Producer guide - IHC Health Solutions

Table of ContentsImportant Addresses and Phone Numbers 2Communicating for America, Inc 3Eligibility of ApplicantsIssue Ages for Individual or Family Coverage 3Issue Ages for Child(ren) Only Coverage 3Adopted Children 3Legal Custody 3Resident State 4Foreign Nationals 4Overseas Travelers 4Medicare Eligible Individuals 4Restricted Occupations 4Underwriting GuidelinesMedical Underwriting Sources 5Height and Weight Guidelines 6-7Preferred Rating 7Co-Morbidity Factor 8Expectant Parenthood 8Disabled Applicants 8Unacceptable Health Conditions 8Pre-Screening 9Term Life Insurance Underwriting Guidelines 9Submitting an ApplicationChecklist for New Applicant 9-10Application Withdrawals 10Pre-Existing ConditionsPre-Existing Conditions 10Full Disclosure of Health Conditions 10Pre-Existing Credit 10HIPPA Eligible Individual 10-11Underwriting DecisionsIssued as Applied 11Exclusionary Riders 111Empowered Underwriting Matrix 12-14Rating 14Higher Deductible 14Decline 14Requirements to PlacePending Requirements 15Exclusionary Riders 15Premium Rating 15Producer Kit/Delivery Certificate 15Effective Dates and BillingEffective Dates 15Billing Date 15Billing Mode Options 15Commissions 15After the SaleInforce Certificate Changes 16-17Medical Claim Review 18Rescission or Reformation of Coverage 18Reinstatement of Coverage 18Continuation 18Turning Age 65 – Medicare Eligibility 181

This guide was designed for the Companion Life Insurance Company’s individually sold health plans made availablethrough IHC Health Solutions and administered by Insurers Administrative Corporation (IAC). It contains importantinformation about new business processing and underwriting guidelines to assist the sales representative in determiningthe eligibility of prospects and applicants. By following these procedures and guidelines, you will help facilitate theprompt review, processing and issuance of your health cases. Throughout this guide, producers will be referred to as“you,” IAC will be referred to as “us” and Companion Life will be referred to as “the company.”Nothing in this guide is intended to guarantee that the described underwriting practices apply in all circumstances. Thecompany’s actual underwriting practices in effect at the time an application is reviewed will apply to the processing andunderwriting of new business.Important Addresses and Phone NumbersInsurers Administrative CorporationUnderwriting Administration and Billing Claims (PPO claims use the address on ID card)1173 W. Main St. Ste. E PO Box 37457 P.O. Box 828Whitewater, WI 53190 Phoenix, AZ 85069-7457 Park Ridge, IL 60068-0828Phone: 866-472-6555 Phone: 800-887-1480 Phone: 877-519-4972Fax: 602-674-9015 Fax: 602-906-4745 Fax: 602-395-0496UW E-mail: Administration E-mail: Claims E-mail:UWind_Wisconsin@iacusa.com admin@iacusa.comCAclaims@iacusa.comWeb site: http://thinkihc.iacusa.comFor information on Communicating for America, Inc. contact:Communicating for America, Inc. (CA)112 E Lincoln Ave.Fergus Falls, MN 56537Phone: 800-432-3276Fax: 218-739-3832Web site: www.CommunicatingforAmerica.orgFor supplies and contracting contact:IHC Health Solutions – Fergus Falls110 E Lincoln Ave.Fergus Falls, MN 56537Phone: 800-576-7179Fax: 1-866-566-2711Forms and Supplies E-mail: supplies@cainc.org (or download from http://thinkihc.iacusa.com)Product Support E-mail: Patty.Strickland@thinkIHC.comFor product support, contest/promotional information, agency support and recruiting contact:IHC Health Solutions – Bloomington8009 34 th Ave. S., Suite 360Bloomington, MN 55425Phone: 866-746-6610Fax: 952-746-6611Product Support and Contest E-mail: Annie.Hauskins@thinkIHC.comRecruiting and Agency Support E-mail: John.Carlson@thinkIHC.com2

Communicating for America, Inc.The Freedom Health Plans are group association plans available to members of Communicating for America, Inc. (CA).CA is a national, nonprofit, nonpartisan rural association founded in 1972 and headquartered in Fergus Falls, Minn. Alongwith the endorsement standards that CA requires Companion Life to abide by, the association membership provides theinsured with numerous benefits.In order to be issued a Freedom Health Plan, the primary applicant must be a member of CA.* A Standard membership isavailable for $8 per month, and a Premier level membership (Bronze, Silver or Gold) is available with monthly dues thatvary based on the membership type and family status. For more information on CA and the benefits provided, please referto the product brochure or visit www.CommunicatingforAmerica.org.* Membership is optional in Kansas and Montana.Eligibility of ApplicantsIssue Ages for Individual or Family CoverageAdult applicants must be 18-64 years of age. A spouse currently residing in the same household as the primary applicantand under age 65 is considered an eligible dependent. We do not recognize common-law relationships or domesticpartners unless required by state law. Dependent children or stepchildren must be unmarried and under age 19*, or underage 25* if a full-time student at an accredited college, vocational school or high school. Full-time means activelyattending at least 12 hours of class per week or attending the minimum hours of class the school considers as full-timestatus. For summer sessions, six credit hours are required if not enrolled for the following semester.* May vary by state law.Issue Ages for Child(ren) Only CoverageChild(ren) applying for coverage on a plan not to include a parent or legal guardian must be 2 months to 17 years of age.Newborn and adopted children can be added to a child-only plan, subject to full underwriting. The youngest child to beinsured must be listed as the applicant, and all other children listed under the dependent section of the application. Aparent or legal guardian must sign the application and answer all medical questions of the children for which coverage isbeing applied. Also, a parent or legal guardian must be the certificate/policy owner and the CA member. When childrencovered under such policies attain age 19 (or 25 if a full-time student), they can be issued coverage under their ownindividual plan without evidence of insurability and charged an adult rate if they reside in a state where the coverage isavailable. If issued their own coverage, they must become a member of CA.To calculate a premium for a child-only plan, enter the youngest child as primary and add additional siblings asdependents. Rates are based on the youngest child’s residential address. Benefits are based on the owner’s residentialaddress.Adopted ChildrenCoverage for adopted children begins on the date of placement with the insured. Placement means that the insured hasphysical custody of the adopted child and is the court-appointed guardian or has final adoption papers. The primaryinsured must notify IAC in writing within 31 days of placement to continue coverage. If notice and payment (ifapplicable) are not received within 31 days of placement, the adopted child is subject to full underwriting.Legal CustodyDependents who do not meet the basic definition of an eligible dependent but who are in the legal custody of the insuredmay be considered for coverage subject to review of legal custody documents. Generally, temporary custody or powers ofattorney are not considered sufficient legal documentation. There must be permanent custody documented by court orderto qualify as an eligible dependent, except as otherwise mandated by state law.3

Resident StateThe Freedom Health Plan being applied for must be available for sale in the applicant’s primary state of residence. Theapplication must be signed in the applicant’s residential state, or you must be licensed in both the residential state and thestate in which the application was signed. Premiums are based on the rates applicable to the applicant’s primary state ofresidence and are adjusted to reflect changes in residence when they occur. Benefits are generally based on the owner’sprimary state of residence.If the owner of the certificate/policy resides in a different state than the applicant, the you must also be licensed in theowner’s residential state. The resident state of the owner will determine the issue state. Therefore, benefits will be based,in general, on the laws applicable to the owner’s residential state. For example: if an applicant resides in Iowa, theapplication was written in Nebraska and the owner resides in Montana, the producer must be licensed in Iowa, Nebraskaand Montana, and the issue state will be Montana.Foreign NationalsAmerican citizenship is not mandatory under this plan as long as the applicant is a legal resident of the United States. Alegal resident is defined as someone who is living in the United States on a full-time basis and who has been issued agreen card or permanent visa status, with only an occasional stay outside of the United States.We require a Social Security number only for adults who are applying for coverage. If an adult does not have a SocialSecurity number, we can accept a copy of his/her “green card” or permanent visa to validate residency.Primary Applicant DependentsH-1 A Nurses H-4H-1 B Professionals H-4Note: The dependent visa category is tied to the primary applicant category to theleft of it. For example, if the primary applicant has a TN classification, his/herdependent(s) would have a TD classification.L-1 B Professionals L-2TN Trade “NAFTA”TC Canadians ONLYTDTBOverseas TravelersPersons to be covered must not be planning or considering extended foreign travel, nor can they live outside the UnitedStates for more than three months of the year. Dependents who are studying abroad are ineligible for coverage since theywould be taking residence in a foreign country.Medicare Eligible IndividualsApplicants who are already eligible to be covered under Medicare are not eligible for coverage under the Freedom HealthPlan. Individuals who are covered under this plan prior to reaching Medicare eligible age may continue coverage. Benefitswill be provided secondary to Medicare. The plan does not automatically terminate when the insured turns age 65.Restricted OccupationsIndividuals who are employed in the following hazardous or high-turnover occupations may be ineligible for coverageunder the Freedom Health Plan.• Adult Entertainment Workers (actors, dancers,• escort service workers, etc.)• Air Traffic Controllers• Armed Forces Personnel• Asbestos/Toxic Chemical Workers• Divers (professional skin or scuba)• Explorers• Explosive Workers• Fire Fighters/Police Officers (full-time)• Fisherman/Crew not returning to port nightly• High Risk Aviation (crop dusters, test pilots, stuntor student pilots)• Loggers or Logging Mill Workers• Masseuse (not licensed or not certified)• Musicians (not including symphony or orchestra)• Oil and Natural Gas Workers (onshore and offshore)• Professional Motor Vehicle Racers• Professional and Semi-Pro Athletes (golf and• bowling accepted)• Professional Rodeo Participants• Pyrotechnists• Roofers and Roofing Contractors• Structural Steel Workers• Underground Miners4

In addition to the list of occupations, the company reserves the right to decline to insure any applicant engaged in certainextra-hazardous occupations or whose acceptance would, in their opinion, not conform to sound underwriting practices.UUnderwriting GuidelinesMedical Underwriting SourcesWe reserve the right to reject any application that, in our opinion, does not conform to sound underwriting principles.Sources of information used in the underwriting process are as follows:1. Application: Each question on the application must be specifically asked of the applicant and the answerrecorded as given. It is never allowable for you to ask a general question such as, “Are you in good health?”, andupon receiving a “yes” reply, answer all health questions with a “no” answer. Except in the case of children-onlyapplications, all answers must come directly from the applicant. All paper applications must be completed in blueor black ink. It is not sufficient to answer questions with dashed or ditto marks. If an error is made, the primaryapplicant should cross through the word or line with a single stroke, then initial and date the correction. Under nocircumstances should a health application be backdated.2. Health Questionnaires (Personal Interviews): Health questionnaires are personal telephone interviews with theclient. A health questionnaire is ordered on all applicants that:• are age 50 to 59,• are age 60 and older, if a doctor is not listed on app to order an APS,• have a condition disclosed on the application without full details,• are children 2 months of age or younger, or• have completed part of the two-part Quick App.Specific conditions can also warrant a health questionnaire. You should tell every applicant that IAC may callhim/her. You may be asked to intervene if we are unable to contact the applicant or need an updated phonenumber.IAC utilizes TelMed of Whitewater, Wis., to perform the health questionnaire process. All of these interviewsare recorded for accuracy and to assure that appropriate customer service standards are maintained. Thestatus of a pending telephone interview can be accessed using the IHC Health Solutions Web sitehttp://thinkihc.iacusa.com.3. Attending Physician’s Statement (APS): Coverage may be considered for applicants who have variousdisclosed medical conditions, but an attending physician’s statement may be required. If an APS is needed, IACwill request it and pay the physician’s fee without asking you to obtain the records! An APS will be ordered onany applicant age 50 and over with a build outside of the normal range and/or tobacco use who also is beingtreated for hypertension and/or high cholesterol.IAC utilizes Parameds.com for APS ordering. The status of a pending APS can be accessed using the IHC HealthSolutions Web site http://thinkihc.iacusa.com4. Motor Vehicle Report (MVR): An MVR will be required if the applicant has three or more moving violationsor any history of DUI (driving under the influence) citations. MVRs can also be ordered at the underwriter’sdiscretion if he/she determines the applicant’s driving history will aid in making a decision on the case.5. Paramedical and Specific Tests: A paramedical includes testing of the applicant’s blood and urine. Vitals,including height and weight, are also taken at that time. The underwriter may also request an EKG. Anexamination, blood test and urinalysis will be required for all applicants ages 50 and over if not replacing priorinsurance and they have not seen a doctor in the past two years. These tests will also be required for all applicantsages 60 and over who have not seen a doctor within two years of the application date.5

Height and Weight GuidelinesThe following height and weight tables may be used as a guide to the eligibility of overweight individuals provided thereare no other medical impairments. We may require a paramedical examination to confirm an applicant’s height andweight. If you have questions about heights/weights not listed on these charts, please contact the IAC UnderwritingDepartment or IHC Health Solutions for assistance. (The height/weight guidelines are different in the state of SouthDakota. Contact IHC Health Solutions for the South Dakota build chart.)HeightNormalMale Build Chart20%rate up50%rate up70% rateupDecline4’10” 100-174 175-191 192-208 209-226 227+4’ 11” 102-178 179-196 197-214 215-232 233+5’ 0” 103-181 182-199 200-217 218-235 236+5’ 1” 105-183 184-201 202-219 220-237 238+5’ 2” 106-186 187-205 206-224 225-243 244+5’ 3” 109-190 191-209 210-228 229-247 248+5’ 4” 112-196 197-216 217-236 237-256 257+5’ 5” 115-202 203-222 223-242 243-262 263+5’ 6” 118-207 208-228 229-249 250-270 271+5’ 7” 122-213 214-234 235-255 256-276 277+5’ 8” 126-220 221-242 243-264 265-286 287+5’ 9” 130-227 228-250 251-274 275-296 297+5’ 10” 134-230 231-253 254-276 277-299 300+5’ 11” 138-236 237-260 261-284 285-308 309+6’ 0” 142-240 241-264 265-288 289-312 313+6’ 1” 147-248 249-273 274-298 299-323 324+6’ 2” 153-253 254-278 279-303 304-328 329+6’ 3” 158-261 262-287 288-313 314-339 340+6’ 4” 163-269 270-306 307-333 334-360 361+6’ 5” 169-275 276-313 314-340 341-368 369+6’ 6” 174-282 283-320 321-348 349-377 378+6’ 7” 178-290 291-330 331-359 360-389 390+6’ 8” 182-296 297-337 338-367 368-398 399+6’ 9” 186-303 304-345 346-375 376-407 408+HeightNormalFemale Build Chart20%rate up50%rate up70%rate upDecline4’10” 90-155 156-170 171-182 183-196 197+4’ 11” 90-160 161-175 176-187 188-199 200+5’ 0” 94-165 166-180 181-192 193-204 205+5’ 1” 96-170 171-185 186-198 199-209 210+5’ 2” 97-175 176-190 191-203 204-214 215+5’ 3” 99-180 181-195 196-208 209-219 220+5’ 4” 102-185 186-200 201-214 215-226 227+5’ 5” 105-190 191-205 206-219 220-231 232+5’ 6” 108-195 196-210 211-224 225-236 237+5’ 7” 111-200 201-215 216-230 231-241 242+5’ 8” 115-205 206-220 221-235 236-246 247+5’ 9” 118-212 213-228 229-242 243-256 257+5’ 10” 122-219 220-235 236-249 250-263 264+5’ 11” 125-225 226-242 243-258 259-271 272+6’ 0” 129-230 231-250 251-267 268-281 282+6’ 1” 132-238 239-257 258-275 276-289 290+6’ 2” 135-245 246-265 266-280 281-296 297+6’ 3” 138-250 251-270 271-285 286-301 302+6’ 4” 142-255 256-276 277-295 296-306 307+6’ 5” 146-260 261-285 286-300 301-311 312+6’ 6” 150-265 266-290 291-305 306-316 317+6’ 10” 190-308 309-351 352-382 383-415 416+6’ 11” 194-316 317-360 361-392 393-426 427+7’ 0” 198-322 323-367 368-400 401-435 436+6

Juvenile Build Table, Ages 14 and UnderHeightInchesAges 0-2 Ages 3-9WeightMinimumWeightMaximumHeightInchesWeightMinimumWeightMaximumHeightInches6’5” 169-240 6’3” 138-2047Ages 10-14WeightMinimum24 8 23 30 18 40 48 44 9226 10 26 34 22 44 52 54 10828 13 31 38 26 54 56 63 12630 15 36 42 32 64 60 74 14432 18 40 46 38 78 64 87 16634 21 42 50 46 94 68 100 18636 23 45 54 56 111 72 113 20638 26 48 58 66 128 76 126 22840 29 52WeightMaximumPreferred RatingA lower, preferred rating is available for qualified applicants. A qualified applicant is defined as someone that must:• Be the proposed insured or spouse (preferred rates are not available for dependent children);• Be age 18 or older, but not older than age 50 (Preferred is available up to age 64 in North Dakota);• Not have a condition that would result in a health exclusion rider or health rate-up at any level of benefitfor the plan; and• Be able to appropriately answer the questions on the preferred rating questionnaire.If applying for a preferred rating, the preferred rating questionnaire must be completed and submitted with theapplication. The applicant applying for preferred rates must also be within the following build charts.Male Preferred Health Build ChartFemale Preferred Health Build ChartHeight Weight Height Weight5’0” 105-152 4’10” 90-1285’1” 110-155 4’11” 92-1305’2” 113-159 5’0” 94-1335’3” 115-162 5’1” 96-1365’4” 117-166 5’2” 98-1405’5” 120-171 5’3” 101-1435’6” 122-175 5’4” 104-1475’7” 125-181 5’5” 107-1515’8” 128-186 5’6” 109-1565’9” 131-191 5’7” 112-1605’10” 134-197 5’8” 115-1655’11” 138-203 5’9” 118-1726’0” 142-208 5’10” 122-1786’1” 147-215 5’11” 125-1836’2” 153-220 6’0” 129-1886’3” 158-226 6’1” 132-1926’4” 163-232 6’2” 135-198

Co-Morbidity FactorIAC considers applicants with more than one coronary risk factor to present a greater risk than the sum of medical loadsfor these conditions could address. As a result, underwriting will assess an additional premium load of 25 percent toapplicants with two coronary risk factors and an additional premium load of 40 percent to applicants who have threecoronary risk factors. Applicants with more than three coronary risk factors will be declined.Underwriting considers the following conditions to constitute a coronary risk factor for underwriting purposes:hypertension (high blood pressure), elevated or treated cholesterol, obesity requiring a medical load, and tobacco use. Anycombination of two or more of these conditions will require a co-morbidity underwriting load or possible declination ofcoverage as indicated above.Expectant ParenthoodNo member of the family may be pregnant or be an expectant parent at the time the application is being written (whetheror not applying for coverage). Current pregnancy is a medical condition that is not acceptable for applicants under theFreedom Health Plans. Also, no family member may have received infertility treatment within the 12 months prior to theapplication. This restriction applies to child-only plans as well.Disabled Applicants (May vary by state)Applicants who are currently disabled and receiving disability benefits are ineligible for coverage under the FreedomHealth Plans.Unacceptable Health Conditions (May vary by state)Each person to be covered must qualify medically as determined in accordance with the company’s underwritingguidelines. Persons with serious existing health conditions may not qualify for coverage. Individuals who arecontemplating surgery or hospitalization or who have undiagnosed ailments or symptoms indicating a potentially seriouscondition, or who are disabled, will also not be accepted. Some impairments can be considered if there has been remissionfor at least 10 years.Refer to the following table for a listing of unacceptable health conditions that would result in a declination of coverage.Please note that not every unacceptable health condition may be listed.Addison’s DiseaseAIDS/ARC/HIV & other ImmuneDisordersAlcoholism, Alcohol AbuseALS (Lou Gehrig’s Disease)Alzheimer’s DiseaseAmputation – disease-relatedAneurysmAngina PectorisAnorexia Nervosa (w/in 2 yrs.)Anxiety Disorders (selected)Aplastic AnemiaArteriosclerosisAtherosclerosisAutismBechet’s SyndromeBipolar Disorder (w/in 7 yrs.)Boeck’s SarcoidBone Marrow TransplantBrain TumorBuerger’s DiseaseBulimiaBypass SurgeryCancer – excluding Skin CancerCardiac PacemakerCardiomyopathyCerebral PalsyCirrhosis of the LiverCombined System Disease8Congestive Heart FailureCoronary Artery DiseaseCoronary Bypass SurgeryCrohn’s Disease (w/in 4 yrs.)DiabetesDrug Abuse/AddictionEmphysemaEndocarditisEpilepsy (Grand Mal)Fetal Alcohol SyndromeGangreneGastrionomaGaucher’s DiseaseHeart Attack/DiseaseHemophiliaHodgkin’s DiseaseHuntington’s ChoreaHydrocephalusJuvenile ArthritisLeukemiaLupus ErythemotosusLymphomaMalignant Melanoma (w/in 5 yrs.)Marfan’s SyndromeMeneire’s Disease (w/in 3 yrs.)Mental RetardationMultiple SclerosisMuscular DystrophyMyasthenia GravisMyelofibrosisMyocardial InfarctionNephrosclerosisOrgan TransplantOrganic Brain SyndromePacemakerParalysisParkinson’s DiseasePolycythemiaPolymyositisPorphuriaPregnancy/InfertilityPrimary Pulmonary HypertensionProsthetic Heart ValvePsychotic DisordersPulmonary EmbolismPulmonic SteriosisRenal Disease (ESRD)SclerodermaSickle Cell AnemiaSimmond’s DiseaseSleep ApneaStrokeSuicide AttemptSyphilisVentrical FibrillationWhipple’s Disease

Pre-ScreeningIf a client has a condition or combination of conditions that may be questionable for health insurance coverage, anunderwriter can work with the you to pre-screen the client. When calling the IAC Underwriting Department for a prescreen,be sure to have all the important information on hand such as: client age, onset of condition(s), currentmedication(s), symptoms, etc.Term Life Insurance Underwriting GuidelinesAdditional term life insurance will not be offered if the primary applicant has any of the following:1. Two or more co-morbidities which include the following: smoking, build, hypertension and hyperlipidemia;2. A build load of 50 percent or more; or3. Participates or engages in a hazardous sport or activity including private aviation.Submitting an ApplicationChecklist for New ApplicantThe following must be sent to apply for coverage:1. The Application. The application can be sent to IAC via fax, e-mail or regular mail. If the client is paying with acheck, include copies of both the IAC and CA checks with the fax or e-mail, and mail the originals to IAC. Also,if submitting the application through fax or e-mail, the original application does not need to be mailed unlessrequested by the underwriting department.2. First Month’s Payment. The applicant can submit the initial payment by check, credit card or bank draft. Ifpaying by check, it should be made payable to IAC for the $20 application fee only. The full month’s premiumwill be charged once the case is issued. Premium checks are cashed when received. Post-dated checks, checkingdeposit slips and agency checks are not acceptable. If the applicant elects credit card or bank draft, the MonthlyAutomatic Payment Plan section of the application must be completed (no physical check is required). At the timeof application, the one-time application fee will be drafted from the submitted credit card or bank account. Pleasenote, the applicant may elect to have the initial mode of payment be different than the mode for ongoing monthlypayments.3. Payment to CA, Inc. A separate payment is required to CA, Inc. with the application. This payment can be madethrough a separate check or credit card charge. If paying by check, make it payable to CA, Inc. for the appropriatedues amount based on the selected membership level. If credit card, complete the credit card payment section ofthe CA membership application and a separate charge will take place when the application is submitted.(Membership is optional in Kansas and Montana.)4. Copy of the Premium Quote. A copy of the computer quote calculated for the applicant must be sent with theapplication. Premium rates are based on resident state. The effective date also determines the premium rate sincerates change monthly based on a trend factor.5. HIPAA Authorization for Release of Health Related Information. This form is required with every application.6. Monthly Automatic Payment Plan. (Optional) If the client chooses to be billed via automatic monthly credit cardcharge or bank draft, a completed monthly automatic payment plan form must be completed. and an originalvoided check or savings account deposit slip must be submitted with the application. Bank draft is only availableon a monthly basis and the draft occurs on the first of each month. A 15 th of the month draft date can be requestedonly to coordinate with a 15 th of the month effective date.7. Preferred Rating Questionnaire. (Optional) The form must be completed and signed by those applicants (primaryand/or spouse) applying for the lower, preferred, rating.8. Confirmation of Sole Employee Entity. (Optional) (Kansas, Michigan, Oklahoma, Tennessee and Wisconsin) Inthese states, a business check will be accepted by IAC only if this form is completed and sent with the application.The client must read and sign that he/she agrees to all the conditions listed on this form.9

9. Individual Health Plan List Bill Election Form. (Optional) This form must be read and signed by the applicantrequesting his/her health insurance premium be included on a list bill. List bill is not available in Colorado,Kansas, Michigan, South Dakota, Tennessee or Wisconsin.10. List Bill/Payroll Deduction Setup Form. (Optional) The employer or originator of a list bill must complete thisform in order to create a billing to include more than one health insurance certificate/policy. List bill is notavailable in Colorado, Kansas, Michigan, South Dakota, Tennessee or Wisconsin.Additional forms may be needed based on state requirements.Application WithdrawalsIn order to withdraw an application, either the applicant or producer must submit written request to discontinue theunderwriting process. If the applicant wishes to re-apply at a later date, a new fully completed, currently dated applicationand new application fee will be required.Pre-Existing ConditionsPre-Existing Conditions - 12/12The certificate/policy defines pre-existing conditions as: “Any bodily injury or sickness for which the individual receivedmedical treatment (including taking medicine prescribed by a doctor), advice or consultation, or which produced distinctsymptoms that would have caused an ordinarily prudent person to seek medical diagnosis or treatment, within the 12months immediately preceding the effective date of insurance.” (May vary by state.)Other than for disclosed conditions described below, no benefits will be payable for expenses incurred in connection withpre-existing conditions as defined above until coverage has been in effect for a 12-month period. After the 12-monthperiod, benefits will not be denied for a pre-existing condition unless that condition has been specifically excluded orlimited by an exclusionary rider attached to the certificate/policy. (State Variations: Arizona: 6/12, Indiana: 6/12, Michigan:6/12, North Dakota: 6/12, New Mexico: 6/6, Wyoming: 6/12)Full Disclosure of Health ConditionsHealth conditions that are fully disclosed in writing on the Freedom Health Plan application will be covered from theeffective date of any coverage provided the condition is not specifically excluded by the certificate/policy, endorsement orexclusionary rider. Therefore, the pre-existing condition limitation will not apply to conditions that are fully disclosed.Health Insurance Portability and Accountability Act (HIPAA) Eligible IndividualAn individual must meet all of the following requirements to be considered a HIPAA-eligible individual and, therefore, tohave guaranteed availability of a health plan (May vary by state):1. Has aggregate, creditable coverage for at least 18 months and this coverage has not been lapsed for 63 days or more.The most recent coverage must be one of the following:a. Group Health Plan—an employee welfare benefit plan as defined in section 3(1) of ERISAb. Government Plan—as defined under section 3(2) of ERISA or any federal government planc. Church Plan—as defined under section 3(33) of ERISAd. Health insurance offered in connection with any of the above plans2. Is not eligible under a group health plan, Part A or Part B Medicare or Medicaid3. Does not have other health insurance coverage4. Most recent coverage was not terminated due to fraud or payment of premiums5. If coming off a group health plan and was offered COBRA or state continuation, he/she must elect and exhaustCOBRA or state continuation provision10

Underwriting DecisionsAfter review of the application and all medical information, the underwriter will make one, or a combination, of thefollowing five decisions:1. Issue the application as applied2. Offer an exclusionary rider3. Offer a rating on one or more applicants4. Offer a higher deductible5. Decline the applicationUnderwriting decisions and requirements will be emailed to you and can also be found on the http://thinkihc.iacusa.comWeb site.If the coverage offered by underwriting is different than requested on the application, the certificate/policy of insurancecan be issued and delivered only if the applicant accepts the modified coverage within the allotted time frame by signing,dating and returning any required acceptance forms to IAC.1. Issued the application as applied: An application that is approved exactly as applied for is a “standard” issue.2. Offer an exclusionary rider: Coverage may be available for applicants with certain medical conditions if a medicalexclusionary rider is issued for treatment related to that condition. Exclusionary riders are permanent and do not expire(may vary by state law). There is a maximum of three riders per applicant. If an applicant is offered an exclusionaryrider, he/she has 15 days from the date the amendment is mailed to sign and return it to IAC, or the case will be closedout. The rider is mailed to the you. Consideration to remove the rider may be given after coverage has been in force forat least 12 months. The certificate/policy holder must request in writing that the rider be removed and provide medicalrecords concerning any medical care or treatment relating to the excluded condition. Following are examples ofmedical conditions likely to require exclusionary riders:Sample Conditions Requiring Exclusionary Riders• Allergies• Arthritis, Osteoarthritis• Asthma• Back or Neck Disorder• Bell’s Palsy• Carpal Tunnel Syndrome• Cataracts• Disk Surgery, within five years• Ear Infections and Disorders, recurrent• Endometriosis• Gall Stones, un-operated• Glaucoma• Hernia, present• Joint Replacement/Knee Disorder• Menstrual Disorders• Migraine Headaches• Phlebitis• Ulcer• Ulcerative Colitis• Varicose VeinsExclusionary riders may also be issued to exclude coverage for medical services incurred as a result of participation in ahazardous activity. For example, if the applicant participates in rodeo activities as a hobby (not on a full-time basis), thecertificate/policy would be issued with a rodeo exclusion rider and medical expenses resulting from the activity wouldnot be covered.11

Empowered Underwriting MatrixThe conditions listed below will be accepted “standard” (without a rider or premium rate-up) if the selected plandeductible is at least the amount listed. For example, under the $5,000 deductible column, “Benign Prostatic Hypertrophy– minimal symptoms, controlled with medications” will be issued standard at a $5,000 deductible or higher.ConditionAcne—No treatment in last three months. No past orfuture treatment with Accutane.Acne—Currently being treated. No Accutane use inthe past or anticipated in the future.Allergies—No other respiratory conditions, with orwithout allergy shots.Allergies and Asthma Combined—Allergies, withour without allergy shots; Asthma—mild, controlledwith one inhaler. Not available to smokers or childrenunder age three.12MinimumDeductible$1,500$2,500$1,500$2,500Anemia—Iron deficiency, present, mild, cause unknown.$1,500Anxiety—Situational, no counseling in last six$1,500months. Rate or rider for medication as needed.Anxiety—Moderate. Over 21 years old. $5,000Arteriosclerosis, Atherosclerosis—Mild, incidentalfinding on x-ray only. Ages 55 and over, no comorbidityfactors apply.$2,500Asthma—Mild, controlled with one inhaler. Note:$1,500Not available to smokers or children under three.Attention Deficit Disorder (ADD); Attention DeficitHyperactivity Disorder (ADHD)—Controlledwith medication. No counseling required or evidenceof aggressive behavior. No anti-psychotic$2,500medication.Baker’s Cyst—Present. $1,500Basal Cell Carcinoma—Single incident, recovered. $2,500Basal Cell Carcinoma—Up to three episodes in thelast two years.$5,000Bell’s Palsy—Stable, not progressive. $5,000Benign Prostatic Hypertrophy—Minimal symptoms.Controlled with medications.$5,000Blepharitis, Bletherospasm $1,500Bone Spur—Asymptomatic, no surgery required. $2,500Breast Implants—Not associated with cancer orbreast disorder.$2,500Bunions or Hammer Toes—Single foot only. $5,000Bursitis or Tendonitis $1,500C-Section Delivery—Due to breech, large baby ornon-progressing labor only.$5,000C-Section Delivery—For all reasons other thanbreech, large baby or non-progressing labor.$10,000Carpal Tunnel Syndrome—Mild or resolved, nofuture surgery required.$2,500Cataract—Un-operated, no impending surgery. $10,000Cerebral Palsy—Ages 21 and over only. Highfunctioning individuals only.$5,000MinimumConditionDeductibleCervicitis—No erosion of the cervix noted. $5,000Chalazion $5,000Cholecystitis—One attack, recovered. $5,000Chronic Fatigue Syndrome—Stable, non-disablingonly.$5,000Chronic Obstructive Pulmonary Disease (COPD)or Emphysema—Mild, incidental finding only. Nosymptoms of airway disease, shortness of breath or$10,000tobacco use in last 12 months.Chronic Otitis Media—With or without ear tubes. $2,500Condyloma Acuminatum (Genital Warts)—Withrecovery of at least one year. No other sexually $1,500transmitted diseases.Conjunctivitis $1,500Corneal Implant—Stable, with no problems for aminimum of two years.$10,000Cystits—Chronic. $5,000Deafness—From birth due to traumatic cause only. $5,000Depression—Mild, one prescription only, no historyof counseling.$2,500Depression—Moderate, over the age of 21 years old. $5,000Deviated Septum—Congenital, after surgery. $1,500Diverticulitis—Single episode, no surgery required. $5,000Diverticulosis—No inflammation. Asymptomatic.Incidental Finding.$2,500Dysfunctional Uterine Bleeding—Current. Controlledwith birth control pills.$2,500Dysmenorrhea—With normal pap smear. $2,500Eszema (Mild), Dermatitis, Keratosis or OtherMild Skin Conditions$1,500Erectile Dysfunction—No know coronary issues. $5,000Fibrocystic Breast Disease—No malignancy suspected.$5,000Fibromyalgia—Stable, non-disabling only. $5,000Fracture with Internal Fixation—Fracture healed,joint stable, more than one year since internal fixationplaced with no symptoms.$5,000GERD (Reflux Disease)—Infrequent and stable.$1,500Rate or rider medication as needed.Glaucoma—Stable. Controlled with drops. Nosurgery anticipated.$10,000Gout—No history of kidney stones or other relatedimpairments.$2,500Gouty Arthritis—Stable, non-progressive. $10,000

Empowered Underwriting Matrix, continuedThe conditions listed below will be accepted “standard” (without a rider or premium rate-up) if the selected plan deductible is at leastthe amount listed.ConditionGrand Mal Epilepsy—Evaluated to rule outbrain lesion or other known cause. Stable withoutseizures for minimum of two years. Compliantwith medications.Headaches (including Migraines)—Onceevaluation and initial work up has been completed.MinimumDeductible$10,000$1,500Heart Murmurs—Described as functional, systolicgrades I or II only.$1,500Hemorrhoids—Asymptomatic. $1,500Hepatitis A and E—Current normal liver functiontest.$1,500Hernia—Asymptomatic, incidental findings only.Not inguinal.$2,500Herpes Simplex II—Genital, no current medication.$1,500Hypertension (HTN)—Well controlled withmaximum of three medications (one is a potassium$10,000supplement). No co-morbidity factors.Hyperthyroidism—One year post treatment withradioactive iodine. No goiter, no other thyroid $1,500conditions.Hypothyroidism—Controlled with thyroid replacementmedications$1,500Indigestion, Gastroenteritis—Occasional attacks,evaluation of symptoms fail to reveal cause.$1,500Irregular Menstruation—Birth control pills toregulate only, no indication of other conditions.$2,500Irritable Bowel Syndrome—Mild, infrequentattacks. No evidence of colitis.$1,500Kidney Stones—One attack, passed spontaneously.$2,500Labrynthitis—Stable, non-disabling. No evidenceof neurological disease with work up.$2,500Lipoma (Benign growth)—Small, asymptomatic,no surgery indicated.$1,500Lupus Erythematosus—Discoid, not systemic.Stable or in remission for minimum of two years.Work up performed to rule out tumors or lesions.$10,000Best cases only.Meniere’s Disease—Stable. No serious underlyingcause identified.$2,500Mental Retardation—No physical impairment,no Down’s Syndrome, IQ of 60 or greater.$5,000Menopausal Syndrome—Non-disabling, one Rx. $1,500Mitral Valve Prolapse—Asymptomatic, incidentalfinding.$1,500Neuritis—Three or fewer episodes in the past twoyears.$5,000MinimumConditionDeductibleOrchitis—Recurrent, complete recovery. $5,000Osteoarthritis—To age 50, at DX, confined tospecific joint, no history of opoids, corticosteroid $2,500injections or hyaluronic acid injections.Osteomyelitis—Complete recovery for minimum$5,000of six months.Osteopenia, Osteoporosis—No symptoms, no$2,500other conditions.Osteopenia—No symptoms, no other conditions. $2,500Ovarian Cyst—Under age 45, single cyst, asymptomatic,adequate investigation to rule out malignancy.$2,500Paroxysmal Atrial Tachycardia—Two to threeattacks annually with no evidence of other heart $5,000disorders.Passive Aggressive Personality Disorder—Over21 years old. Mild outbreaks of disorder only. $10,000Controlled and compliant with medication.Peptic Ulcer Disease—No malignancy or H-$5,000pylori. Complete recovery.Petit Mal Epilepsy—No underlying cause foundafter work up. Well controlled with infrequent$5,000episodes (one or two a year) and compliant withmedications.Phlebitis—Superficial, no current edema. $5,000Pilonidal Cyst—Asymptomatic or drained onlywith complete recovery.$2,500Polycystic Ovaries—No anticipated surgery. $5,000Pregnancy Complications—Multiple miscarriages,eclampsia, preeclampsia.$10,000Pre-Menstrual Syndrome—Mild, non-disabling,controlled with one medication only.$1,500Prostatitis—Single occurrence, recovered. $1,500Prostatitis—Recurrent, mild to moderate. Presentor current.$5,000Pterygium $1,500Pyelonephritis, Pyelitis—Complete recovery. $2,500Radiculitis—Single episode, complete recovery. $1,500Raynaud’s Disease or Phenomenon—Stable,mild to moderate.$2,500Reactive Airway Disease—Mild to moderate,non-disabling. Controlled with inhaler.$2,500Rectocele, Cystocele, Urethrocele—Present, nosurgery indicated.$10,000Renal Cyst—Only one kidney affected, no impairedfunction of either kidney. Incidental finding$10,000only.13

Empowered Underwriting Matrix, continuedThe conditions listed below will be accepted “standard” (without a rider or premium rate-up) if the selected plan deductible is at leastthe amount listed.MinimumConditionDeductibleRestless Leg Syndrome—Other neurologicalproblems ruled out.$2,500Retinitis Pigmentosa $10,000Ruptured Ear Drum—Mild to moderate hearingloss.$5,000Sciatica—No herniation or bulging disc. $5,000Sebaceous Cyst—Small asymptomatic. No surgeryindicated.$1,500Sexually Transmitted Diseases (Other thanAIDS or ARC)—Single episode, complete recovery.$2,500Sinusitis—Chronic or acute. Not current. $1,500Sinus Tachycardia—Pulse rate to 100. Noknown coronary disease.$1,500Sleep Apnea—After successful surgery only. Nocoronary disease.$2,500Spinal Strain or Sprain—Single episode, completerecovery. No disc bulge or herniation.$1,500Spinal Strain or Sprain—Chronic, no herniationor bulging discs. Non-disabling.$5,000Tourette Syndrome—Mild. $5,000ConditionTremor—Benign, non-progressive. Not attributedto Parkinson’s Disease or other diagnosedneurological disorder. Thorough neurologicalwork up performed.MinimumDeductible$5,000Tuberculosis—Positive serology without diseasemanifestation. Serology positive a minimum of $2,500one year.Tuberculosis—With disease manifestations, currentto minimum of two years.$5,000Tumor—Class 6 or 7. Excised with completerecovery minimum of two years.$5,000Tumor—Class 3, 4 or 5, complete recovery for aminimum of two years.$10,000Urethritis—Acute, recovered. $1,500Vaginitis—Complete recovery. $1,500Varicose Veins—Mild, asymptomatic, surfaceveins only. No surgery indicated.$1,500Vertigo—Occasional, mild with work up to ruleout underlying neurological disease.$2,500The following guidelines apply when considering a condition for empowered or deductible underwriting on plans with afamily deductible.To calculate the deductible to apply to each family member:• Divide the family deductible by two if the application contains between two and four applicants to obtain the• allowable deductible for each individual family member.• Divide the family deductible by three if the application contains five or more applicants to obtain the allowable• deductible for each individual family member.• Utilize the individual allowable deductible to determine if a condition is eligible for empowerment(deductible• underwriting) utilizing the empowered/deductible underwriting condition underwriting list.• The individual allowable deductible must be at least the amount of the minimum deductible allowed for• empowerment for the condition in question.Examples:1. A family of two applies for a plan with a $2,000 family deductible. The deductible is divided by two leavingeach family member with a $1,000 allowable individual deductible. Since no condition qualifies for empowerment/deductibleunderwriting consideration with only a $1,000 deductible, no special consideration is allowed.2. A family of seven applies for a $10,000 family deductible plan. The family deductible is divided by threeleaving each family member with a $3,333 individual allowable deductible. In this example each familymember is eligible for empowered/deductible underwriting consideration for any condition that does not requirea minimum of a $5,000 deductible.14

Underwriting Decisions, continued3. Offer a rating on one or more applicants: An application can be approved with a rating. A rating will increase themonthly premium of the certificate. The minimum rating issued on an applicant is five percent and the maximumis100 percent. Ratings increase in five percent increments. Common medical impairments that usually warrant arating include builds that fall outside the height/weight guidelines and elevated blood pressure.4. Offer a higher deductible: In order to lower the Company’s risk on a certain individual, the underwriter may offerthe applicant coverage with a deductible higher than initially requested. Increasing the deductible may also be a wayto lower a rating and therefore keep premium as low as possible (see the Empowered Underwriting Matrix above).5. Decline the application: In the event that the underwriter feels that more than three exclusionary riders or more thana 100 percent rating are needed, the application will be declined. Certain health conditions will be declined uponreceipt of the application due to the severity of the condition. See the list of “Unacceptable Health Conditions” onpage 8.Please note, coverage cannot be declined if the applicant is a HIPAA-eligible individual in the state of Arizona orTennessee.Requirements to PlacePending RequirementsCorrespondence for pending requirements is sent to the producer. All pending requirements can be viewed on thehttp://thinkihc.iacusa.com Web site. Requirements must be received within 60 days of application date to avoid closingthe case.Exclusionary RidersThe exclusionary rider is faxed to you or is available on the Web site. The rider must be signed by the primary applicantand returned to IAC before the case can be placed in force. A fax copy of the rider is acceptable. Riders are alsoavailable in correspondence on the Web site. The rider must be signed and returned or verbally accepted on IAC’srecorded phone line within 15 days.Premium RatingIf the case is rated, the applicant must accept the premium rating. Coverage can be placed inforce once acceptance isgiven and if 85 percent of the required standard premium has been paid. Any premium shortages due to a rating arebalance billed to the insured. An amendment must be signed by the primary insured.Producer Kit/Delivery CertificateAll issued certificates and ID cards are mailed to the insured. Any outstanding delivery requirements must be completedand returned within 30 days of the date they were mailed.Effective Dates and BillingEffective DatesThe applicant may request a plan effective date of either the 1st or 15th of the month. IAC must receive the applicationfor insurance on or before the requested effective date. IAC will honor the effective date requested if they can approvethe application within 15 days of the requested date.If the applicant is replacing coverage, it may be in his/her best interest to elect an effective date of the 1st of the monthfollowing approval and keep his/her current coverage in force until notice of approval is received. Please note: Arequested effective date cannot be changed once the certificate is issued. You have up to 60 days to submit allunderwriting requirements based on the date the application was signed. After 60 days, the case will be closed out.*** Never advise an applicant to cancel existing health coverage until the company’s coveragehas been approved by underwriting and accepted by the client.***15

BillingPremium is due by the 1st of the month unless the applicant had requested a 15th of the month draft date to coordinatewith a 15th of the month effective date. If a 15th of the month effective date and 1st of the month draft date arerequested, coverage (if approved) will be made effective on the 15th of the month. However, IAC will generate a billingstatement at the time of issue for a half-month premium to get the plan on the 1st of the month billing cycle.Billing Modes and OptionsThe Freedom Health Plans allow for automatic bank draft or credit card charge on a monthly basis or direct billingquarterly, semi-annually, or annually. Monthly direct billing is only available with a list bill.CommissionsEarned commissions are paid twice per month. Premiums received at IAC from the 1st through the 15th of the month arepaid on the 21st. Premiums received the 16th through the end of the month are paid on the 7th.Advanced commissions are paid weekly. Cases issued between Thursday and the end of the day Wednesday are paid outeach Friday.After the SaleType of Change Requirements Underwriting ApprovalRequiredNameWritten Request and LegalDocumentationNoIAC ActionLetter to confirm the change, newcertificate face page and ID cardswill be sent to the insuredAddress Phone or Written Request No Letter to confirm the change sentto the insuredNewborn Baby AdditionWritten Request within 31 Days------------------------Completed application if after31 DaysNo – within 31 days--------------------------YesLetter to confirm addition, newcertificate face page and ID cardswill be sent to the insuredAdd a Family Member (otherthan newborn)Completed Application Yes Letter to confirm addition,certificate face page and ID cardsent to the insuredRemove a Family MemberWritten Request from thePrimary InsuredNoLetter confirming the change, newcertificate face page and ID cardsent to the insuredMode of Payment – from directbill to monthly automaticpaymentWritten Request, AuthorizationForm, and Voided CheckNoLetter to notify of change andamount to be draftedMode of Payment – monthlyautomatic to direct billingPhone or Written Request No Revised billing mailedLower DeductibleWritten Request from thePrimary Insured with NewCompleted Medical Section ofthe ApplicationYesIf approved, letter confirming thechange, new certificate face pageand ID card (if affected by thechange); if declined, letter is sentnotifying insured of decision16

Type of ChangeIncrease DeductibleAdd Wellness or OutpatientAccident RiderAdd Enhanced PrescriptionDrug Card RiderRemove a Benefit RiderPPO Network ChangeReinstatementRequest for Removal of an ExclusionaryRider or RatingContinuation for DependentPlan change – (e.g. Traditionalto PPO, no deductible or benefitrider changes)RequirementsWritten Request from thePrimary InsuredWritten Request from thePrimary InsuredWritten Request from thePrimary Insured with New CompletedMedical Section of the ApplicationWritten Request from the PrimaryInsuredUnderwriting ApprovalRequiredNoWritten Request from the PrimaryNoInsuredWritten Request from the PrimaryInsured with a New CompletedMedical Section of the Application; Yesall premiums due as of thereinstatement dateWritten Request from the PrimaryInsured, all Medical RecordsYesRegarding the Condition at theInsured’s ExpenseWritten Request from the ContinuingDependent if age 19 or Over. Also,written request from the currentprimary member removing the Nodependent from coverage; a new CAMembership application is needed forthe dependentWritten Request from the PrimaryInsuredWritten Request from the PrimaryInsuredNoYesYesNoIAC ActionLetter confirming the change, newcertificate face page and ID card(if affected by the change)Letter confirming the change andnew certificate face page sent tothe insuredIf approved, letter confirming thechange and new certificate facepage; if declined, letter is sentnotifying insured of decisionLetter confirming the change andnew certificate face page sent tothe insuredLetter confirming the change andnew ID card sent to the insuredIf approved, letter confirmingreinstatement is sent to insured; ifdeclined, letter is sent notifyingclient of decision sentIf approved, letter confirming thechange is sent to the insured; ifdeclined, letter is sent notifyinginsured of decision is sentLetter confirming the continuation,new certificate face page andID card sent to dependent and thecurrent primary insuredLetter confirming the change, newcertificate face page and ID cardsent to the insuredTermination of CoverageNote: Depending on the original eligible/billing date, terminations are madeeffective on the 1 st or 15 th of the monthfollowing receipt of the request or the lastfully paid month. Premium refunds willnot be paid to insureds on monthly bankdraft billing mode.NoLetter to confirm the terminationand Certificate of CreditableCoverage sent to insuredAdding or removing benefits or dependents, making plan changes, etc. are all effective on the 1st or 15th of the month (depending onbilling mode) following approval and/or receipt of the request. You are copied on all correspondence.17

Medical Claim ReviewClaims received at IAC that are inconsistent with information provided on the application or may be subject to apre-existing condition limitation are sent to medical review. When a claim is reviewed, the analyst will look at the originalapplication, telephone interview, evaluation of prior coverage, and determination of HIPAA eligibility. Investigations willdetermine if the condition on the claim is a pre-existing condition or if there was a material misrepresentation in theapplication. The producer and insured will be sent correspondence providing the status of the medical review process.Rescission or Reformation of CoverageFalse or misleading information on the application may be the basis for rescission or reformation of coverage. Rescissionvoids the coverage back to the effective date. Reformation allows a rating to be applied or an exclusionary rider to beadded to the policy back to the effective date. Be sure that the applicant completes the application accurately, including allanswers to medical questions and height and weight information.RewritesA re-written application on an inforce case that currently utilizes monthly bank draft of monthly credit card bill will onlyneed to submit a copy of a voided check or credit card for the enrollment fee. IAC will not draft or charge the rest of thepremium until the case is issued so that the insured is not paying two premiums simultaneously.Reinstatement of CoverageReinstatement is available in all states for up to 60 days from the lapse date. An application and all premium due is requiredto re-evaluate the health status of proposed insureds. Additional underwriting requirements may be requested at thetime of reinstatement. Reinstatement will only be approved if the original underwriting decision is still valid. If a rider orrating would now be required to approve the case, the reinstatement will be denied. If approved, the reinstated coveragewould not have a lapse and there would be no change of effective dates.Reinstatement is not allowed for insureds that have submitted a written request to cancel coverage.ContinuationContinuation of coverage is available to dependents that lose eligibility. A request for the dependent to continue on his/herown certificate must be received within 31 days of the status-changing event. If approved, the dependent will have thesame benefits as the certificate from which s/he converted.Turning Age 65 – Medicare EligibilityA notice will be sent 90 days in advance of an existing insured turning age 65 and therefore, eligible for Medicare coverage.This notice will inform the client of the ability to continue coverage under our plan but that benefits will be payablesecondary to Medicare. Coverage will NOT automatically terminate upon the insured’s 65 th birthday.18