icome tests. Uless otherwise oted, applicats who caot comply with these additioal requiremets are geerally ot eligible for coverage, but check with a uderwriter if you re ot sure. Occupatios are grouped by geeral idustry. To locate a occupatio, look first alphabetically for the job descriptio ad, if uable to locate, the check by idustry. Geeral Descriptio of Occupatioal Classes Class 6A Cotais oly the most stable executive ad professioal occupatios where work is performed i a office settig with o evirometal hazards, o direct supervisio of persos with maual resposibilities ad miimal travel. Class 5A Class Cotais executive ad professioal occupatios where work is performed i a office settig with o evirometal hazards, o direct supervisio of persos with maual resposibilities ad miimal travel. Cotais other executive ad professioal occupatios where most work is performed i a office settig with o evirometal hazards ad o direct supervisio of persos with maual resposibilities. Class Class Class Class Cotais a variety of maagerial, professioal, ad techical occupatios icludig may health care occupatios. The majority of work is performed i a settig with miimal evirometal hazards. Cotais occupatios that require more movemet ad travel or more maual dexterity or light physical effort. Some evirometal hazards may be preset i the work settig. Cotais occupatios with a greater emphasis o moderate to heavy physical labor ad more direct exposure to workplace hazards. Cotais occupatios that are uisurable due to excessive exposure to workplace hazards ad relatively poor eared icome or job stability. Multiple Occupatios If the evet a applicat has more tha oe occupatio, the occupatioal classificatio will be based o the occupatio ivolvig the greatest level of evirometal hazards. Icome from the part-time or seasoal occupatios will geerally ot be cosidered whe determiig beefit eligibility. Maximum Beefit Amouts The maximum base beefit amouts available by occupatioal class are show i the table below. Occupatioal Class Short- Term Accidet Oly Maximum Base Beefit Short- Term Accidet ad Sickess Log- Term Accidet ad Sickess Busiess Operatig Expese 6A, 5A, $5,000 $5,000 $10,000 $15,000 $5,000 $5,000 $8,000 $12,000 $5,000 $5,000 $6,000 $6,000 $5,000 $5,000 $5,000 $5,000 Short-Term Accidet Oly, Short-Term Accidet ad Sickess ad Log-Term Accidet ad Sickess are subject to additioal limitatios based o isurable icome that are cotaied i the Icome Qualificatio Table sectio of this guide. The maximum BOE mothly beefit may ot exceed the average mothly operatig expeses for the 12-moth period precedig the date of the applicatio. Beefit ad Elimiatio Periods There are o occupatioal-related beefit period restrictios o ay of the short-term coverages, icludig the Busiess Operatig Expese. Sectio 5 M26043_