-
7/30/2019 M8487-02 Freedom UW Med Cond Guide Final 1.10.13
1/8
Underwriting Medical Conditions Guide
Issued by Forethought Lie Insurance Company
ForethoughtFreedomSM
M8487-02 2013 Forethough0113
FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
-
7/30/2019 M8487-02 Freedom UW Med Cond Guide Final 1.10.13
2/8
8487-02 2013 Forethough0113FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
-
7/30/2019 M8487-02 Freedom UW Med Cond Guide Final 1.10.13
3/8
M8487-03 2013 Forethough0113FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
Forethought FreedomSM
Underwriting Medical Conditions Guide
This Underwriting Medical Conditions Guide has been developed to assist you in
pre-qualiying your clients or the Forethought FreedomSMproduct.
Prior to beginning the application process, we suggest that you ask your client i he or she
has had any medical problems in the last several years, such as heart disease, heart surgery,diabetes, stroke, cancer, lung disease, etc. Ater collecting the details regarding your clients
medical history, reer to the guide to determine the probable plan o insurance or which he
or she may qualiy.
Please remember that this is only a guide and the nal underwriting decision will be
based on all data collected, including MIB, Inc., prescription database search, and a tele-
interview. Please contact our Underwriting Department at [email protected]
or 1-888-606-6372 with any questions.
Forethought Lie Insurance Company (Forethought) reserves the right to request any
additional inormation deemed necessary to make an underwriting decision.
-
7/30/2019 M8487-02 Freedom UW Med Cond Guide Final 1.10.13
4/8
Medical Conditions Considerations ProbableUnderwriting Result
Activities o Daily Living Currently requiring assistance with any ADL Decline(ADL)
AIDS Ever been diagnosed or treated or Decline
Alcohol dependency Diagnosed, treated, advised to have treatment, taken or been prescribed ROPmedication or in the last 24 months
Alzheimers disease Ever been diagnosed, treated or advised to have treatment or, taken or Declinebeen prescribed medication or
Amputation Due to disease in the last 24 months ROPAmyotrophic lateral sclerosis Ever been diagnosed, treated or advised to have treatment or, taken or Decline(ALS) been prescribed medication or
Aneurysm Surgery perormed within the last 12 months. Diagnosed, treated, advised ROPto have treatment or, taken or been prescribed medication or in the last12 months
Aneurysm Diagnosed, treated or taken medication or 13 to 24 months ago. No treatment Gradedor medication in the last 12 months
Angina Diagnosed, treated, advised to have treatment, taken or been prescribed ROPmedication in the last 12 months
Angina Diagnosed, treated or advised to have treatment, taken medication or Graded13 to 24 month ago. No attacks, treatment or medication takenin the last 12 months
Angioplasty Surgery perormed within the last 12 months. Treated, advised to have ROPtreatment or, taken or been prescribed medication or in the last 12 months
Angioplasty With a history o stroke ROP
Angioplasty With a history o transient ischemic attack (TIA) ROP
Angioplasty With a history o diabetes ROP
Angioplasy Surgery perormed 13 to 24 months ago. Treated or taken medication or Graded13 to 24 months ago. No treatment or medication taken in the last 12 months
Atrial brillation Diagnosed, treated, advised to have treatment or, taken or been prescribed Gradedmedication or in the last 24 months
Atrial utter Diagnosed, treated, advised to have treatment or, taken or been prescribed Gradedmedication or in the last 24 months
Bipolar disorder Diagnosed, treated, advised to have treatment, taken or been prescribed Gradedmedication or in the last 24 months
Bradycardia Diagnosed, treated, advised to have treatment or, taken or been prescribed Gradedmedication or in the last 24 months
Brain tumor Diagnosed, treated, advised to have treatment, taken or been prescribed ROPmedication or in the last 24 months
Bypass surgery Surgery perormed within the last 12 months. Treated, advised to have ROPtreatment or, taken or been prescribed medication or in the last 12 months
Bypass surgery With a history o stroke ROP
Bypass surgery With a history o transient ischemic attack (TIA) ROP
Bypass surgery With a history o diabetes ROP
Bypass surgery Surgery perormed 13 to 24 months ago. Treated or taken medication or Graded13 to 24 months ago. No treatment or medication taken in the last 12 months
Cancer Other than basal cell o the skin, diagnosed, treated, advised to have ROPtreatment, taken or been prescribed medication or in the last 24 months
Cardiomyopathy Diagnosed, treated, advised to have treatment, taken or been prescribed Declinemedication or in the last 24 months
Cardiomyopathy With a history o a stroke or TIA ROP
Cardiomyopathy With a history o diabetes ROP
Carotid artery surgery Surgery perormed in the last 12 months ROP
Carotid artery surgery Surgery perormed 13 to 24 months ago Graded
Chemotherapy Currently receiving or been advised to receive Decline
2
8487-02 2013 Forethough0113FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
-
7/30/2019 M8487-02 Freedom UW Med Cond Guide Final 1.10.13
5/8
Medical Conditions Considerations ProbableUnderwriting Result
Chronic bronchitis Diagnosed, treated, advised to have treatment, taken or been prescribed Gradedmedication or in the last 24 months
Chronic hepatitis Diagnosed, treated, advised to have treatment, taken or been prescribed Gradedmedication or in the last 24 months
Chronic memory loss Ever been diagnosed, treated or advised to have treatment or, taken or Declinebeen prescribed medication or
Chronic obstructive Diagnosed, treated, advised to have treatment, taken or been prescribed Gradedpulmonary disease (COPD) medication or in the last 24 months
Cirrhosis o the liver Diagnosed, treated, advised to have treatment, taken or been prescribed ROPmedication or in the last 24 months
Conned to a bed Currently conned to a bed Decline
Congestive heart ailure Diagnosed, treated, advised to have treatment, taken or been prescribed Declinemedication or in the last 24 months
Congestive heart ailure With a history o a stroke or transient ischemic attack (TIA) ROP
Congestive heart ailure With a history o diabetes ROP
Convulsion Convulsion within the last 12 months Graded
Coronary artery disease Diagnosed, treated, advised to have treatment, taken or been prescribed ROPmedication in the last 12 months
Coronary artery disease With a history o stroke ROP
Coronary artery disease With a history o transient ischemic attack (TIA) ROPCoronary artery disease With a history o diabetes ROP
Coronary artery disease Diagnosed, treated or advised to have treatment, taken medication or 13 to Graded24 months ago. No treatment or medication taken in the last 12 months
Debrillator Currently implanted Graded
Dementia Ever been diagnosed, treated or advised to have treatment or, taken or Declinebeen prescribed medication or
Diabetes With retinopathy/eye disorder in the last 24 months ROP
Diabetes With kidney disorder in the last 24 months ROP
Diabetes With insulin shock in the last 24 months ROP
Diabetes With a history o a stroke ROP
Diabetes With a history o a transient ischemic attack (TIA) ROP
Diabetes With a history o heart attack ROP
Diabetes With a history o heart disease ROP
Diabetes With a history o bypass surgery ROP
Diabetes With a history o angioplasty or stent placement ROP
Diabetes Taken insulin within the last 5 years Graded
Diabetes With a history o a heart valve replacement ROP
Diabetes With a history o congestive heart ailure ROP
Diabetes With a history o cardiomyopathy ROP
Diabetic coma In the last 24 months ROP
Drug dependency Diagnosed, treated, advised to have treatment, taken or been prescribed ROP
medication or in the last 24 monthsEmphysema Diagnosed, treated, advised to have treatment, taken or been prescribed Graded
medication or in the last 24 months
End stage kidney disease Ever been diagnosed, treated or advised to have treatment or, taken or Declinebeen prescribed medication or
Endarterectomy Surgery perormed within the last 12 months. Been treated or, advised ROPto have treatment or, taken or been prescribed medication or, in thelast 12 months
Endarterectomy Surgery perormed 13-24 months ago. Been treated or, advised to have Gradedtreatment or, taken or been prescribed medication or, 13-24 months ago.No treatment or medication taken in the last 12 months
8487-02 2013 Forethough0113FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
-
7/30/2019 M8487-02 Freedom UW Med Cond Guide Final 1.10.13
6/8
Epilepsy Seizure within the last 12 months Graded
Heart attack Diagnosed, treated, advised to have treatment, taken or been prescribed ROPmedication in the last 12 months
Heart attack Multiple heart attacks ROP
Heart attack With a history o stroke ROP
Heart attack With a history o transient ischemic attack (TIA) ROP
Heart attack Diagnosed, treated or advised to have treatment, taken medication or Graded
13 to 24 month ago. No treatment or medication taken in the last 12 months
Heart surgery Surgery perormed within the last 12 months. Treated, advised to have ROPtreatment or, taken or been prescribed medication or in the last 12 months
Heart surgery Surgery perormed 13 to 24 months ago. Treated or taken medication or Graded13 to 24 months ago. No treatment or medication taken in the last 12 months
Heart transplant Had or been recommended to have Decline
Heart valve replacement Surgery perormed within the last 12 months. Treated, advised to have ROPtreatment or, taken or been prescribed medication or in the last 12 months
Heart valve replacement Surgery perormed 13 to 24 months ago. Treated or taken medication or Graded13 to 24 months ago. No treatment or medication taken in the last 12 months
Heart valve replacement With a history o diabetes ROP
Heart valve replacement With a history o a stroke or transient ischemic attack (TIA) ROP
Hepatitis Diagnosed, treated, advised to have treatment, taken or been prescribed Gradedmedication or in the last 24 months
HIV positive Ever been diagnosed or treated or Decline
Hodgkins disease Diagnosed, treated, advised to have treatment, taken or been prescribed ROPmedication or in the last 24 months
Home Health Care Currently receiving any type o home health care Decline
Hospice Care Currently receiving hospice care Decline
Hospitalized Currently in a hospital Decline
Hospitalized Two or more hospitalizations or any reason, within the last 12 months Graded
Incarceration/Prison Currently in prison Decline
Irregular heartbeat Diagnosed, treated, advised to have treatment or, taken or been prescribed Gradedmedication or in the last 24 months
Kidney dialysis Currently receiving or been advised to receive Decline
Kidney ailure Ever been diagnosed, treated or advised to have treatment or, taken Declineor been prescribed medication or
Kidney transplant Had or been recommended to have Decline
Leukemia Diagnosed, treated, advised to have treatment, taken or been prescribed ROPmedication or in the last 24 months
Liver ailure Ever been diagnosed, treated or advised to have treatment or, taken Declineor been prescribed medication or
Liver transplant Had or been recommended to have Decline
Lou Gehrigs disease (ALS) Ever been diagnosed, treated or advised to have treatment or, taken Declineor been prescribed medication or
Lung transplant Had or been recommended to have DeclineLymphoma Diagnosed, treated, advised to have treatment, taken or been prescribed ROP
medication or in the last 24 months
Melanoma Diagnosed, treated, advised to have treatment, taken or been prescribed ROPmedication or in the last 24 months
Multiple Myeloma Diagnosed, treated, advised to have treatment, taken or been prescribed ROPmedication or in the last 24 months
Multiple sclerosis Diagnosed, treated, advised to have treatment, taken or been prescribed Gradedmedication or in the last 24 months
Nursing Home Currently conned to a nursing home Decline
Medical Conditions Considerations ProbableUnderwriting Result
4
8487-02 2013 Forethough0113FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
-
7/30/2019 M8487-02 Freedom UW Med Cond Guide Final 1.10.13
7/8
Medical Conditions Considerations ProbableUnderwriting Result
Oxygen Currently using or been advised to use ( other than or sleep apnea) Decline
Pacemaker Currently implanted or been advised to have implanted Graded
Parkinsons disease Diagnosed, treated, advised to have treatment, taken or been prescribed Gradedmedication or in the last 24 months
Psychiatric acility Currently conned to a psychiatric acility Decline
Psychosis Diagnosed, treated, advised to have treatment, taken or been prescribed Gradedmedication or in the last 24 months
Radiation Currently receiving or been advised to receive Decline
Schizophrenia Diagnosed, treated, advised to have treatment, taken or been prescribed Gradedmedication or in the last 24 months
Seizure Seizure within the last 12 months Graded
Stent placement Surgery perormed within the last 12 months. Treated, advised to have ROPtreatment or, taken or been prescribed medication or in the last 12 months
Stent placement With a history o stroke ROP
Stent placement With a history o transient ischemic attack (TIA) ROP
Stent placement With a history o diabetes ROP
Stent placement Surgery perormed 13 to 24 months ago. Treated or taken medication or Graded13 to 24 months ago. No treatment or medication taken in the last 12 months
Stroke Stroke occurred within the last 12 months. Treated, advised to have ROPtreatment or, taken or been prescribed medication or in the last 12 months
Stroke Multiple strokes ROP
Stroke With a history o heart disease ROP
Stroke With a history o angioplasty or stent placement ROP
Stroke With a history o heart attack ROP
Stroke Stroke occurred 13 to 24 months ago. Treated or taken medication or Graded13 to 24 months ago. No treatment or medication taken in last 12 months
Stroke With a history o a transient ischemic attack (TIA) ROP
Stroke With a history o a heart valve replacement ROP
Stroke With a history o cardiomyopathy ROP
Stroke With a history o congestive heart ailure ROP
Stroke With a history o bypass surgery ROP
Supra ventricular tachycardia Diagnosed, treated, advised to have treatment or, taken or been prescribed Gradedmedication or in the last 24 months
Tachycardia Diagnosed, treated, advised to have treatment or, taken or been prescribed Gradedmedication or in the last 24 months
Transient ischemic attack (TIA) TIA occurred within the last 12 months. Treated, advised to have treatment ROPor, taken or been prescribed medication or in the last 12 months
Transient ischemic attack (TIA) Multiple transient ischemic attacks (TIA) ROP
Transient ischemic attack (TIA) With a history o heart disease ROP
Transient ischemic attack (TIA) With a history o angioplasty or stent placement ROP
Transient ischemic attack (TIA) With a history o bypass surgery ROP
Transient ischemic attack (TIA) With a history o heart attack ROPTransient ischemic attack (TIA) TIA occurred 13 to 24 months ago. Treated or taken medication or Graded
13 to 24 months ago. No treatment or medication taken in last 12 months
Transient ischemic attack (TIA) With a history o a stroke ROP
Transient ischemic attack (TIA) With a history o a heart valve replacement ROP
Transient ischemic attack (TIA) With a history o cardiomyopathy ROP
Transient ischemic attack (TIA) With a history o congestive heart ailure ROP
Wheel Chair Currently conned to or using Decline
8487-02 2013 Forethough0113FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
-
7/30/2019 M8487-02 Freedom UW Med Cond Guide Final 1.10.13
8/8
Forethought Lie Insurance Company
Administrative Ofce
One Forethought CenterBatesville, IN 47006
Phone: 1-888-606-6372Email: [email protected]
www.forethought.com
8487-02 2013 Forethough0113FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
Forethought FreedomSM is unded through the purchase o whole lie insurance rom Forethought Lie Insurance Company,Indianapolis, Indiana. Depending upon insurance plan ofered, death benet may vary during rst two policy years. A
representative who may also be an agent o Forethought Lie Insurance Company can answer any questions you may have.
Forethought Lie Insurance Company (Forethought), provides innovative insurance and nancial solutions or amiliesmanaging retirement and end-o-lie needs. Headquartered in Indianapolis, Indiana, Forethought provides lie insurance
and annuities.
Forethought has been consistently recognized by A.M. Best or nancial strength.
As o June 30, 2012, Forethought has assets owned and under management in excess o $5.9 billion, approximately$1.7 billion in annual revenue, and more than $5.3 billion o lie insurance and annuity reserves.
With over 25 years o proven integrity, Forethought has served more than a million customers who rely on us to protectthe nancial uture o their amilies.