1. health and fitness
2. disease

MINI UNDERWRITING MANUAL
YOUR
REFERENCE
GUIDE
TO
CURRENT
PRUDENTIAL
UNDERWRITING
T A B L E
O F
C O N T E N T S
Get To Know Why Some Clients “Prefer Us”
Rx For Success – Index
Rx For Success – Breast Cancer
Rx For Success – Coronary Artery
Disease – Plaque Burden
Rx For Success – Diabetes Mellitus
Rx For Success – Individual Inquiry Offers
Rx For Success – Prostate Cancer
Rx For Success – Build
Rx For Success – Coronary Artery Disease –
Therapuetics
Make the Most of Prudential's Underwriting
Credit opportunuties
Financial Underwriting Highlighter
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
NR-017189 Ed. 04/09 Exp.07/10
G E T T O K N OW
WHY SOME CLIENTS “PREFER” US...
Some categories of individuals who may qualify for our Preferred Underwriting:
Most commercial pilots for U.S. based airlines1
Clients who plan to travel to most foreign countries for 3 months
or less annually (business or pleasure)*1
Scuba divers who dive up to 100 feet
Individuals with cholesterol levels up to and including 249,
even if on cholesterol lowering medications2
Male/Female 6'0", ages 18-64, up to 213 pounds1
Male/Female 6'0", ages 65 and over, up to 228 pounds1
Some categories of individuals who may qualify for our
advantageous Non-Smoker Plus ratings:
Cigar/pipe smokers and smokeless tobacco users
Nicotine patch or Nicorette gum users
Individuals with cholesterol levels up to and including 274
Male/Female 6'0", ages 18-64, up to 243 pounds
Male/Female 6'0", ages 65 and over, up to 294 pounds
Civilian student and private pilots up to 200 hours per year
We look for the best possible impaired risk treatment
for clients with the following impairments:
Breast Cancer
Bladder Cancer
Coronary Artery Disease
Diabetes Mellitus (Adult onset)
Asthma
Mood Disorders
Prostate Cancer cases
Hepatitis C
Build
Elevated liver function tests
These scenarios could qualify for Preferred Best as well.
Individuals with cholesterol levels up to 219 may qualify for Preferred Best, even if on cholesterol medications.
*This does not apply to foreign countries Prudential considers to be extremely hazardous.
This material is designed to provide general information in regard to the subject matter covered. It should
Securities and Insurance Products:
be used with the understanding that we are not rendering legal, accounting or tax advice. Such services
Not Insured by FDIC or any Federal Government Agency. May Lose Value.
should be provided by your own advisors. Accordingly, any information in this document cannot be used
Not a Deposit of or Guaranteed by the Bank or any Bank Affiliate.
by any taxpayer for purposes of avoiding penalties under the Internal Revenue Code.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
Prudential, Prudential Financial, the Rock logo and the Rock Prudential logo are registered service marks of The Prudential Insurance Company of America,
Newark, NJ and its affiliates.
1
2
F O R I N T ER N A L U S E O N L Y . N O T F O R U SE W I T H T H E P U B L I C.
Contact Your Prudential
Wholesaler for more
information.
©2009 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
0150749-0001-00 Ed 04/2009 Exp. 10/2010
Alphabetical Order
Abdominal Aortic Aneurysm (86)
Adrenal Insufficiency
(including Addison’s Disease) (109)
NEW!
Adrenal Mass (141)
Alcohol (102)
Angina (71)
Anxiety Disorders (26)
Aortic Valve Disorders (21)
Asthma (66)
Athlete’s Heart (38)
Atrial and Ventricular
Septal Defects (52)
Atrial Fibrillation (44)
Atrioventricular Blocks
(A-V Blocks) (89)
Attention Deficit Hyperactivity
Disorder (ADHD) (75)
Avocations – Mountain Climbing (110)
Barrett’s Esophagus (81)
Benign Prostatic Hypertrophy (BPH)
and Prostatitis (95)
Bilirubin and Alkaline
Phosphates (132)
Bladder Cancer (50)
Blood Tests (79)
NEW! Brain Natriuretic –
Peptide (BNP) (157)
Breast Cancer (25)
Bronchiectasis (152)
Build (42)
Bundle Branch Block (BBB) (33) NEW!
Business Insurance: Underwriting
Considerations for IPO’s +
“Start-Ups”(97)
Calcium and Parathyroid
Disease (123)
Cancer — General Concepts and
Terms (40)
NEW! Carbohydrate –
Deficient Transferrin (CDT) (158)
Cardiac Catheterization (7)
Corotid Artery Disease –
ultra sound (154)
Cerebrovascular Accident (Stroke) (74)
Cervical Cancer (62)
Chronic Lymphocytic Leukemia (45)
Chronic Obstructive Pulmonary
Disease (COPD) (11)
Clots and Emboli (127)
Colon Polyps (67)
Colorectal Cancer (24)
Complete Blood Count (156)
Coronary Artery Bypass Graft
(CABG) (10)
Coronary Artery Disease —
Plaque Burden (153)
Coronary Artery Disease —
Therapeutics (46)
Cotinine Test for Smokers (119)
Crohn’s Disease (134)
CT and MRI Cardiac Imaging (149)
Cushing’s Syndrome (125)
Cystic Fibrosis (151)
Depression and Anxiety Disorders (26)
Diabetes Mellitus (12)
Diabetes Mellitus Complications (13)
Diabetes Mellitus Classification (124)
Diabetes Mellitus Controlled (131)
Dilated Cardiomyopathy (92)
Drug Abuse (103)
Eating Disorders (76)
Electrocardiograms and
T-wave Changes (2)
Employee Stock Ownership Plans
(ESOP) (150)
Endometrial (Uterine) Cancer (60)
Enlarged Heart (90)
Epilepsy (59)
Estimated Glomerular
Filtration Rate (159)
Evaluation of Coronary Artery
Disease (23)
Exercise (Stress) Electrocardiograms
(ECGs) (5)
Financial Underwriting –
Key Employee (114)
General Avocations (137)
Glomerulonephritis (70)
Hairy Cell Leukemia (63)
Headaches (98)
Heart Disease In Women (30)
Heart Failure (94)
Hemochromatosis (55)
Hepatitis A, B, C (18)
Hepatitis B (108)
Hepatitis C (107)
Homocysteine (83)
Hypercoagulable Clotting
Disorders (84)
Hypertension (High Blood Pressure) (6)
Hypertrophic Cardiomyopathy (91)
Income Protection Financial
Underwriting (139)
Individual Inquiry Offers (142)
Insurance Medicine (19)
Interstitial Lung Disease (101)
Iron Deficiency Anemia (117)
Irregular Heart Beat (27)
Kidney Function Tests (KFTs) (138)
Kidney Transplants (49)
Laboratory Issues (118)
Lipid Levels —
The Risk of Arteriosclerosis (1)
Liver Cirrhosis (116)
Liver Tests (3)
Lymphoma (87)
Medical Information Bureau (MIB) (31)
Metabolic Syndrome X (136)
Mild Cognitive Impairment
and Dementia (129)
Mitral Valve Disorders (22)
Mitral Valve Prolapse (MVP) (4)
Monoclonal Gammopathy (72)
Multiple Sclerosis (34)
Myocardial Infarction
(Heart Attack) (14)
Nonalcoholic Fatty Liver Disease (135)
Older Age Diabetes (65)
Older Aged Underwriting:
Frisky vs. Frail (54)
Ovarian Cancer (53)
Pacemakers (20)
Pancreas (99)
Panhypopituitarism (122)
Parkinson’s Disease (57)
Patent Foramen Ovale (PFO),
Atrial Septal Aneurysm (ASA) (155)
Peptic Ulcer Disease (58)
Percutaneous Transluminal
Angioplasty (PTCA) (8)
Peripheral Neuropathy (112)
Peripheral Vascular Disease (PVD) (80)
Personality Disorders (78)
Pheochromocytoma (126)
Physical Fitness or Treadmill
Credit (56)
FOR THE EDUCATION OF PRODUCERS/BROKERS. NOT FOR USE WITH THE PUBLIC.
Contact Your Prudential
Wholesaler for more
information.
Polycystic Kidney Disease (115)
Polycythemia Vera (88)
Pregnancy (130)
Premium Financing (147)
Prostate Cancer (113)
Prostate Specific Antigen - PSA (48)
Prostatic Intraepithelial Neoplasia
(PIN) and Atypia (96)
Proteinuria (69)
Pulmonary Function Tests (64)
Pulminary Nodules (140)
Rating Reductions (61)
Rheumatoid Arthritis (35)
Sarcoidosis (47)
Scleroderma/CREST (68)
Sickle Cell Anemia (144)
Single Employer 419(e)
Welfare Benefit Plans (145)
Skin Cancer (32)
Scuba Diving (104)
Sleep Apnea (17)
Spinal Cord Injury (51)
Substance Abuse —
General Terms (100)
Systemic Lupus Erythematosus
(SLE) (37)
Testicular Cancer (36)
Thrombocytopenia (148)
Thrombocytosis (146)
Thyroid Cancer (85)
Thyroid Disease (121)
Transient Ischemic Attack
(TIA) (16)
Tuberculosis (TB) (41)
Tumor Markers (105)
Ulcerative Colitis (39)
Ultrafast CT and Coronary Artery
Disease (82)
Underwriting Cover Letter (111)
Underwriting With Class (93)
Urinalysis (106)
Valvular Heart Surgery (43)
Viral Infections (128)
(see back page for numerical order listing)
©2009 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
NR-000001 Ed. 01/2009 Exp. 10/2010
Rx For Success now available on CD*!
E-mail your CD* request to [email protected]. Include your name, company, mailing address, and the number of CDs you would
like. For the most recent list as well as copies of all current Rxs, visit pruxpress.com and Pru Life Links.
1. Lipid Levels — The Risk of
Arteriosclerosis
2. Electrocardiograms and T-wave
Changes
3. Liver Tests
4. Mitral Valve Prolapse (MVP)
5. Exercise (Stress)
Electrocardiograms (ECGs)
6. Hypertension (High Blood Pressure)
7. Cardiac Catheterization
8. Percutaneous Transluminal
Angioplasty (PTCA)
10. Coronary Artery Bypass Graft
(CABG)
11. Chronic Obstructive Pulmonary
Disease (COPD)
12. Diabetes Mellitus
13. Diabetes Mellitus Complications
14. Myocardial Infarction (Heart
Attack)
16. Transient Ischemic Attack (TIA)
17. Sleep Apnea
18. Hepatitis A, B, C
19. Insurance Medicine
20. Pacemakers
21. Aortic Valve Disorders
22. Mitral Valve Disorders
23. Evaluation of Coronary Artery
Disease
24. Colorectal Cancer
25. Breast Cancer
26. Depression & Anxiety Disorders
27. Irregular Heart Beat
30. Heart Disease In Women
31. Medical Information Bureau (MIB)
32. Skin Cancer
33. Bundle Branch Block (BBB)
34. Multiple Sclerosis
35. Rheumatoid Arthritis
36. Testicular Cancer
37. Systemic Lupus Erythematosus
(SLE)
38. Athlete’s Heart
39. Ulcerative Colitis
40. Cancer — General Concepts and
Terms
41. Tuberculosis (TB)
42. Build
43. Valvular Heart Surgery
44. Atrial Fibrillation
45. Chronic Lymphocytic Leukemia
46. Coronary Artery Disease Therapeutic
47. Sarcoidosis
48. Prostate Specific Antigen (PSA)
49. Kidney Transplants
50. Bladder Cancer
51. Spinal Cord Injury
52. Atrial and Ventricular Septal
Defects
53. Ovarian Cancer
54. Older Age Underwriting: Frisky vs.
Frail
55. Hemochromatosis
56. Physical Fitness or Treadmill
Credits
57. Parkinson’s Disease
58. Peptic Ulcer Disease
59. Epilepsy
60. Endometrial (Uterine) Cancer
61. Rating Reductions
62. Cervical Cancer
63. Hairy Cell Leukemia
64. Pulmonary Function Tests (PFTs)
65. Older Age Diabetes
66. Asthma
67. Colon Polyps
68. Scleroderma/CREST
69. Proteinuria
70. Glomerulonephritis
71. Angina
72. Monoclonal Gammopathy
74. Cerebrovascular Accident (Stroke)
75. Attention Deficit Hyperactivity
Disorder (ADHD)
76. Eating Disorders
78. Personality Disorders
79. Blood Tests
80. Peripheral Vascular Disease (PVD)
81. Barrett's Esophagus
82. Ultrafast CT and Coronary Artery
Disease
83. Homocysteine
84. Hypercoagulable Clotting
Disorders
125. Cushing’s Syndrome
85. Thyroid Cancer
126. Pheochromocytoma
86. Abdominal Aortic Aneurysm
127. Clots and Emboli
87. Lymphoma
128. Viral Infections
88. Polycythemia Vera
129. Mild Cognitive Impairment and
89. Atrioventricular Blocks
Dementia
(A-V Blocks)
130. Pregnancy
90. Enlarged Heart
131. Diabetes Mellitus Controlled
91. Hypertrophic Cardiomyopathy
132. Bilirubin & Alkaline Phosphates
92. Dilated Cardiomyopathy
134. Crohn’s Disease
94. Heart Failure
95. Benign Prostatic Hypertrophy
135. Nonalcoholic Fatty Liver Disease
(BPH) and Prostatitis
136. Metabolic Syndrome X
96. Prostatic Intraepithelial Neoplasia
137. General Avocations
(PIN) and Atypia
138. Kidney Function Tests (KFT)
97. Business Insurance: Underwriting
139. Income Protection Financial
Considerations for IPO’s + “StartUnderwriting
Ups”
140.
Pulminary Nodules
98. Headaches
141. Adrenal Mass
99. Pancreas
142. Individual Inquiry Offers
100. Substance Abuse –
144. Sickle Cell Anemia
General Terms
145. Single Employer 419(e) Welfare
101. Interstitial Lung Disease
Benefit Plans
102. Alcohol
146.
Thrombocytosis
103. Drug Abuse
147.
Premium Financing
104. Scuba Diving
148.
Thrombocytopenia
105. Tumor Markers
149.
CT and MRI Cardiac Imaging
106. Urinalysis
150. Employee Stock Ownership
107. Hepatitis C
Plans (ESOP)
108. Hepatitis B
151. Cystic Fibrosis
109. Adrenal Insufficiency
152. Bronchiectasis
(including Addison’s Disease)
153. Coronary Artery Disease –
110. Avocations – Mountain
Plaque Burden
Climbing
154. Corotid Artery Disease –
111. Underwriting Cover Letter
ultra sound
112. Peripheral Neuropathy
155. Patent Foramen Ovale (PFO),
113. Prostate Cancer
Atrial Septal Aneurysm (ASA)
114. Financial Underwriting –
NEW! 156. Complete Blood Count
Key Employee
NEW! 157. Brain Natriuretic –
115. Polycystic Kidney Disease
Peptide (BNP)
116. Liver Cirrhosis
NEW! 158. Carbohydrate –
117. Iron Deficiency Anemia
Deficient Transferrin (CDT)
118. Laboratory Issues
NEW! 159. Estimated Glomerular
Filtration Rate
119. Cotinine Test for Smokers
120. Foreign Residence and Travel
121. Thyroid Disease
122. Panhypopituitarism
123. Calcium and Parathyroid
Disease
*CD contains RX# 1-150 (excluding #9, #15, #28, #29, #73, #77, #93, #120, #124, #133 and #143)
FOR THE EDUCATION OF PRODUCERS/BROKERS. NOT FOR USE WITH THE PUBLIC.
Breast Cancer
Breast cancer is the most common cancer in women in the United States and second to lung cancer as cause of cancer
deaths. The National Cancer Institute estimates that the risk of a woman developing breast cancer in her lifetime is 1 in
8 (more than half of the lifetime risk is after age 65). Some cancers are discovered when the woman finds a palpable
mass in her breast. Other cases are diagnosed by screening mammography (breast x-ray). The diagnosis of breast cancer
is made by biopsy.
Staging is done to determine the prognosis, to direct therapies, and for reporting results in treatment research studies.
The staging system of the American Joint Committee on Cancer Staging uses TNM (tumor, node, metastasis)
classification. The primary tumor is evaluated by size, involvement of other tissues, status node, and presence or
absence of distant metastasis.
Non-invasive cancer (aka in-situ) has a better prognosis than invasive tumors. Tumor size is an independent prognostic
factor. Each involved node worsens the prognosis. There is risk of recurrence if no treatment is given beyond removing
the tumor. The risk is less for DCIS (ductal cancer in-situ) than for (LCIS) lobular cancer in-situ.
For breast cancer, the mortality risk varies with the stage of the cancer.
Lymph Node
Involvement
Metastasis
Rating
Age at Diagnosis
no
no
<40 yr. old use Tumor Table D
>40 yr. old use Standard
no
age <45 yr. old PP 5 yrs then enter
Tumor Table A, 6th yr.
age 45-65 yr. old use Tumor Table B
age > 65 yr. old use Tumor Table D
no
no
some cases may be considered
moveable axillary LN if size
>2 cm but no LN or if size
< 2 cm and only 1-2 LNs involved
chestwall
or skin
involvement
fixed axillary LN
or
internal mammary LN
no
any size
yes/no
Stage
Tumor Size
0
in-situ
I
* 2 cm
no
II
III
IV
> 2 cm
decline
any distant
metastasis
decline
Lifelong follow-up is required to detect recurrences which can occur as late as 30 years after the initial diagnosis of cancer.
This handout shows our malignant tumor rating schedule absent other significant health problems for individual policies.
Other prognostic factors besides lymph node involvement and tumor size which can affect the underwriting rating include:
adequate follow-up care, hormone receptor status, grade, vascular or lymphatic invasion, and menopausal status and DNA
appearance.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
{Name
Phone Number
E-mail Address
Website Address}
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx025 IFS-A005004 Ed. 10/08 Exp. 10/10
Malignant Tumor Rating Schedule
A
B
C
D
Within 1st year
Decline
Decline
Decline
$5x3
2nd year
Decline
Decline
$7.50x5
$5x2
3rd year
Decline
$10x6
$7.50x4
$5x1
4th year
$15x6
$10x5
$7.50x3
0
5th year
$15x5
$10x4
$7.50x2
0
6th year
$15x4
$10x3
$7.50x1
0
7th year
$15x3
$10x2
0
0
8th year
$15x2
$10x1
0
0
9th year
$15x1
0
0
0
For example, Stage I breast cancer diagnosed in a woman age 60 who is now in the third year following treatment would
be rated under Tumor Table B: $10x6
To get an idea of how a client with a history of breast cancer would be viewed in the underwriting process, feel free to use
the attached Ask “Rx” pert underwriter for an informal quote
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Breast Cancer - Ask "Rx" pert underwriter
(ask our experts)
Producer ____________________________________________ Phone ___________________ Fax ______________________
Client ______________________________________________ Age/DOB _________________ Sex ______________________
If your client has had breast cancer, please answer the following:
1. Please list date of diagnosis: ____________________________________________________________________________
2. How was the cancer treated?
n removing the tumor only
n lumpectomy or wide excision
n mastectomy
n radiation therapy
n chemotherapy
n hormonal therapy (tamoxifen)
3. Please list date treatment completed: ____________________________________________________________________
4. Is your client on any medications?
n yes, please give details __________________________________________________________________
n no
5. What stage was the cancer?
n Stage 0 (in-situ)
n Stage I
n Stage II
n Stage III
n Stage IV
6. Were lymph nodes involved? If yes, how many? ___________________________________________________________
7. Has there been any evidence of recurrence?
n yes, please give details ___________________________________________________________________
n no
8. Date and results of last mammogram: ____________________________________________________________________
7. When was your client’s last colonoscopy and CEA level? Please give date and
results: ______________________________________________________________________________________________
8. Has your client smoked cigarettes in the last 12 months?
n yes
n no
9. Does your client have any other major health problems (ex: cancer, etc.)?
n yes, please give details __________________________________________________________________
n no
Please include the pathology report of the breast cancer.
After reading the Rx for Success on Breast Cancer, please feel free to use this Ask “Rx” pert underwriter for an informal
quote.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx025 IFS-A005004 Ed. 10/08 Exp. 10/10
Coronary Artery Disease – Plaque Burden
Thickening of the arteries in the body (atherosclerotic process) begins during adolescence. It is now believed that
atherosclerosis is the body’s attempt to heal endothelial inflammation or injury. First, fatty streaks form beneath the
endothelium (the inner lining of the artery wall). As the fatty streak matures, it develops a lipid core that is covered by smooth
muscle and connective tissue to form a fibrous cap. This is called arterial plaque. The plaque enlarges and the lumen of
the vessel becomes narrowed/stenosed. Small areas of unstable plaque in the heart may rupture, releasing lipids and
necrotic material into the blood stream, which causes an acute thrombus (clot). Acute obstruction, resulting from the rapidly
formed clot, is thought to be the cause of many acute events and heart attacks. Areas of slowly enlarging plaque cause
mechanical obstruction to blood flow and symptoms of angina.
Anatomy of the heart’s blood supply varies considerably from person to person. Evaluation on an individual’s heart circulation
requires coronary angiogram. The major coronary arteries lie over the heart and feed the heart through smaller arteries in
the wall. References to “three vessel” disease usually indicate that the left anterior descending (LAD), circumflex (Cx) and
right coronary artery (RCA) are significantly stenosed. Angiogram reveals the plaque burden; that is, the number of vessels
involved and their percent stenosis.
In general, patients with single-vessel disease do well with either medical or surgical intervention. For example, the
symptomatic individual with limited disease who wishes to remain physically active may benefit from opening the artery with
a catheter (percutaneous intervention [PCI]). The greater the extent of coronary atherosclerosis (e.g. left main [LMCA] or
three vessel disease) the more compelling CABG becomes, especially if left ventricle (LV) function is depressed. Patients with
lesser extent of disease and localized lesions are good candidates for PCI.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
{Name
Phone Number
E-mail Address
Website Address}
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx153 IFS-A127188 Ed. 10/08 Exp. 10/10
Underwriting CAD risk requires detailed analysis of the extent of the disease. Disease severity is assessed by multiple factors
including:
4Plaque burden by catheterization
4Number of events and stability
4Systolic LV function
4Diastolic LV function
4Exercise tolerance
4Current symptoms or abnormal stress testing (with or without scan/echo)
4Other vascular disease
For example:
56 year old non-smoking man has a history of an acute myocardial infarction (MI), followed by a cardiac catheterization,
showing one vessel disease of 95% in LAD that was stented. He fully recovered with good heart function (LV normal
ejection fraction) and negative stress test with favorable METS. He takes aspirin, beta blocker and has normal lipids on
a statin drug. This applicant would be rated Non-smoker Plus.
56 year old non-smoking man has a history of an acute MI, followed by a cardiac catheterization showing 3 vessel
disease with 95% LAD lesion, 70% in RCA, and 50% Cx. He is recovered after the stents in LAD and RCA, with good
heart function (normal LV ejection fraction) and had a negative stress test with favorable METS. He is takes aspirin, beta
blocker and has normal lipids on a statin drug. This applicant would be rated Table C.
To get an idea of how a client with a history of Coronary Artery Disease would be viewed in the underwriting process, feel free
to use the Ask “RX”pert underwriter on the next page.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Coronary Artery Disease - Plaque Burden - Ask "Rx" pert underwriter
(ask our experts)
Producer ____________________________________________ Phone ___________________ Fax ______________________
Client ______________________________________________ Age/DOB _________________ Sex ______________________
If your client has had CAD, please answer the following
1. Please list date(s) of the CAD diagnosis: ___________________________________________________________________
2. Has your client had any of the following?*
n heart attack _____________________________________ (date)
n coronary angioplasty (PTCA)
_____________________ (date)
n heart failure ____________________________________ (date)
n CABG __________________________________________ (date)
n valve surgery ____________________________________ (date)
3. Is your client on any medications (including aspirin)?
n yes, please give details __________________________________________________________________________
n no
4. Has a stress (exercise) ECG been completed?
n yes - normal____________________________________ (date)
n yes - abnormal__________________________________ (date)
n no
5. Has your client had any chest discomfort since the treatment?*
n yes, please give details __________________________________________________________________________
n no
6. Please check if your client has had any of the following:
n abnormal lipid levels
n diabetes
n high blood pressure
n irregular heart beats
n peripheral vascular disease
n cerebrovascular or carotid disease
n overweight
n elevated homocysteine
7. Has your client smoked cigarettes in the last 12 months?
n yes
n no
8. Does your client have any other major health problems (ex: cancer, etc.)?
n yes, please give details __________________________________________________________________________
n no
*Please submit a copy of any recent angiogram report and any recent stress tests.
After reading the Rx for Success on CAD Plaque Burden, please feel free to use this Ask “Rx” pert underwriter for an
informal quote.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx153 IFS-A127188 Ed. 10/08 Exp. 10/10
Diabetes Mellitus
Diabetes Mellitus (DM) is characterized by abnormal sugar metabolism causing hyperglycemia (high blood sugar). Chronic
hyperglycemia adversely affects the body. In the vascular system, there can be events such as strokes and heart attacks
caused by atherosclerosis. There can also be renal disease, peripheral neuropathy, and blindness. In the United States,
DM is a leading cause of end stage kidney disease, leg amputations, and blindness.
Blood sugar enters cells via the action of insulin, which is a hormone produced by the beta cells of the pancreas. Factors
that contribute to hyperglycemia include reduced insulin secretion, decreased blood sugar (glucose) usage by the body, or
increased glucose production.
Type 1 diabetes formerly called juvenile-onset or insulin dependent (IDDM), has a peak age at onset of 12 years old. It
is unusual to begin after age 40. Type 1 DM is due to beta cell destruction so that no insulin is produced and must be
replaced by insulin injections. Symptoms include excessive thirst, excessive urination, and weight loss.
Type 2 diabetes was formerly called adult-onset or noninsulin dependent (NIDDM). It is characterized by 1) variable
degrees of resistance to the action of insulin, 2) impaired insulin secretion by the beta cells, or 3) impaired glucose
production. Type 2 DM usually develops over the age of 30, but its incidence is increasing in children and adolescents,
especially those who are obese. (Eighty percent of Type 2 patients are obese. Many have excessive thirst or urination, but
most have no symptoms. Type 2 may also require insulin in the later stages.) Type 2 is initially treated with diet and
exercise. If decreased calorie intake and increased exercise does not result in blood glucose control, oral medication is
added. Some oral medications include: sulfonylureas, alpha-glucosidase inhibitors, thiazolidinedione, metformin, and
repaglinide. Risk factors for the development of NIDDM are older age, obesity, positive family history and history of
gestational diabetes.
Secondary diabetes can result from pancreatic disease, hormonal syndromes (Cushing’s syndrome), drug-induced disease
(thiazide diuretics, steroids, phenytoin) or those associated with syndromes such as hemochromatosis and acromegaly.
Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are also termed subclinical or borderline diabetes.
Patients generally have no symptoms. Many go on to develop diabetes. There is an increased risk of cardiovascular
disease.
Gestational diabetes is diagnosed when glucose intolerance is discovered during a pregnancy. It is associated with
increased perinatal complications. Risk factors for the development of gestational diabetes are older age, overweight,
previous large or stillborn babies, or positive family history of diabetes. Women with a history of gestational diabetes have
an increased risk of developing Type 2 diabetes (as high as 50% within 10 years and 70% within 20 years).
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
{Name
Phone Number
E-mail Address
Website Address}
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx012 IFS-A143200 Ed. 10/08 Exp. 10/10
Diagnostic Criteria for Diabetes
• Fasting blood glucose: 2 readings greater than or equal to 126 mg/dl
• 75 gram oral glucose tolerance test:
Diabetes:
Impaired glucose tolerance:
2-hour sample greater than 200 mg/dl
2-hour sample between 140–200 mg/dl
• A positive 100 gram glucose tolerance test for pregnant women to screen for gestational diabetes.
Other laboratory studies used to monitor diabetes include glycosylated hemoglobin (HbA1c) and fructosamine. HbA1c
gives an indication of glucose control over the preceding 60 days, and fructosamine (glycosylated protein) measures
glucose control over a 20-day time span.
Diabetes is a progressive disease which can be slowed by meticulous control of blood sugar, weight control and exercise.
Diabetes control is monitored by testing glycosylated hemoglobin in the blood and by home monitoring of blood sugar.
Normal glycosylated hemoglobin is a value of < 6 (though range of normal varies among testing laboratories). The goal for
known diabetes is <7. Glycosylated hemoglobin over >8 is evidence of poor control.
Rating for diabetes mellitus depends on 1) age at onset 2) years since diagnosis, 3) control of the diabetes, and 4)
presence of complications. Ratings increase with younger ages, longer time since onset, poor control and complications.
Table for Diabetes Mellitus (based on age and duration)
Age at Issue
0-7 years
8.0–14 years
15- 20 years
Over 20 years
0-17
Decline
Decline
Decline
-
18-34
Table E
Table E
Table F
Table G
35-49
Table D
Table D
Table E
Table F
50-65
Table C
Table D
Table D
Table E
66+
Table B
Table C
Table D
Table D
Prudential has a number of best case scenarios available. Please see Rx for Success on Diabetes Mellitus Controlled for
more details on diabetes control and best case scenarios.
You may also consider reviewing other Rx for Success topics such as Diabetes Mellitus Complications or Older Age
Diabetes.
To get an idea of how a client with a history of diabetes would be viewed in the underwriting process, please feel free to
use the attached Ask “Rx” pert underwriter for an informal quote.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Diabetes Mellitus - Ask "Rx" pert underwriter
(ask our experts)
Producer ____________________________________________ Phone ___________________ Fax ______________________
Client ______________________________________________ Age/DOB _________________ Sex ______________________
If your client has diabetes, please answer the following:
1. Please list date when first diagnosed: ______________________________________________________________________
2. How often does your client visit their physician? (also note date of last visit) ___________________________________
3. The client's diabetes is controlled by
n diet alone
n oral medication _______________________ (medication & doses)
n insulin ______________________________ (amount of units/day)
4. Is your client on any other medications?
n yes, please give details _________________________________________________________________________
n no
5. Please give the most recent blood sugar reading ____________________________________________________________
6. Does your client monitor their own blood sugar? __________________________________
7. If available, please give the most recent glycohemoglobin (HbA1c) or fructosamine level
_______________________________________________________________________________________________________
8. Please check if your client has had any of the following:
n chest pain or coronary artery disease
n overweight
n kidney disease
n neuropathy
n hypertension
n abnormal ECG
n elevated lipids
n black out spells
n protein in the urine
n retinopathy
9. Has your client smoked cigarettes in the last 12 months?
n yes
n no
10. Does your client have any other major health problems (ex: cancer, etc.)?
n yes, please give details _________________________________________________________________________
n no
After reading the Rx for Success on Diabetes Mellitus Classification, please feel free to use this Ask “Rx” pert
underwriter for an informal quote.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx012 IFS-A143200 Ed. 10/08 Exp. 10/10
Individual Inquiry Offers
An inquiry offer, “ballpark,” or quick quote is a preliminary pricing estimate for a specific impairment, usually made without
the benefit of complete underwriting documentation. The table below provides ballpark estimates for some frequently seen
impairments, and provides criteria for obtaining an underwriting offer. Underwriting for most impairments will require an
Attending Physician’s Statement (APS) as well as the specific reports noted below.
Best case scenarios and rated offers are subject to review of full underwriting requirements, including medical and nonmedical histories, and must conform to all other preferred criteria. In some situations, Prudential may offer Preferred
categories when other carriers may not.
Condition
Alcohol/drug abuse
and/or treatment
Reports Needed
Best Case Scenario (nonsmokers)
Unable To Offer
Preferred Non Tobacco if abstinent for 10 or more
years.
Treatment records
Non Smoker Plus if abstinent for 6 or more years.
Evidence of current drug or
alcohol use or combined with
severe depression histories.
Asthma
Treatment records
Preferred Best if mild with 2 or fewer episodes per
year even with a steroid inhaler.
Persistent wheezing, limited
activity, severe or multiple
attacks, current oxygen,
hospitalization within 6 months.
Aviation
Questionnaire
Preferred Best for most commercial airline pilots.
Test piloting, unusual hazards,
foreign airline pilots.
Non Smoker Plus for students and private pilots up
to 200 hours per year.
Build (using height
of 6 ft. as an
example)
Exam verified
Cancer
Pathology report
Non Smoker Plus after 6-10 years, depending on
the specific type, grade, and location of the cancer.
Cancer that has spread beyond
the original organ, metastatic
cancer, positive surgical
margins.
Cerebral vascular
disease –
Stroke/TIA
COPD/Emphysema
APS
Non Smoker Plus for a TIA history over 10 years
ago if age > 55 at time of event. For strokes >7
years ago, age >55 at time of event – Table B.
Multiple infarcts with
cognitive/memory defect or
significant physical impairment.
PFTs – pulmonary function
tests
Mild and well controlled can be a Table B.
Progressive and/or on oxygen (see
Asthma).
All cardiac tests done since
diagnosis such as
catheterization,
echocardiogram, treadmill,
ECG, perfusion, scans
Non Smoker Plus for mild disease impacting
single artery (not left main), minimal plaque
burden, good cardiac function (ejection fraction >
55%) and quality medical care and lifestyle.”
Age less than 30 at diagnosis or
an ejection fraction less than
40%.
Coronary Artery
Disease
Preferred Best for male/female ages 18-64, height
6 ft., up to 213 lbs or at ages 65+ up to 228 lbs.
Significantly over weight or under
weight or morbidly obese.
Non Smoker Plus for male/female ages 18-64,
height 6 ft., up to 243 lbs or at ages 65+ up to 294
lbs.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
{Name
Phone Number
E-mail Address
Website Address}
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx142 IFS-A100619 Ed. 10/08 Exp. 10/10
Condition
Reports Needed
Best Case Scenario (nonsmokers)
Unable To Offer
Dementia
N/A
N/A
Generally not acceptable for
individual contracts.
Depression
Treatment history
Preferred Best if mild and 2 or fewer medications
with no anti-psychotics.
Suicide attempt or electric shock
treatment within one year, more
than 2 suicide attempts,
currently psychotic or manic.
Diabetes and glucose HGBA1C and urine for
microalbumin
intolerance
Non Smoker Plus for ages 50 or higher at
diagnosis, taking no insulin, and HGBA1C is 7.0 or
less.
HGBA1C’s of 11 or greater or
proteinuria over 50 mg/dl.
Elderly
APS
Preferred Best may be possible if stable and all
preferred criteria are met.
Frail with deteriorating health.
Hepatitis C & B
Blood tests – liver function
tests (LFTs) and any viral
loads
Preferred Best for Hepatitis B, Preferred Non
Tobacco for Hepatitis C, if fully recovered with normal
viral loads and normal LFTs for at least 2 years.
Advanced liver disease with
cirrhosis or liver enzyme tests
more than 3x normal.
Kidney disease
Creatinine and urine
Preferred Best may be possible if stable, creatinine
is 1.3 or less and urine is normal.
Chronic renal failure with
creatinine over 2.
Liver tests (AST, ALT,
GGT)
Blood tests and any liver
scans or biopsies
Preferred Best if only 1 enzyme elevated:
LFTs with liver enzyme tests more
than 5x normal.
AST ≤ 5x normal, ALT ≤ 4x normal or GGTP ≤ 4x
normal.
Preferred Best may be available with multiple
elevations if liver enzymes < or = to 2x normal and
there is no adverse medical/alcohol history.
Prostate cancer
Pathology report
Non Smoker Plus may be possible for Stages 1-2
with Gleason score of 6 or less, prostatectomy over
1 year ago, pre-surgery PSA of 20 or less, and
current PSA less than 0.1.
Post op PSA over 1.0 or rising,
stage 4, or a gleason score of 8 10.
Sleep apnea
Sleep study
Preferred Best for mild and for moderate with
verified and effective CPAP use.
No follow up sleep study or noncompliance with CPAP.
Tobacco
Details of all tobacco used
with dates used
Preferred Best available if no tobacco use for 5
years
N/A
Preferred Non Tobacco available if no tobacco use
for 3 years
Non Smoker Plus available for all tobacco use
except cigarettes – even with a (+) nicotine.
Valvular heart
disease
Echocardiogram
Preferred Best may be available for minimal
disease and over age 75.
Severe valvular disease as noted
in the APS.
Cases do not always clearly match the Quick Quote criteria above, and there are many conditions not on the list
above. If you have a case you would like us to review for a Quick Quote, send an e-mail to your dedicated Quick
Quote e-mail box. You can also use our Rx for Success questionnaires and My Underwriter a customized rating
estimator available on pruxpress.com to assist with obtaining a quote.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Prostate Cancer
The prostate is a walnut sized gland that surrounds the urethra at the base of the bladder. Risk of cancer increases based
on family history and advancing age. Most prostate tumors are adenocarcinomas. Another form of tumors seen in the
prostate gland is sarcoma, which has a worse prognosis. Prostate cancer is the most common cancer in men. In terms of
cancer deaths in men, prostate cancer ranks second (lung cancer being first.) About 3⁄4 of men in their 80s have cancer at
biopsy. Currently available screening tests are prostate specific antigen (PSA) and digital rectal exam (DRE). PSA is a
tumor marker specific to the prostate. The “normal” range varies with age. However, these ranges have been questioned
and may miss a large proportion of cancers.
< 50
<
2.5 ng/ml
50-59
<
3.5 ng/ml
60-70 yr
<
4.5 ng/ml
> 70 yr
<
6.5 ng/ml
In underwriting, prostate cancer is assessed by stage and grade. Stage refers to the extent of the cancer (tumor size and/or
spread). The Gleason system grades the aggressiveness of the tumor from 2 to 10. The higher the Gleason Score the more
likely a tumor will spread beyond the gland to other sites. Gleason 2-4 is non-aggressive while Gleason 8-10 is aggressive.
Treatment most often consists of prostate resection (called a radical prostatectomy) or radiation. Hormonal treatment is
offered for metastatic disease, to elderly men, or to men with poor health.
Localized low grade prostate cancer is sometimes not treated but followed with close observation. This fourth treatment
option is often referred to as “watchful waiting”.
PSA levels are followed after treatment of cancer. A rising PSA suggests that tumor is currently present and a persistently
low PSA suggests successful control.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
{Name
Phone Number
E-mail Address
Website Address}
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx113 IFS-A069431 Ed. 10/08 Exp. 10/10
Clients with prostatic adenocarcinoma are considered after they have completed treatment, show no current evidence of
disease, and have adequate follow- up care. In most cases, men who underwent radical prostatectomy will be considered
after one year. If radiation treatment (external radiation or seed implants) was given, underwriting is usually delayed for 2
years.
For example:
Client A
Stage T2*
Best case
More than one year after radical resection of the prostate with pretreatment
PSA < 20, Gleason score < 6, and current PSA undetectable
No rating
Client B
More than 2 years after radiation treatment with pretreatment
No rating
Stage T2*
Best case
PSA < 10, Gleason score < 6, and current PSA < 0.5 with no rise in PSA
since treatment
Client C
Stage T2*
Radical resection of the prostate, Gleason 7, pretreatment
PSA <20, and PSA undetectable at time of application
Postpone the first
then temporary extras
year after surgery,
are applied through
the 6th year
*Stage 2 is disease that is confined within the prostate.
For others, longer postponement and ratings may be required. This will depend on stage, Gleason score, and PSA levels
before and after treatment.
To get an idea of how a client with a history of prostate cancer would be viewed in the underwriting process, feel free to
use the Ask “Rx” pert underwriter on the attached page for an informal quote.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Underwriting Prostate Cancer - Ask "Rx" pert underwriter
(ask our experts)
Producer ____________________________________________ Phone ___________________ Fax ______________________
Client ______________________________________________ Age/DOB _________________ Sex ______________________
If your client has Prostate Cancer, please answer the following:
1. Please list date of diagnosis: _____________________________________________________________________________
2. How was the cancer treated?
n observation only
n TURP (transurethral prostatectomy)
n radical prostatectomy
n radiation therapy (seed implant or external beam radiation)
n hormone therapy
n other, please specify _____________________________________________________________________________
3. Is your client on any medications?
n yes, please give details ___________________________________________________________________________
n no
4. What stage was the cancer?
______________________________________________________________________________________________________
5. What was the Gleason score?
______________________________________________________________________________________________________
6. Please give the date and result of the most recent PSA test:
______________________________________________________________________________________________________
7. What was the PSA prior to treatment?
______________________________________________________________________________________________________
8. Does your client have any other major health problems (ex: heart disease, etc.)?
n yes, please give details _________________________________________________________________________
n no
After reading the Rx for Success on Prostate Cancer, please feel free to use this Ask “Rx” pert underwriter for an informal
quote.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx113 IFS-A069431 Ed. 10/08 Exp. 10/10
Build
Build is one of the basic life risk characteristics and one of the oldest. There is increased mortality at both extremes of
weight as the graph below shows. The Center for Disease Control (CDC) reports that in 1999-2000 15% of American
children and adolescents (ages 6-19) are overweight. For American adults, 64% are overweight or obese. Overweight
conditions, or obesity, are often precursors to hyperlipidemia, diabetes, cardiovascular disease, or cancer. While an
underweight condition may be normal, it may also be an indicator of an eating disorder or an underlying acute or chronic
illness.
2.5
Risk
Mortality
2.0
1.5
1.0
low
very low
Body mass index
20
25
high
moderate
30
35
40
weight (kg)/height (m)2)
Those whose excess weight is muscle and bone, with little fat, and whose weight distribution is good are better risks than the
obese. Body mass index (BMI) is a commonly used measurement of adiposity (fat as opposed to muscle) per height. The
build table takes this into consideration by giving a weight range classified by height and BMI. Significantly overweight
patients have an increased risk for coronary heart disease, diabetes, hypertension, and hyperlipidemia.
See page 2 which shows our build tables for adult’s ages 18-64 and page 3 for ages 65 and over.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Contact Your Prudential
Wholesaler for more
information.
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx042 IFS-A156848 Ed.10/08 Exp. 10/10
BUILD TABLES – Male and Female - Ages 18 to 64
Height (inches) / Weight (pounds)
Class
Debit
BMI
IC
4’10”
4’11”
5’0”
5’1”
5’2”
5’3”
5’4”
5’5”
5’6”
5’7”
5’8”
5’9”
5’10”
5’11”
81
84
87
90
93
96
99
102
105
108
112
115
118
122
17
Minimum
15
18
86
89
92
95
98
101
105
108
111
115
118
122
125
129
Not Rated
0
29
138
143
148
153
158
163
169
174
179
185
190
196
202
207
15
31
148
153
158
164
169
175
180
186
192
198
203
209
216
222
25
33
158
163
169
174
180
186
192
198
204
210
217
223
230
236
30
38
182
188
195
201
208
215
222
228
236
243
250
257
265
273
Standard*
Class A
Class B
40
40
192
199
206
213
220
227
234
242
249
257
264
272
280
288
50
43
203
210
217
224
232
239
247
255
263
271
279
287
296
304
60
45
213
221
228
236
244
252
260
268
276
285
293
302
311
320
75
47
224
232
240
248
256
264
273
281
290
299
308
317
326
336
Class C
85
49
234
243
251
259
268
277
285
294
304
313
322
332
341
351
Class D
125
51
244
253
262
270
279
288
298
307
317
326
336
346
356
366
Class E
175
53
255
264
273
282
291
301
310
320
330
340
350
361
371
382
Class F
225
56
265
275
284
294
303
313
323
333
344
354
365
376
387
398
>57
266
276
285
295
304
314
324
334
345
355
366
377
388
399
Decline
Class
Debit
IC
BMI
6’0”
6’1”
6’2”
6’3”
6’4”
6’5”
6’6”
6’7”
6’8”
6’9”
6’10”
17
125
129
132
136
139
143
147
151
154
158
162
Minimum
15
18
132
136
140
144
148
151
155
159
164
168
172
Not Rated
0
29
213
219
225
232
238
244
250
257
263
270
277
Standard*
Class A
Class B
15
31
228
234
241
247
254
261
268
275
282
289
296
25
33
243
250
256
263
271
278
285
292
300
307
315
30
38
280
288
296
304
312
321
329
337
346
355
364
40
40
297
305
313
322
330
339
348
357
366
375
385
50
43
313
321
330
339
348
358
367
376
386
396
406
60
45
329
338
347
357
366
376
386
396
406
416
427
75
47
345
355
365
374
384
395
405
415
426
437
448
Class C
85
49
361
371
382
392
403
413
424
435
446
457
469
Class D
125
51
377
387
398
409
420
431
442
454
465
477
489
Class E
175
53
393
404
415
426
438
449
461
473
485
497
510
Class F
225
56
409
421
432
444
456
468
480
493
505
518
531
>57
410
422
433
445
457
469
481
494
506
519
532
Decline
For individuals heavier than the maximum limits for Class D or lighter than the minimum stated weight for their height (i.e. IC range),
an APS is required.
*When build debits = +30 and there are no additional debits for medical impairments, accept unrated, Non-smoker or
Smoker as appropriate.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
BUILD TABLES – Male and Female - Ages 65 and Over
Height (inches) / Weight (pounds)
Class
Debit
IC
BMI
19
4’10”
4’11”
5’0”
5’1”
5’2”
5’3”
5’4”
5’5”
5’6”
5’7”
5’8”
5’9”
5’10”
5’11”
91
94
97
100
104
107
110
114
117
121
125
128
132
136
Minimum
15
20
95
99
102
106
109
113
116
120
124
127
131
135
139
143
Not Rated
0
31
148
153
158
164
169
175
180
186
192
198
203
209
216
222
15
35
167
173
179
185
191
197
203
210
216
223
230
237
243
250
25
40
191
198
204
211
218
225
233
240
247
255
263
270
278
286
30
45
215
222
230
238
246
254
262
270
278
287
295
304
313
322
40
46
220
227
235
243
251
259
267
276
284
293
302
311
320
329
50
47
224
232
240
248
256
265
273
282
291
299
308
318
327
336
Class A
Class B
60
49
234
242
250
259
267
276
285
294
303
312
322
331
341
351
75
50
239
247
255
264
273
282
291
300
309
319
326
338
348
358
Class C
85
51
244
252
261
269
278
287
296
306
315
325
335
345
355
365
Class D
125
53
253
262
271
280
289
299
308
318
328
338
348
358
369
379
Class E
175
55
263
272
281
290
300
310
320
330
340
350
361
372
383
394
Class F
225
56
265
275
284
294
303
313
323
333
344
354
365
376
387
398
>57
266
276
285
295
304
314
324
334
345
355
366
377
388
399
Debit
BMI
Decline
Class
IC
19
6’0”
6’1”
6’2”
6’3”
6’4”
6’5”
6’6”
6’7”
6’8”
6’9”
6’10”
140
144
148
152
156
160
164
168
173
177
181
Minimum
15
20
147
151
155
160
164
169
173
177
182
186
191
Not Rated
0
31
228
234
241
247
254
261
268
275
282
289
296
15
35
258
265
272
279
287
295
302
310
318
326
334
25
40
294
303
311
319
328
337
345
354
363
372
382
30
45
331
340
350
359
369
379
389
399
409
419
429
40
46
338
348
358
367
377
387
397
407
418
428
439
50
47
346
355
365
375
385
396
406
416
427
438
449
Class A
Class B
60
49
361
371
381
391
402
412
423
434
445
456
468
75
50
368
378
389
399
410
421
432
443
454
466
477
Class C
85
51
375
386
396
407
418
429
440
452
463
475
487
Class D
125
53
390
401
412
423
435
446
458
469
481
494
506
Class E
175
55
405
416
427
439
451
463
475
487
500
512
525
Class F
225
56
409
421
432
444
456
468
480
493
505
518
531
>57
410
422
433
445
457
469
481
494
506
519
532
Decline
For individuals heavier than the maximum limits for Class D or lighter than the minimum stated weight for their height (i.e. IC range),
an APS is required.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
Build - Ask "Rx" pert underwriter
(ask our experts)
Producer ____________________________________________ Phone ___________________ Fax ______________________
Client ______________________________________________ Age/DOB _________________ Sex ______________________
1. Please list your client’s current build: height __________ weight ______________________________________________
2. Has your client’s weight changed in the past year?
I yes, increase ______lbs. decrease _______lbs.
I no
3. Has your client ever had any weight reduction surgery?
I yes, please give details __________________________________________________________________________
I no
4. Please check if your client has had any of the following:
I coronary artery disease
I diabetes
I high blood pressure
I elevated cholesterol or triglycerides (lipid levels)
5. Is your client on any medications?
I yes, please give details __________________________________________________________________________
I no
6. Has your client smoked cigarettes in the last 12 months?
I yes, please give details __________________________________________________________________________
I no
7. Has a stress electrocardiogram (treadmill test) been completed within the past year?
I yes; normal_______________________________(date)
I yes; abnormal_____________________________(date)
I no
8. Does your client have any other major health problems (ex: cancer, etc.)?
I yes, please give details __________________________________________________________________________
I no
After reading the Rx for Success on Build, please feel free to use this Ask “Rx” pert underwriter for an informal quote.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx042 IFS-A156848 Ed. 10/08 Exp. 10/10
Coronary Artery Disease – Therapeutics
Standard therapeutics for CAD include coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI),
medication, and life style changes. Recent advances in CAD therapy include stents, transmyocardial revascularization,
enhanced external counterpropulsion (EECP), and angiogenic growth factors.
Coronary Artery Stents
PCI, also known as percutaneous transluminal angioplasty (PTCA), involves placement of a catheter through a skin incision
into an artery (usually the femoral artery) and maneuvering the catheter through the arterial system to the coronary artery.
Stents are expandable coils, tubes, or mesh that are permanently implanted in the coronary artery during PCI. Restenosis
risk has always been a problem after any PCI procedure. Stent placement reduces this risk, but continues to have a
problematic restenosis rate. In order to reduce restenosis rates, intra-vascular radiation may be given during the procedure
– which is called brachytherapy. Drug-eluting stents (containing drugs such as rapamycin/Sirolumus or paclitaxel/Taxol) are
also available and have a lesser restenosis rate than ordinary stents.
Transmyocardial Revascularization
This is a surgical procedure that involves puncturing the heart muscle with multiple holes using a laser. This is thought to
allow channels for blood from the left ventricle to the ventricular muscle. The outer surface seals within minutes.
Enhanced External Counterpropulsion (EECP)
Some patients continue to suffer from angina despite maximal medical and surgical intervention. EECP is a non-invasive
procedure that can reduce anginal symptoms, presumably by increasing blood flow to the coronary arteries. Symptom relief
seems to last long after the end (which may last more than a month at one hour per day) of the therapeutic sessions. A
series of compression cuffs are placed along the legs and sequentially inflated, timed with the ECG cycle.
Angiogenic Growth Factors
Chemical stimulants, known as angiogenic growth factors, are currently under study as a potential treatment for patients
with coronary artery disease (CAD) that cannot be helped by the standard forms of therapy. Such factors seem to stimulate
the growth of new blood vessels within the heart muscle.
Individual consideration in underwriting will be given to any applicant receiving the last three forms of treatment for CAD.
An offer for individual life insurance is unlikely. For cardiac stents, including brachytherapy and drug-eluting stents, please
refer to Rx Percutaneous Transluminal Angioplasty (PTCA) to get an idea of how an applicant would be viewed in
underwriting.
Advances in medicine have led to new therapeutic devices for coronary artery disease. Except for the last device listed,
these devices are used to remove blockage from within the coronary artery and are used in conjunction with PTCA
(percutaneous transluminal angioplasty). PTCA is a procedure that involves placing a flexible tube (catheter) percutaneously
(through a skin incision) into an artery (usually the femoral artery) and maneuvering the catheter transluminally (guided
through the arterial system by means of xray) to the coronary artery.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
{Name
Phone Number
E-mail Address
Website Address}
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx046 IFS-A068711 Ed. 10/08 Exp. 10/10
Directional Coronary Atherectomy
Directional coronary atherectomy uses a low pressure positioning balloon and a cutter which spins at 2,500 rpm to remove
fragments of the atheroma (coronary artery blockage) and stores them in the catheter tip. It was developed in 1984 and
FDA approved in 1990. By 1992, 33,000 procedures had been done (10% of all non-surgical coronary revascularization).
A 1993 study compared PTCA with atherectomy and found a better success rate with the atherectomy but a higher early
complication rate and higher cost with no long term advantage.
Rotational Atherectomy
Rotational atherectomy uses a Rotablator with a burr at the tip which is coated with diamond chips and spins at 150,000190,000 rpm. The atheromatous plaque is broken down into millions of microparticles (smaller than a red blood cell).
Early reported success rate is 84% (95% if also done in conjunction with a PTCA). Restenosis (reblockage) occurs in 41%.
Lasers
Laser delivers pulsed ultraviolet energy through a flexible catheter containing hundreds of optical fibers. The laser vaporizes
the athermatous plaque. It is more effective if combined with PTCA.
Perfusion Balloon Catheter
This balloon catheter allows blood to pass through the catheter while the balloon is inflated. It maintains blood flow to the
heart muscle during a prolonged inflation. It is useful in treating acute coronary artery dissections (tears in the artery wall)
caused by PTCA.
To get an idea of how a client with a history of CAD treated with one of these procedures would be viewed in the underwriting
process, feel free to use the “Ask “Rx” pert underwriter” on the attached page for an informal quote.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
CAD - New Therapeutic Devices - Ask “Rx” pert underwriter
(ask our experts)
Producer ____________________________________________ Phone ___________________ Fax ______________________
Client ______________________________________________ Age/DOB _________________ Sex ______________________
If your client had had a coronary angioplasty, atherectomy, or coronary artery stent placed, please answer the following:
1. Please list date(s) and type of the coronary revascularization procedure:
______________________________________________________________________________________________________
2. Has your client had any of the following?
n heart attack _______________________(date)
n bypass surgery _____________________(date)
3. Is your client on any medications?
n yes, please give details ___________________________________________________________________
n no
4. Has a follow-up stress (exercise) ECG been completed since the revascularization procedure?
n yes - normal ______________________ (date)
n yes - abnormal ____________________ (date)
n no
5. Has your client had any chest discomfort since the revascularization procedure?
n yes, please give details ___________________________________________________________________
n no
6. Please check if your client has had any of the following:
n elevated cholesterol
n overweight
n high blood pressure
n diabetes
n family history of heart disease
7. Has your client smoked cigarettes in the last 12 months?
n yes, please give details ___________________________________________________________________
n no
8. Does your client have any other major health problems (ex: cancer, etc.)?
n yes, please give details ___________________________________________________________________
n no
Please submit a copy of the angiogram report and any recent stress tests.
After reading the Rx for Success on CAD-New Therapeutic Devices, please feel free to use this Ask “Rx” pert underwriter
for an informal quote.
This material is intended for insurance informational purposes only and is not personal medical advice for clients.
This marketing material includes an expiration date and use of this material must be discontinued as of the expiration date.
FOR INTERNAL USE ONLY. NOT FOR USE WITH THE PUBLIC.
©2008 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
Rx046 IFS-A068711 Ed. 10/08 Exp. 10/10
MAKE THE MOST OF PRUDENTIAL’S
UNDERWRITING CREDIT OPPORTUNITIES
When it comes to impaired risk underwriting, Prudential Financial
is an industry leader.
Term insurance
included in
Underwriting
Credits
Prudential’s underwriting credits are available for any face amount, for any
age, for any product and for any table rating. They are also available for
smokers and non-smokers. Overall, there are more than two dozen
impairments eligible for credits. See the chart below for more information:
Impairment
Crediting Opportunities
Blood Pressure
Credits may be available if echocardiogram results, done within the prior year, show normal left
ventricular wall thickness. Additional credits may be available for a normal maximal treadmill ECG,
done within the prior year, with normal blood pressure response to exercise. Maximum credits for normal
stress echocardiogram meeting above criteria.
Breast Cancer
Credits may be available for in-situ breast cancer, over age 40 at diagnosis, low-grade (1-2)
malignancy, treated with resection, and good follow-up with normal annual mammograms.
Build
Credits may be available if there are no additional medical impairments and there is no evidence of
metabolic syndrome (a group of abnormal findings related to the body’s metabolism, including excess
body fat, elevated lipids, low HDL cholesterol, borderline or elevated B/P, and borderline or elevated
blood glucose). Additional credits may be available for negative maximal treadmill, nuclear scanning, or
stress echocardiogram testing done within the prior year.
Chest Pain
Credits may be available where quality follow-up cardiac testing has been done and was normal.
Coronary Artery Disease
Credits may be available for a normal maximal treadmill ECG done within the prior year. Additional
credits may be available for normal nuclear scanning or negative stress echocardiogram done within
the prior year.
Diabetes
Available credits vary based on type of DM (Type 1 or 2), treatment (diet, oral medication or insulin), age
of onset, level of control and other factors such as normal build, BP and HDL.
EBCT (Electron Beam Computed
Tomography)/Ultra Fast CT
Credits may be available if a follow-up nuclear scan is negative.
ECG – Heart Blocks
Credits for first-degree block may be available for a normal treadmill or for two years of stability. For left
bundle branch block, credits may be available for a negative nuclear scan or if the LBBB has been
present and stable for at least 3 years.
ECG – Major & Minor T Waves
Credits may be available for a normal EBCT (if insured is age 50), or a normal maximal treadmill ECG.
Additional credits may be available for normal nuclear scanning, catheterization or stress
echocardiogram. Resting echocardiogram credits may be available to offset major T waves. (All testing
must be completed after the onset of the T wave changes.)
ECG – PVC’s
Credits may be available if the applicant is under age 40, or for a normal EBCT (if insured is age 50 and
up), or a normal maximal treadmill ECG. Additional credits may be available if both a negative
echocardiogram and exercise treadmill ECG were performed. (All testing must be completed after the
onset of the PVC’s.)
Continued on next page…
FOR FINANCIAL PROFESSIONAL/PRODUCER USE ONLY.
Contact Your Prudential
Wholesaler for more
information.
©2009 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
0150547-00001-00 Ed. 04/09 Exp. 10/10
Impairment
Crediting Opportunities
ECG – ST Segment
Changes
Credits may be available if applicant is female and under age 60, or male and under age 40, there are
no other ECG changes, no family history of CAD, and no personal history of diabetes, hypertension, or
hyperlipidemia. Also, credits may be available for a normal EBCT (if insured is age 50 and up), or a
normal maximal treadmill ECG. Additional credits may be available for normal nuclear scanning or
stress echocardiogram. (All testing must be completed after the onset of the ST segment changes.)
Elevated Liver Enzymes
Credits may be available if the insured is currently on certain medications known to elevate liver
enzymes. Additional credits may be available for negative hepatitis screening or other specialized liver
tests, if there has been no history or criticism of alcohol use.
Family History
Credits may be available if both parents live to age 70 or higher. Additional incremental credits may be
available if both parents survive to age 75 and age 80.
Glomerulopathy
Credits may be available for normal creatinine clearance over the prior 6 months. Additional credits
may be available if creatinine clearance is > 90 and stable for the prior 10 years.
Inflammatory Bowel Disease
(Crohn’s and Ulcerative Colitis)
Credits may be available if there have been no significant episodes and no medications required (other
than aminosalicylate products such as Azulfadine, Colazal, Asacol, Pentasa, Dipentum, or Rowasa) for
5 years, current LFT’s are normal, and a colonoscopy done within the prior 2 years is normal.
Lipids
Credits may be available for a normal EBCT (if insured is age 50 and up), or a normal maximal
treadmill ECG. Additional credits may be available for normal nuclear scanning or stress
echocardiogram. Credits may also be available if the applicant is age 66 or older, or when higher HDL
cholesterol levels result in lower ratios of total cholesterol to HDL cholesterol.
Malabsorption
Credits may be available if condition has remained consistently stable.
Malignant Tumors
Credits against table ratings (not against flat extra ratings) may be available for quality, ongoing
surveillance.
Mood & Anxiety Disorders
Credits may be available when episodes are of short duration, easily controlled, with no hospitalization
and stable for at least one year.
Neurogenic Bladder
Credits may be available if the insured is well trained and compliant with self-catheterization.
Pacemaker
Credits may be available for five years of stability since the pacemaker insertion. Additional credits may
be available if there has been a normal maximal stress treadmill with normal nuclear scanning, and a
normal echocardiogram.
Personality Disorders
Credits may be available if it has been at least 10 years since diagnosis, with no social problems,
flare-ups, or other psychiatric issues.
Prostate Specific Antigen (PSA)
Credits may be available if current PSA is < 10 and a current free PSA is > 25%.
Sleep Apnea
Credits may be available if a sleep study is available, there are no complications, no problems with
blood pressure, no surgical treatment, and good control and compliance with CPAP (Continuous Positive
Airway Pressure machine).
Substance Abuse
Credits may be available for consistent participation in groups such as Alcoholics Anonymous or
Narcotics Anonymous.
Treadmill ECG
Credits may be available for normal nuclear scanning, exercise echocardiogram, or cardiac
catheterization.
Underwriting Credit Opportunities are just one more way you can grow your business with The Rock®!
Call today for more information: For MDs and OCMs, contact your assigned Life Underwriting Specialist.
Producers should call their Underwriting Team.
This material is designed to provide general information in regard to the subject matter covered.
It should be used with the understanding that we are not rendering legal, accounting or tax
advice. Such services should be provided by the client’s own advisor. Accordingly, any information
in this document cannot be used by any taxpayer for purposes of avoiding penalties under the
Internal Revenue Code.
Securities and Insurance Products:
Not Insured by FDIC or Any Federal Government Agency.
May Lose Value.
Not a Deposit of or Guaranteed by Any Bank of Bank Affiliate.
This marketing material is subject to an expiration date, and use of this material must be discontinued as of the expiration date.
FOR FINANCIAL PROFESSIONAL/PRODUCER USE ONLY.
HIGHLIGHTER
FINANCIAL UNDERWRITING
What is Financial
Underwriting?
Financial Underwriting is the evaluation of a prospective insured’s personal or
business financial background and current economic situation. The analysis of an
individual’s financial situation takes place every time a case is underwritten,
although the depth of this evaluation is based on the amount of insurance applied
for. The purpose of this evaluation is to determine the proposed insured’s need for
insurance and make sure that the amount of insurance applied for is reasonable and
in line with his or her needs.
Why is Financial
Underwriting Important?
Financial underwriting is important in order to prevent overinsurance. Overinsurance occurs when the amount of life insurance in force on an individual
exceeds his/her economic or “human life” value. The primary purpose of life
insurance is to provide funds to help replace the economic loss which results from
the premature death of the insured person. If the amount of insurance carried on an
individual exceeds any possible loss on the part of the beneficiary, it could be
considered speculative and it is not in the insured’s nor the company’s best interest.
Insurable Interest
In order for a life insurance purchase to be valid, the beneficiary must have an
insurable interest in the proposed insured. Insurable interest exists if the beneficiary
benefits financially from the proposed insured’s continued existence and would
suffer a financial loss at the death of the insured.
Premium Payer
Who pays the premium is an important factor for underwriting to consider in
evaluating a case. While the premium payer will most frequently be the insured,
there are many acceptable reasons for someone else to pay the premiums, including
certain business and estate planning situations, or when coverage is requested on a
dependent child or spouse.
If someone other than the insured is paying the premiums, underwriting will look at
the relationship of the premium payer to the insured and the reason he or she is
paying the premiums. The premium payer’s income and the total amount of
insurance the premium payer has on his/her own life are evaluated to determine the
total amount of risk and the validity of the case.
Affordability
Affordability is an important factor that must be evaluated to determine if a product
recommendation is suitable to meet a customer’s needs. There are two basic
relationships that underwriting looks at in evaluating whether a client will be able
to sustain the premiums:
Premium to Income Relationship. In conjunction with the Income Factor Tables
(refer to the Income Factor Tables section of this highlighter for the tables), the
relationship of premium outlay to the proposed insured’s gross annual income is
considered. A good rule of thumb is that the total premium outlay for all life
insurance policies supported by the premium payer’s income should not exceed
10% of the premium payer’s before tax income. In certain situations, it may be
acceptable, from a financial underwriting perspective, for premiums to be as high as
20%. If you feel such a case is warranted, contact underwriting before submitting an
FOR THE EDUCATION OF PRODUCERS/BROKERS. NOT FOR USE WITH THE PUBLIC.
FINANCIAL UNDERWRITING HIGHLIGHTER
Affordability (Cont…)
application for insurance. Be sure to provide underwriting with a cover letter
outlining why you believe the need and amount of coverage are warranted and
why the premiums are affordable.
Premium to Liquid Net Worth Relationship. If the premium to before tax income
relationship is greater than 10%, premiums may need to be paid from a client’s
liquid assets. In that case, it becomes necessary to consider whether the premium
payer’s liquid net worth is sufficient to sustain the premiums and whether this is an
appropriate use of these assets. The answers to these questions will be dependent
on the proposed insured’s overall financial situation. A good rule of thumb is that
the premium should not exceed 25% of the premium payer’s liquid net worth.
Amount of Insurance
Underwriting will also evaluate how the amount of insurance being requested was
determined. Results from a comprehensive needs analysis, or recommendations
from an accountant, attorney or other advisor can make a difference when
evaluating the case. If the proposed insured simply told you how much insurance he
or she wanted to purchase, you should determine if that amount of insurance is
reasonable and convey that information to underwriting.
When determining the overall amount of insurance which will generally be granted
to an individual, the underwriters take into account any existing insurance coverage
he/she already has inforce and any insurance being applied for with other
companies.
A complete needs analysis takes these factors into account and is an important and
useful tool in helping the agent, the client and the underwriter understand how
much insurance is required and why.
In most situations, the amount of insurance applied for should be directly related to
the need the life insurance was purchased to satisfy, such as to replace lost income,
or cover a debt such as a mortgage or small business loan. From an underwriting
point of view, insurance purchased for the following reasons is generally acceptable:
Last Expenses
Income Replacement/Survivors’ Income
Debt Repayment (i.e. mortgage or college loans)
Estate Settlement
Income in Respect of a Descendent (IRD)
Business Insurance
While life insurance has other specialty uses such as cash value accumulation, the
primary purpose must be for death benefit protection.
Income Replacement
A client’s income is one of the factors looked at in determining the amount of
insurance that will be granted for income replacement. An individual’s total income
can be comprised of earned and unearned income.
Earned income can be defined as income that will normally cease upon the death of
the insured, such as salaries, pensions, Social Security and cash distributions from a
business.
Life insurance may be considered as a means to replace lost earned income upon
the death of the insured.
FOR THE EDUCATION OF PRODUCERS/BROKERS. NOT FOR USE WITH THE PUBLIC.
2
FINANCIAL UNDERWRITING HIGHLIGHTER
Income Replacement
(Cont…)
Unlike earned income, unearned income does not cease upon the death of the
insured. Unearned income includes pure investment income and distributions from
401(k) plans and IRAs. Life insurance may be needed to cover any potential tax
liability on this unearned income upon the insured’s death (Refer to the “Income In
Respect of a Decedent” section of this highlighter for additional information).
Unearned income increases one’s ability to pay premiums and may be available to
help offset some of the financial losses the survivors may experience. However,
these available proceeds may decrease the need for insurance after the potential tax
liability has been taken into consideration.
A software generated income needs analysis can be useful in determining the
amount of income that should generally be replaced by life insurance.
Needs typically covered by income protection include mortgage protection,
education needs and to provide continuing income to support dependents upon the
death of the insured.
Income Factor Tables
The following Income Factor Tables are guides to the maximum amount of
insurance (excluding group coverage), which is generally acceptable in relation to
the earned income of an individual with or without dependents. To use the Income
Factor Tables, multiply the proposed insured’s earned income by the corresponding
factor based on his/her age at time of application.
Individuals that are married or with dependents
AGES
to 30
31-40
41-50
51-60
61-70
71-80
INCOME
$
$
$
$
$
$
FACTOR
x’s
x’s
x’s
x’s
x’s
x’s
30
25
20
15
10
5
AMOUNT OF INS.
=
=
=
=
=
=
$
$
$
$
$
$
Individuals without dependents with incomes < $50,000
AGES
to 30
31-40
41-50
51-60
61-70
71-80
INCOME
$
$
$
$
$
$
FACTOR
x’s
x’s
x’s
x’s
x’s
x’s
15
10
8
7
5
0
AMOUNT OF INS.
=
=
=
=
=
=
$
$
$
$
$
$
Individuals without dependents with incomes >$50,000
AGES
to 30
31-40
41-50
51-60
61-70
71-80
INCOME
$
$
$
$
$
$
FACTOR
x’s
x’s
x’s
x’s
x’s
x’s
20
15
10
8
5
0
AMOUNT OF INS.
=
=
=
=
=
=
$
$
$
$
$
$
FOR THE EDUCATION OF PRODUCERS/BROKERS. NOT FOR USE WITH THE PUBLIC.
3
FINANCIAL UNDERWRITING HIGHLIGHTER
Debt Repayment
People often purchase insurance to cover a significant debt such as a mortgage,
college debt or a small business loan. Life insurance can be used to ensure the
repayment of the debt should they die while the loan is still outstanding.
If no other need exists and the loan is personal, an amount equal to the loan balance
is generally acceptable. This is the case for home mortgages and college loans.
For business loans, an amount of insurance equal to the non-collateralized portion
of the loan, or up to 70% of the loan amount, is generally acceptable.
Income in Respect of a
Decedent
Income in Respect of a Decedent (IRD) may occur at the death of the owner of
assets consisting of previously untaxed money.
Although there are several types of Income in Respect of a Decedent, of particular
interest is the potential tax liability of IRA’s, 401(k) accounts, 403(b) funds and
other tax-deferred vehicles. While prudent planning may allow these assets to be
directed beyond the surviving spouse, it cannot entirely eliminate the eventual tax
liability.
Individuals may find that the income provided from corporate pensions, Social
Security benefits and other assets are sufficient to meet their anticipated retirement
lifestyle. They may decide to transfer unneeded monies invested in a 401(k), 403(b)
or in IRAs to a beneficiary upon their death.
If the qualified money is transferred to the surviving spouse, they have the option,
within IRS regulations, of rolling the tax-deferred proceeds into another taxdeferred retirement account or taking a potentially taxable distribution. If the
beneficiary is not the spouse, he/she may be required, within IRS guidelines, to
liquidate the account at a faster rate and pay tax upon the liquidation. Retirement
account balances can be substantial and the tax rate can be as high as 40%. Life
insurance may be an appropriate resource to provide ready cash to pay the required
income tax.
Whether or not insurance is the appropriate vehicle for this purpose should be
evaluated by applying the following factors:
current income from pension, Social Security and other assets utilized for daily
needs are sufficient so that the IRA, 401(k) or 403(b) won’t be spent down.
source of premium payments — premium payments should come from earned
or investment income or from the required minimum distribution. NOTE: If
more than the required minimum distribution will be used to fund life
insurance, Company “Think Twice” financing forms are always required. State
specific replacement forms may also be required.
The amount of insurance applied for should take into consideration:
current value of the IRA, 401(k) or 403(b).
current inforce insurance.
Estate Settlement
Life insurance continues to be an effective way to provide funds for clients with
larger estates to pay estate taxes. This is especially true when the estate assets are
not liquid, as is often the case with ownership in family run businesses, family farms
and when real estate is a predominant asset.
FOR THE EDUCATION OF PRODUCERS/BROKERS. NOT FOR USE WITH THE PUBLIC.
4
FINANCIAL UNDERWRITING HIGHLIGHTER
Estate Settlement (Cont…)
Ownership
In order to keep the life insurance proceeds out of the estate and prevent them from
being subject to estate taxes, the life insurance policy should generally be owned by
someone other than the insured, such as by the heirs or an irrevocable life insurance
trust. Insured-owned policies which are later transferred to a trust are subject to a 3
year lookback period. This means that the proceeds may be included in the value of
the estate, and therefore, subject to estate taxes if the insured dies within the 3-year
period. For that reason, it is advisable that the trust be formed prior to the purchase
of life insurance so that the trust can be the applicant and owner of the policy.
Amount of Insurance
All the facts of a case need to be considered when attempting to determine the
amount of life insurance needed to pay estate taxes. Underwriting will look at factors
such as the liquidity of the estate, the amount of the gross estate, the prospective
estate value, and the timing of the life insurance purchase. The amount and type of
insurance should be suitable based on a complete needs analysis. In general, an
amount of life insurance equal to the estimated estate taxes is acceptable.
Projecting the Value of an Estate
For purposes of determining the appropriateness of the amount of life insurance
coverage applied for, Underwriting will generally allow the value of the estate to be
projected using a 6 percent growth rate for a period of 8 to 10 years. This means
that life insurance can generally be applied for today, on the estimated estate taxes
of the projected value of the estate at some point in the future.
Good judgment should be exercised when projecting the value of an estate. For
example, a period shorter than 10 years may be more reasonable for prospective
insureds age 70 or older. It may be possible to project the growth of the estate for
a period longer than ten years if the proposed insureds are younger or if second-todie insurance is applied for.
The projected estate growth must be substantiated with acceptable documentation,
which should be submitted to Underwriting with a cover letter (Refer to the
“General Underwriting Guidelines Highlighter”, (IFS-A078363) for underwriting
considerations and information. If documentation substantiates that the estate is
growing at a rate greater than 6 percent, a higher growth rate may be acceptable for
projecting the estate. This will also depend on the makeup of the estate and its
actual growth rate over the past 5 to 10 years.
In general, an estate’s value should not be projected beyond 11⁄2 to 2 times its current
value. An estate projected to an amount substantially larger than its current value
can result in over-insurance, which can create adverse selection and present some
risk to the proposed insured and the Company. In such a case, the insured’s death
benefit would not reasonably represent the financial loss to the beneficiaries, but
could in fact, create a financial reward for all of them. In essence, the insured would
be worth more dead than alive.
Unified Credit Against Estate Tax
Generally, most estates qualify for a credit against estate taxes. (NOTE: This credit
is applicable if the individual is a US Citizen and or a Resident Alien; however, this
does not apply to Non-resident Aliens.) This credit may be translated into an
“applicable exclusion amount”. This is the amount of property that can pass to the
heir’s estate tax free.
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FINANCIAL UNDERWRITING HIGHLIGHTER
Estate Settlement (Cont…)
In 2002, the unified credit exemption amount for estate and gift taxes was increased
to $1 million, the 5% surtax was repealed and estate and gift tax rates in excess of
50% were repealed. The table below summarizes the subsequent increases in the
applicable exemption amount and decreases in the top estate and gift tax rate.
Calendar Year
2006
2007
2008
2009
2010
Estate and GST Applicable
Exemption Amount
$ 2 million
$ 2 million
$ 2 million
$3.5 million
repealed
Highest Estate and
Gift Tax Rate
47%
46%
45%
45%
gift tax only, equal to top individual
income tax rate
With the passing of the Economic Growth and Tax Relief Reconciliation Act of
2001, estate taxes are eased gradually through 2009, and then repealed for only one
year, 2010. Then in 2011, the previous 2001 law comes back into effect with a $1
million estate tax applicable exception amount and top tax rate of 55% plus
surcharge. Given the tax revenue loss associated with this legislation through 2010,
it is not at all certain that Congress will act in later years to retain the estate tax
repeal.
Business Insurance
Life insurance can also be used to protect a business against the loss of a key
employee or provide the funds for business continuation.
In order for a business to retain the income tax free treatment of death benefit
proceeds, the business needs to meet the notice and consent requirements of IRC
Section 101(j).
Key Person Insurance
If key person insurance is being applied for, underwriting will generally accept
amounts up to 5 to 10 times the key person’s gross annual salary. This is generally
viewed as the amount required to replace the key person. (A key person is generally
a valuable employee who is not a business owner or controlling stockholder).
Amounts higher than this may be accepted in certain situations, i.e. if there is a
large outstanding loan against the business, with the key person clearly the key to
generating the revenues necessary to pay back the loan. Note, however, that it is
unlikely that we will insure the full amount of a loan. (See Debt Repayment section
of this highlighter).
In order to expedite your application, the following information should be provided
to underwriting to help evaluate the key employee’s economic value to the business.
This information can be provided in a Cover Letter to underwriting:
The key person’s current compensation
The total compensation for the management group
The percent of key person’s compensation to total management’s
compensation
The cost of replacing the key person
Anticipated revenue/profit for the next 3-4 years
Percent of revenue/profit attributed to the key person.
Individual’s BIO and how this strengthens the value of the “Key Person”.
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FINANCIAL UNDERWRITING HIGHLIGHTER
Business Insurance (Cont…)
Much of this information can be obtained from the business owner, but sometimes
you will need to contact the business owner’s accountant. The accountant can
sometimes be an important decision maker in the purchase of business insurance.
Once the business owner confirms the need and agrees on the solution, be sure to
keep the accountant involved as appropriate.
Key Person Insurance in New York
New York has established regulatory standards for the issuance of key person
company owned life insurance to ensure the individuals being insured are in fact
key persons and that the corporation would thus have an insurable interest in their
lives. According to New York regulations, for the purposes of establishing whether
there exists an insurable interest at the time a policy is issued, a person shall
automatically be considered a key person if:
a) The employee is one of the five highest paid officers of the employer.
b) An employee is five-percent owner of the employer. A “five-percent owner” shall
mean:
1. If the employer is a corporation, any person who owns or controls more than
5% of the outstanding stock of the corporation or stock possessing more than
5% of the total combined voting power or all stock of the corporation; or
2. If the employer is not a corporation, any person who owns more than 5% of
the capital or profits interest in the employer;
c) The employee had compensation from the employer in excess of $90,000 in the
preceding year;
d) The employee is among the highest paid 35% of all employees; or
e) The employee or other person makes a significant economic contribution to the
company (e.g., an employee who is responsible for management decisions, has a
significant impact on sales or a special rapport with customers and creditors,
possesses special skills, or would be difficult to replace).
For the purposes of satisfying (e) above, a person should be considered a key person
if that person:
Fulfills such functions as: Manager, Director, Officer or other such
management position directing other individuals,
Possesses special skills or talents derived by education or experience and as
such would require meaningful time and expense to replace,
Is critical to sales and revenue generating activities and may have a proven track
record in that regard,
Has connections or relationships with key customers or accounts that would
suffer without the individual's continued involvement.
If an individual satisfies (a) through (d) above, the case is acceptable from an
insurable interest perspective. If it meets the criteria for (e) as qualified above, that
should also be acceptable. If a case falls outside of these guidelines and it is not
clear from the application or other case development information that NY's
insurable interest standards for keyman coverage are satisfied, certification from the
Employer/Corporation explaining how and why the case meets NY insurable
interest standards as outlined in (a) - (e) may be required.
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FINANCIAL UNDERWRITING HIGHLIGHTER
Business Insurance (Cont…)
Buy-Sell Agreements
A buy-sell agreement is generally formed to prevent the liquidation of a business
upon the death of one of the owners. Under this type of arrangement, a buyer is
generally selected and a purchase price is agreed to while the business owner is
living. Life insurance can generally be used to fund a buy-sell agreement. An
amount equal to the liability created under the buy-sell agreement is generally
acceptable.
A cover letter should include the details and status of the buy-sell agreement, who
the owners are, and their percent of ownership, the amount of inforce and applied
for insurance on all owners and sound Business Financials.
Funding a Buy-Sell
Arrangement with
Life Insurance
A Unilateral Buy-Sell Arrangement can be used when the sole owner of a business
wants to sell the entire business to someone upon his or her death. Life insurance
can be used to fund the buy-sell agreement. The individual purchasing the business
buys life insurance on the life of the business owner in an amount equal to the value
of the business. Upon the death of the business owner, the buyer receives the
policy proceeds and uses the cash to purchase the business from the owner’s estate.
This arrangement ensures continuation of the business, allows the owner to select
an appropriate successor, provides the successor with funds to purchase the
business and provides the estate with a buyer with cash to purchase the business.
The buy-sell agreement also serves to set the price of the business for estate tax
purposes. This is a legitimate use of life insurance and an amount equal to the value
of the business is generally acceptable.
Using Life Insurance
when a Family-Owned
Business is Part of the
Estate
The purpose of using a Unilateral Buy-Sell Arrangement is also applicable when a
family-owned business is part of the estate, and the owner wishes to leave the
business to only one of his/her heirs.
Suppose, for example, your client, Mr. Smith owns a family farm with a value of
$1,500,000. This farm is part of his overall estate which has a value of $3,500,000.
His son, Harry has worked with him on the farm and has contributed in large part
to its success in recent years. Upon his death, Mr. Smith wants to leave the farm to
his son Harry. Mr. Smith, however, has two other children, Jake and Mary. Jake is a
writer and has no interest in running a farm. Mary has moved out of state to pursue
a career in acting. Mr. Smith wants to treat all of his children fairly by leaving an
amount equal to the value of the farm to Jake and Mary.
For our example, let’s suppose the estate taxes are estimated to be $1,220,000.
Based on the information provided, Harry may be able to purchase insurance on
Mr. Smith in an amount equal to the value of the farm. Mr. Smith may also choose
to set up an irrevocable life insurance trust which will purchase insurance to cover
the estimated estate taxes. Thus, the total amount of insurance purchased on Mr.
Smith would equal $2,220,000.
FOR THE EDUCATION OF PRODUCERS/BROKERS. NOT FOR USE WITH THE PUBLIC.
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FINANCIAL UNDERWRITING HIGHLIGHTER
Using Life Insurance when a Upon Mr. Smith’s death (2011), $1,220,000 of the life insurance proceeds could be
Family-Owned Business is
used to pay the estate taxes. The $1,500,000 farm could be passed on to Harry.
Part of the Estate (Cont…)
Harry uses the $1,000,000 in death benefit proceeds to purchase the farm from the
estate. This $1,000,000 plus the remaining $2,000,000 of the estate could be split
between the two remaining children so they will all get the same amount.
This assumes Harry personally purchased the excess coverage ($1,000,000) over
the estate tax needed. The estate tax portion ($1,220,000) is assumed purchased in
an irrevocable life insurance trust.
Estate Divided among 3 Children
Estimated Estate Tax = $1,220,000
$675,000
life insurance proceeds
$3,500,000
Projected Total
Estate
$1,500,000 Farm
Remaining
$1,000,000 Life
Insurance Proceeds
}
$3,500,000 – $1,500,000 farm + $1,000,000
Life Insurance Proceeds over and above
Estate tax costs
Remaining Estate
$3,000,000
Harry
1,500,000 farm
Jake
1,500,000
FOR THE EDUCATION OF PRODUCERS/BROKERS. NOT FOR USE WITH THE PUBLIC.
9
Mary
$1,500,000
FINANCIAL UNDERWRITING HIGHLIGHTER
Using Life Insurance when
a Family-Owned Business is
Part of the Estate (Cont…)
This example works out evenly for all the children because of the numbers we used
and the amount of children. This may not always be the case. If for example, Mr.
Smith had four children, they would not all be left with the same amount. Harry
would still get the $1,500,000 farm, but the $3,000,000 remaining would now be
divided between three children leaving $1,000,000 for each of the remaining
children.
Estate Divided among 4 Children
$675,000
life insurance proceeds
Estimated Estate Tax = $1,220,000
$3,500,000
Projected Total
Estate
1,500,000 Farm
Remaining
$1,000,000 Life
Insurance Proceeds
}
$3,500,000 – $1,500,000 farm + $1,000,000
Life Insurance Proceeds
Remaining Estate
$3,000,000
Harry
$1,500,000 farm
Jake
$1,000,000
Mary
$1,000,000
Susan
$1,000,000
But since cash and property are not really equivalents, Mr. Smith may be more
concerned with leaving an equitable division to his children rather than an equal
division. In this situation, Harry would get more than the others. An amount of
insurance greater than this would generally not be approved if the sole reason was
to provide all children with equal amounts.
FOR THE EDUCATION OF PRODUCERS/BROKERS. NOT FOR USE WITH THE PUBLIC.
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FINANCIAL UNDERWRITING HIGHLIGHTER
Sources of Information/
Documentation
In most cases, the information received during the client interview is sufficient to
determine if the amount of insurance applied for is appropriate. For very large or
complex cases including estate settlement or business situations, more extensive
information may be required. These cases involve higher risks and require the
evaluation of more than just income and ability to pay. It may, therefore, be
necessary to submit financial documents that are generally not required for smaller
amounts of coverage. The type of information underwriting is looking for is that
which will substantiate the amount of insurance being applied for. The information
should answer such questions as:
What is the purpose of the Insurance?
How was the amount of the insurance applied for determined?
Who will be the policy owner and premium payer?
What is the current amount of inforce and applied for insurance?
The proposed insured, his or her advisors, attorneys or accountants may also be
required to submit documentation to support the need for the amount of insurance
requested. This documentation may include personal or business financial
statements such as W-2’s or tax returns, employment contracts, loan or trust
agreements, buy-sell agreements, etc. It is always a good idea to inform clients,
attorneys, accountants and other financial advisors that they may be required to
provide additional information. This type of financial documentation is required on
face amounts of $10,000,000 or more.
Summary
The most important source of information about a proposed insured is you. As you
analyze a person’s insurance needs, you gain knowledge of a potential client’s worth
and income. Any pertinent information should be communicated to underwriting.
It may be advisable to submit a cover letter to underwriting that explains how the
amount of insurance requested was determined. Any documentation used during
this process should be included with the cover letter.
The Confidential Financial Questionnaire may be used to capture some of this
financial information. The extent of this information depends on the amount of
insurance you are recommending and the purpose for which it is intended.
©2009 The Prudential Insurance Company of America
751 Broad Street, Newark, NJ 07102-3777
www.prudential.com
ALL RIGHTS RESERVED
IFS-A000068 Ed 01/2009 Exp 07/2010
FOR THE EDUCATION OF PRODUCERS/BROKERS. NOT FOR USE WITH THE PUBLIC.
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