peace of mind final expense

AGENT GUIDE

Underwriting GuidelinesPremium Rates

• Super Preferred Plan (Policy Form No. 3458)

• Preferred Plus Plan (Policy Form No. 3458)

• Preferred Plan (Policy Form No. 3458)

• Standard Plus Plan (Policy Form No. 3459)

• Standard Plan (Policy Form No. 3460)

(Not for use in the state of NC)

Exclusively Offered By

9919(7/18) AGENT RATE CARD FOR FIELD USE ONLY CN11-038

PEACE OF MINDFINAL EXPENSE

(Ages 50 through 85)W h o l e L i f e I n s u r a n c e

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Table of Contents

Item: Page #:

Underwriting Guidelines ........................................................................................... 4

Policy Specifications ................................................................................................ 4

Plan Descriptions ..................................................................................................... 5

Telephone Interview Information .............................................................................. 5

Application Completion Guidelines .......................................................................... 6-8

Other Required Forms / Key Administrative Guidelines ........................................... 9

State Specifics ......................................................................................................... 10

Bank Draft Procedures / E-Check Procedures......................................................... 10

Product Software ..................................................................................................... 11

Build Chart ............................................................................................................... 11

Super Preferred & Preferred Plus Guidelines/Build Chart ........................................ 12

Rider Descriptions .................................................................................................... 13-15

Children's Insurance Agreement .............................................................................. 13

Accidental Death Benefit Rider ................................................................................ 13

Waiver of Premium Rider .......................................................................................... 13

Nursing Home WP Rider .......................................................................................... 14

Terminal Illness Rider ................................................................................................ 15

Confined Care Rider ................................................................................................. 15

Monthly Income Replacement Option ...................................................................... 15

Prescription Reference Guide .................................................................................. 16-31

Medical Impairment Guide ....................................................................................... 32-33

Rates Per 1,000 ........................................................................................................ 34-38

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UNDERWRITING GUIDELINESOur Peace of Mind life insurance plans target a broad spectrum of the final expense insurance market. These policies and our application Form 9466 (with state variations) accommodate a simplified approach to purchasing life insurance. Peace of Mind "Super Preferred" policy is for those with no serious health history and who can answer "NO" to all health questions 1 through 8 on the application and the supplemental application (Form No. 3180).Peace of Mind "Preferred Plus" policy is for those with no serious health history and who can answer "NO" to all health questions 1 through 8 on the application and the supplemental application (Form No. 9917).Peace of Mind "Preferred" policy is for those with no serious health history and who can answer "NO" to all health questions 1 through 8 on the application.Peace of Mind "Standard Plus" policy is for those who answer "NO" to questions 1 through 7, but "YES" to health question 8.Peace of Mind "Standard" policy is for those who answer "NO" to questions 1 through 3, "YES" to any health questions 4 through 7.If health questions 1, 2, or 3 are answered "YES" the applicant is not eligible for any of the Peace of Mind plans.The Peace of Mind application features simple "YES" or "NO" questions that enable you to quickly determine which plan of insurance the applicant may be eligible for.

POLICY SPECIFICATIONS

Issue Ages (Age Last Birthday): 50 to 85

Premium Paying Period: To age 100

Minimum Death Benefit $2,500 ($5,000 in Washington)

Maximum Death Benefit - Super Preferred, Preferred Plus and Preferred Plans

Ages 50 to 75: $50,000

Ages 76 to 85: $30,000

Maximum Death Benefit - Standard Plus and Standard Plans Ages 50 to 85: $25,000

Policy Fee $60 (Non-Commissionable)

Modal Factors:

Monthly EFT 0.088

Quarterly 0.262

Semi-Annual 0.519

No Cost Riders Included: Availability:

Terminal Illness Accelerated Benefit Rider* All plans

Accelerated Benefit Confined Care Rider* Super Preferred, Preferred Plus and Preferred Death Benefit Plans Only

Optional Benefits and Riders: Availability:

Childrens Insurance Agreement Rider (Covers Children, Grandchildren & Great-Grandchildren) All plans

Waiver of Premium Rider Super Preferred, Preferred Plus and Preferred Death Benefit Plans Only

Nursing Home Waiver of Premium Rider Super Preferred, Preferred Plus and Preferred Death Benefit Plans Only

Accidental Death Benefit Rider Not Available on Standard Plan

Application No (with some state variations) 9466

* Included at no additional premium, where available.

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PLAN DESCRIPTIONSPeace of Mind "Super Preferred": Simplified issue whole life policy with level death benefit of 100% of face amount paid immediately.Peace of Mind "Preferred Plus": Simplified issue whole life policy with level death benefit of 100% of face amount paid immediately.Peace of Mind "Preferred": Simplified issue whole life policy with level death benefit of 100% of face amount paid immediately. Select "Immediate Death Benefit" on the application.

Peace of Mind "Standard Plus": Simplified issue whole life policy which pays 30% of selected face amount the 1st year, 70% paid the 2nd year and 100% paid the 3rd and subsequent years. 100% paid for accidental death, all years. Select "Graded Death Benefit (Percentage of Face Amount)" on the application.

Peace of Mind "Standard":Simplified issue whole life policy which pays return of premium plus 10% interest for 3 years if under age 65, 2 years if age 65 or older. 100% paid after graded period. 100% paid for accidental death, all years. Select "Return of Premium" on the application.

SIMPLIFIED UNDERWRITINGEligibility for coverage is based on:• A simplified "YES/NO" application, &• A telephone interview (if applicable), & • Check with the Medical Information Bureau (MIB, Inc.), &• Check with a Pharmaceutical related facility(s), & • Proposed Insured’s build (see the liberal height/weight charts found in this guide)

TELEPHONE INTERVIEWA telephone interview conducted with the Proposed Insured is required on every application for the Super Preferred, Preferred Plus, Preferred and Standard Plus plans, prior to the policy being issued.After fully completing the application you may call from the client’s home for the personal history telephone interview. The interview is designed to confirm the answers given on the application. The interview can be completed in either of 2 ways:1) at point-of-sale (recommended), or2) the Company will contact the Proposed Insured upon receipt of the application. Point-of-sale telephone interviews can be completed by calling the toll free number below. When calling be sure to identify yourself, Company and product being applied for "Peace of Mind". In addition, if applying for the “Super Preferred” or “Preferred Plus” plans, indicate this to the interview company. The applicant must always complete the telephone interview without assistance from the agent or another person. If the interview is completed at point-of-sale, mark the "Telephone interview completed" question "Yes" in the upper, right-hand corner of the application. If the sale is made outside of the vendor's hours of operation or if the interview is not completed at point-of-sale, mark this question "NO" and the Company will initiate the call upon receipt of the application.

NOTE: The Standard Plan does not require an interview.

APPTICAL: 877-351-17737:30am-1:00am Monday thru Friday CST9:00am-9:00pm Saturday & Sunday CST

Apptical Service is available only for point-of-sale interviews on Final Expense applications for issue ages 50 to 85. If the interview cannot be completed point-of-sale, the interviews will be placed using EMSI. For Apptical interviews, you MUST write "Apptical" in the top right-hand corner of the application and include the Apptical case number provided to you. Agents MUST ALWAYS submit the application to the Home Office along with the HIPAA form (No. 9526); even if your client is not eligible for coverage or decides not to proceed with the application process. The Company is required by law to maintain these documents in our files. In this event, please write "Withdraw" at the top of the application. If the client will be applying for the Standard death benefit plan, a telephone interview is not required.

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APPLICATION COMPLETIONThe following section is provided to assist agents with the completion of the life insurance application, Form No. 9466. It follows along, item by item, with the application used.• As a reminder, the application must be completed in its entirety to prevent unnecessary processing delays.• In addition, please complete (and send in along with the application) any other required forms referred to earlier in this

agent guide.

Front of the Application:• Proposed Insured – Provide the Proposed Insured’s full legal name.• Address – Proposed Insured’s physical address • City / State / Zip Code• Telephone Case Number – provide the case number provided to you by the interview company (if interview completed

point-of-sale).• Telephone Interview Completed: — If completed point-of-sale, check the “Yes” box. Otherwise check the “No” box. — Always provide a valid phone number. — Best Time to Call – If the telephone interview was not completed point-of-sale, please indicate the best time for the

vendor to contact the proposed insured.• Male / Female – select appropriate gender• Date of Birth – Please enter as MM/DD/YYYY• Age – calculate based upon age last birthday as of the policy date• State of Birth – If the applicant was not born in the U.S., list the country of birth.• Social Security Number• Height and Weight – Record the Proposed Insured’s current height and weight. Refer to the build tables of this guide to

assist in determining the appropriate plan to apply for based on build.• Owner: — Name — Relationship to the Proposed Insured — Social Security Number — Address — City/State/Zip• Primary and Contingent Beneficiary: — Full names of Primary and Contingent beneficiaries (if applicable) must be listed on the application including the

beneficiary’s relationship to the Proposed Insured. — A beneficiary must have a legitimate insurable interest defined as a current interest in the life of the insured. Examples

include family members, a Trust or an insured’s Estate. NOTE: Funeral homes are not acceptable beneficiary designations.• Plan – Check the box for the appropriate death benefit plan being applied for. This is based on the answers to the health

questions and the Proposed Insured’s build. When applying for the Preferred Plan check the "Immediate Death Benefit" box. When applying for the Standard Plus Plan check the "Graded Death Benefit (Percentage of Face Amount) box and when applying for the Standard Plan check the "Return of Premium Death Benefit" box.

• Face Amount of Insurance $ – enter the amount of coverage being applied for.• Tobacco Use — Please check the box “Yes” or “No” to the tobacco use question. — The question reads “during the past 12 months have you used tobacco in any form (excluding occasional cigar or

pipe use)?” — “Tobacco Use” includes cigarettes, pipe, chewing tobacco, cigars, snuff or other tobacco products • Plan Acceptance Check Box ("Check here if you are willing to accept…") – Check this box if your client is willing to

accept whichever death benefit plan they may qualify for. If checked, this will prevent the need to complete a signed endorsement due simply to a change of plan.

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• Riders (be sure to check the box next to each rider being applied for): — Child Rider • Indicate the number of children applying for coverage • Enter 1 unit ($5,000) or 2 units ($10,000) of coverage — Accidental Death Benefit Rider • Check the box for ADB • Indicate the amount of coverage — Waiver of Premium • Check the "Other" box • Indicate "WP" in the blank provided — Nursing Home Waiver of Premium • Check the "Other" box • Indicate "NHWP" in the blank provided

• Automatic Premium Loan (APL) – check “Yes” or “No” (check "Yes" to ensure the Proposed Insured has this option if ever needed.)

• Mode: — Bank Draft — Draft 1st Prem on Req Date – bank draft on which the 1st draft will occur upon the “Requested Policy Date” you

will enter. — Other• Modal Premium – enter the desired premium based on the frequency by which the client will pay • CWA (check appropriate box, if applicable): — E-Check Immediate 1st Premium – only select this option if the company is to draft the proposed insured’s bank

account IMMEDIATELY upon receipt of the application. NOTE: You must also complete the E-Check section of form 9978-SLS and submit it with the application.

— Collected $ – only select this option if actually collecting initial payment and mailing it to the Home Office.• Mail Policy To – check the "agent" box to indicate the policy contract will be mailed to Senior Life Services.• Requested Policy Date – the Requested Policy Date or the initial draft, if applicable, cannot be more than 30 days out

from the date the application was signed.• Replacement Section: — Answer questions A & B — If replacing coverage, please provide the other insurance company name, policy # & amount of coverage. — NOTE: Complete any state required Replacement forms – For state specific replacement instructions & replacement

forms, please refer to the company website.• Physician Name, City/State & Phone – provide the name and contact information of the Proposed Insured’s doctor or

medical facility• Health Questions: — If any answer to questions 1 through 3 is answered “Yes” the Proposed Insured is not eligible for any coverage. — If any answer to questions 4 through 7 is answered “Yes” the Proposed Insured should apply for the Standard Plan. — If any part of question 8 is answered "Yes" the Proposed Insured should apply for the Standard Plus plan. — If all questions 1 through 8 are answered “No” the Proposed Insured should apply for the Preferred Plan.

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Back of the Application:• Child, Grandchild, and Great Grandchild Coverage: — For each child to be covered provide their name, sex, birthdate & relationship to the Proposed Insured. — If more space is needed to list the children covered, please provide their information on a separate sheet of paper

and submit along with the application.• Proposed Children’s Health Statement: — This statement applies to all of the children proposed for coverage — Those who do not qualify for coverage based on this health statement should be listed on the line for “Exceptions”.• Signed at – provide both the city and state indicating where the applicant was when the application was taken.• Date of Application – the application date should always be the date the Proposed Insured answered all the medical

questions and signed the application.• Signature of Proposed Insured: — The Proposed Insured should sign their own application. — Power of Attorney (POA) signatures are not acceptable.• Signature of Owner – complete only if the Owner of the policy is different than the Proposed Insured. If Owner is

different, they MUST sign and date the application as well as the Proposed Insured.• Agent’s Report – complete all of the following: — Answer both replacement questions — Agent’s Remarks - provide any special instructions or notes for the Home Office — Agent’s Printed Name — Date — Agent’s Signature — Agent Number — Percentage (if splitting the commission with another agent, indicate the appropriate percentage for each agent)• Pre-Authorization Check Plan – Authorization To Honor Charge Drawn – complete the following if premiums are being

paid via bank draft. A complete explanation of bank draft procedures is found in this guide: — Insured name — Account Holder name — Name of the bank or financial institution — Address of the bank — Transit/ABA Number (a.k.a. routing number) — Account Number — Check if the account is either a “Checking” or “Savings” account — Requested Draft Day – day of the month for recurring drafts — Signature of the account holder — Date

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OTHER REQUIRED FORMS / KEY ADMINISTRATIVE GUIDELINES• Incomplete or unsigned applications – applications that are not completed in their entirety or are missing

required signatures will be amended or returned for completion. Please make sure that all blanks are filled in and the application has been reviewed and signed by the Owner and Proposed insured. Also, remember to include your agent number.

• Terminal Illness Accelerated Benefit Riders Disclosure Statement, Form No. 9474 – must be presented to the applicant and the agent must certify that it has been presented. (The states of MA, VA and WA require this disclosure form to be signed by the applicant and submitted with the application.)

• Accelerated Benefit Confined Care Rider Disclosure Statement, Form No. 9761 – must be presented to the applicant and the agent must certify that it has been presented when applying for the Super Preferred, Preferred Plus or Preferred Plans.

• HIPAA, Form No. 9526 – must be submitted with each application.• Replacement Form (if required) – complete all replacement requirements as per individual state insurance

replacement regulations.• All changes must be crossed out and initialed by Proposed Insured. – No white outs or erasures are permitted

on the application.• Applications for Standard Plan – While completing the health questions on the application with the proposed

insured if you encounter a “yes” answer in the Standard section, that is the last health question that must be answered. After that initial “yes” answer, the health questions following may be left unanswered.

(NOTE: When the Standard plan is being applied for, a telephone interview is not required).• Initial Premium – The first full modal premium is required with the application, unless the initial premium is bank

draft. The initial premium can be submitted in the form of applicant’s personal check, E-Check, or bank draft for 1st premium. See the E-Check procedures described in this guide.

CUSTOMER BENEFITS• Simple YES/NO application• No medical exams or blood work required• Affordable rates that will not increase• Benefits not subject to Federal income tax• Cash value for emergencies and other needs

PEACE OF MIND: Field Underwriting Hints.Underwriters will try to evaluate the risk as quickly as possible, so the following factors are essential:• Good Field Underwriting – Carefully ask all of the application questions and accurately record the answers. • Client Honesty and Cooperation – Underwriting relies heavily on the application; therefore, complete and

thorough answers to the questions are necessary. Please stress this and prepare the Proposed Insured for the interview. The interview will be brief, pleasant, professionally handled, and recorded.

SPEED UP YOUR TURNAROUND TIME!Practice these simple guidelines BEFORE asking any health questions stress the importance for ‘truthful and complete’ answers, including tobacco usage that will ‘match’ information already in the applicant’s medical records, national prescription database, MIB, etc.

THE MORE COMPLETE INFORMATION you can provide on the application significantly REDUCES the need to order medical records and speeds up issue time!

PRACTICE GOOD FIELD UNDERWRITING OR…An agent with a history of submitting applications with Non-Admitted medical information will likely receive special attention when their applications are reviewed by the Underwriting Department. Medical records on those applicants will be requested until the Underwriting Department believes that agent has corrected their field under-writing problems.

Do not let poor field underwriting contribute to unnecessary delays in both the issuing of your business and the payment of your compensation.

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STATE SPECIFICS• California:

— Notice of Lapse designee Form No. 3011 must be completed and sent to the Home Office along with the life application.

— California Senior Notice Form No. 9555 must be completed and sent to the Home Office along with the application on sales to clients age 65 or older.

— California Notice Regarding Sale and Liquidation of Assets Form No. 9649 must be completed and sent to the Home Office along with the application on sales to clients age 65 or older.

• Florida—If applying for the Grandchild Rider, the signature of a legal guardian of the child(ren) is required. • Kansas—Due to state’s replacement regulations, we will not accept new applications in this state when a

replacement sale is involved.• Kentucky—Due to state’s replacement regulations, we will not accept new applications in this state when a

replacement sale is involved.• North Carolina—Please use agent guide Form No. 3177 for sales in this state.• Pennsylvania— Disclosure Statement Form No. 8644-PA must be completed and presented to the client in

conjunction with each application. One copy of the form is left with the client and another copy is sent to the Home Office along with the life application.

• South Dakota—Refer to Agent Guide as to what plan applicant is eligible for based on health question responses.ALL STATE EXCEPTIONS MAY NOT BE INCLUDED ABOVE

ALL PRODUCTS NOT APPROVED IN ALL STATES

BANK DRAFT PROCEDURESDraft First Premium Once Policy is Approved (“D1P”):1) Complete the Bank Authorization Form on page 2 of the application. You must specify the Draft Date on the authorization. (a) Drafts cannot occur more than 30 days from the application date, (b) Drafts cannot be on the 29th, 30th or 31st of the month or (c) If an effective date is being requested on the 1st page of application then the D1P date must be within

10 days of that requested effective date.2) A copy of a void check must accompany the application. If one is not available, then you must also submit a Bank

Information form (Form No. 3028-SLS).3) In the “Agent Comments” section of the application found just above the Bank Authorization, please indicate: (a) “D1P”, (b) the month and date in which you want the first draft to occur. For example “D1P Feb 4th”. The day chosen will

also be the same day of month for recurring drafts.Immediate Draft for Cash with Application (CWA) using E-Check Authorization:1) Complete the E-Check Authorization (Form No. 9978-SLS). With the use of this form, the company will draft immedi-

ately for the 1st premium upon receipt of the application. (Funds must be currently available to avoid overdrafts)2) A check must be placed in the section of the form labeled “Place Check Here”. If a check is not available, you

must hand write the following in this section: (1) Account No., (2) Routing No., (3) Accountholder Name belonging to the account to be drafted and (4) name of the Financial Institution (above the routing number).

3) A Completed Bank Authorization Form on page 2 of the application is also required. You must specify the draft date for recurring drafts. Drafts cannot be on the 29th, 30th or 31st of the month

4) A copy of a void check must accompany the application for the recurring draft. If one is not available, then you must also submit a Bank Information form (Form No. 3028-SLS).

OPTION FOR BILLING ON 2ND, 3RD OR 4TH WEDNESDAY OF EACH MONTHMany seniors today are receiving their Social Security payments on the 2nd, 3rd or 4th Wednesday of each month rather than on a specific date each month. If you have a client receiving their payments under this scenario and would like to take advantage of the flexibility provided by this option, please abide by the following instructions:In the “Requested Policy Date” field on the front of the application, simply indicate one of the following instead of pro-viding an actual policy date:• “2W”–if payments are received on the 2nd Wednesday of the month• “3W”–if payments are received on the 3rd Wednesday of the month• “4W”–if payments are received on the 4th Wednesday of the month(The actual Policy Date will be assigned by the Home Office once the application is received and should be left blank on the application.)In addition please indicate either “2W”,”3W” or “4W” in the field labeled “Requested Draft Day” which is part of the bank authorization form found on the back of the application.The procedure is just that simple. The rest of the application paperwork is completed in the normal fashion. Also you still have the option of requesting immediate drafts for CWA; just follow the normal procedures for doing so.

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PRODUCT SOFTWARE No NAIC Illustration is required for the sale. However, quotes can be run based on a desired face amount or premium amount to customize a solution for your client. To run quotes using your smart phone or tablet, please go to www.insuranceapplication.com/phonequote.

BUILD CHARTS (Unisex)

(Use the chart below to help determine the appropriate plan)

Ht.

Maximum Weight for Plan Minimum Weight for Plan

Preferred Standard Plus Standard* Preferred Standard**

4’10’ 211 212 - 220 221 - 230 92 87 - 91

4’11” 218 219 - 228 229 - 238 94 89 - 93

5’ 225 226 - 236 237 - 246 96 91 - 95

5’1” 233 234 - 244 245 - 254 99 94 - 98

5’2” 241 242 - 252 253 - 262 101 96 - 100

5’3” 248 249 - 260 261 - 271 105 100 - 104

5’4” 256 257 - 268 269 - 280 107 102 - 106

5’5” 264 265 - 276 277 - 288 110 105 - 109

5’6” 273 274 - 285 286 - 297 112 107 - 111

5’7” 281 282 - 294 295 - 306 116 111 - 115

5’8” 289 290 - 303 304 - 316 119 114 - 118

5’9” 298 299 - 312 313 - 325 123 118 - 122

5’10” 307 308 - 321 322 - 335 126 121 - 125

5’11” 315 316 - 330 331 - 344 131 126 - 130

6’ 324 325 - 339 340 - 354 135 130 - 134

6’1” 334 335 - 349 350 - 364 139 134 - 138

6’2” 343 344 - 359 360 - 374 142 137 - 141

6’3” 352 353 - 368 369 - 384 146 141 - 145

6’4” 361 362 - 378 379 - 394 149 144 - 148

* Above the weight on the high end of this range is a decline**Below the weight on low end of this range is a decline

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BUILD CHARTPEACE OF MIND Super Preferred and Preferred Plus

(Unisex)Height Maximum* Minimum*4’10’ 181 924’11” 188 94

5’ 195 965’1” 201 995’2” 208 1015’3” 215 1055’4” 221 1075’5” 228 1105’6” 235 1125’7” 243 1165’8” 250 1195’9” 257 123

5’10” 265 1265’11” 272 131

6’ 280 1356’1” 288 1396’2” 296 1426’3” 304 1466’4” 312 149

* If above the maximum or below the minimum weight in the chart above, client is not eligible for Super Preferred or Preferred Plus. Please consult build chart on previous page to help determine plan eligibility.

UNDERWRITING GUIDELINESPreferred PlusIn order for the proposed insured to qualify for the Preferred Plus plan, you must follow these instructions: • A supplemental application (Form No. 3180) must be completed and the applicant must be able to answer

all health questions in Section A as “No”. Submit this supplement along with the life application. (Section B of the supplemental application should not be completed.)

• The base life application must be completed and the applicant must be able to answer all health questions as “No”.

• The proposed insured must not exceed the limits in the following build chart.• Use the Preferred Plus rates for premium calculations.• Indicate to interview company that this will be a "Preferred Plus Plan".

Super PreferredIn order for the proposed insured to qualify for the Super Preferred plan, you must follow these instructions: • A supplemental application (Form No. 3180) must be completed and the applicant must be able to answer

all health questions in Sections A & B as “No”. Submit this supplement along with the life application. • The base life application must be completed and the applicant must be able to answer all health questions

as “No”. • The proposed insured must not exceed the limits in the following build chart.• Use the Super Preferred rates for premium calculations.• Indicate to interview company that this will be a "Super Preferred Plan".

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OPTIONAL RIDERS

ACCIDENTAL DEATH BENEFIT (ADB) Policy Form 7159

Annual Premiums Per $1,000 of Insurance(Not Available on Standard Plan)

Issue Age Rate50-55 $ 2.0056-60 2.5061-65 3.0066-70 4.0071-75 6.5076-80 10.00

ADB provides an additional amount of death benefit should the insured die as a result of an accident. Issue Ages: 50-80Minimum Amount: $2,500Maximum Amount: Equal to the face amount of the policyBenefit Terminates: At age 100

ADB Calculation Example: Male, Age 65, Monthly, $10,000 ADB ($3.00 X 10) multiplied X .088 = $2.64 per month. Add ADB monthly premium to life coverage monthly premium for total monthly premium.

Children's Insurance Agreement Plan (Covers Children, Grandchildren, and Great-Grandchildren)Policy Form 3164Per Unit selected, this rider provides $5,000 per unit, of life insurance protection on each child, grandchild and great grandchild through age 25. This benefit also guarantees their future insurability for up to $25,000 of individual protection regardless of their health.Rider coverage is fully paid-up in the event of the primary insured's death.Issue Ages: Primary Insured : 50 - 80 Grandchildren: 15 days - 18 yearsPremium: $12.00 annually per grandchild per unitMaximum Units: 2

Grandchild Rider Calculation Example: 3 grandchildren ($12.00 X 3) multiplied X .088 = $3.17 per month. Add the monthly premum to life coverage monthly premium for the total monthly premium.

WAIVER OF PREMIUM RIDER Policy Form 7180

Rate per $100Issue Age Rate Per $100

50 $10.23

51 $11.27

52 $12.46

53 $13.79

54 $15.30

55 $16.98

Waiver of Premium and Nursing Home Waiver of Premium Riders are eligible to be sold in conjunction with each other. Rider availability may vary by state.Description: If elected, the company will waive the payment of each premium of the policy in the event of total and permanent disability of the Insured as defined and specified in the rider agreement. Rider coverage expires at age 60 (unless rider is in effect).Issue Ages: 50-55Available Only on: Super Preferred, Preferred Plus and PreferredWaiver of Premium and Nursing Home Waiver of Premium Riders are eligible to be sold in conjunction with each other. Rider avilability may vary by state.

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NURSING HOME WAIVER OF PREMIUM RIDERPolicy Form 9984, Annual Premium per $1,000

(Available Only On the Super Preferred, Preferred Plus and Preferred Plans)Male Female

Issue Age Non-Tobacco Tobacco Non-Tobacco Tobacco50 0.33 0.35 0.51 0.5251 0.33 0.35 0.51 0.5252 0.34 0.36 0.52 0.5353 0.34 0.36 0.52 0.5354 0.35 0.36 0.53 0.5455 0.35 0.36 0.53 0.5456 0.35 0.37 0.54 0.5557 0.41 0.43 0.65 0.6658 0.51 0.54 0.81 0.8259 0.57 0.63 0.94 0.9560 0.63 0.68 1.03 1.0461 0.70 0.76 1.14 1.1562 0.84 0.89 1.34 1.3563 1.05 1.10 1.62 1.6464 1.19 1.24 1.84 1.8565 1.31 1.37 2.00 2.0266 1.47 1.57 2.24 2.2767 1.76 1.92 2.68 2.7268 2.21 2.46 3.33 3.3869 2.55 2.87 3.85 3.9170 2.80 3.19 4.22 4.3471 3.15 3.64 4.76 5.0372 3.82 4.50 5.79 6.3573 4.80 5.75 7.28 8.2674 5.49 6.64 8.34 9.6675 6.02 7.32 9.21 10.7776 6.75 8.25 10.53 12.4277 8.10 9.99 12.99 15.5178 10.08 12.50 16.59 19.9879 11.49 14.30 19.15 23.1780 12.51 15.62 21.01 25.4381 13.92 17.42 23.49 28.3482 16.45 20.62 27.92 33.4683 20.05 25.20 34.26 40.7984 22.52 28.35 38.62 45.8285 23.70 29.86 40.69 48.21

Description:This rider will waive payment of policy premiums becoming due during the insured’s confinement in a qualified nursing home as defined in the rider. The insured must be confined continuously for a waiting period of 90 consecutive days before any benefits are applicable. Benefits are not retroactive & policy premiums must continue to be paid during the waiting period. Confinement means the insured receives care for at least 90 consecutive days in a nursing home and the care is recommended by a physician due to the insured’s inability to care for himself/herself. Issue Ages: 50 – 85 Coverage Period: Same as the base policy.Waiver of Premium and Nursing Home Waiver of Premium Riders are eligible to be sold in conjunction with each other. Rider avilability may vary by state.

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RIDERS INCLUDED AT NO ADDITIONAL COSTTerminal Illness Accelerated Benefit Rider Policy Form No. 9473With this benefit you can receive up to 100% of the death benefit of the policy if diagnosed as terminally ill where life expectancy is 12 months or less (24 months in some states). This rider where available is added to every policy at no additional premium. An Actuarial Adjustment Factor and an Administrative Charge of $150 will be assessed at the time of acceleration. Remember to leave disclosure statement Form 9474 with the applicant. (The states of MA, VA and WA require this disclosure form to be signed by the applicant and submitted with the application.)

Accelerated Benefits Rider-Confined Care Policy Form No. 9760With this benefit, if you are confined to a nursing home at least 30 days after the policy is issued you can receive a monthly benefit of up to 5.0% of the face amount per month. This rider where available is added to policies issued as the Super Preferred, Preferred Plus and Preferred Plans at no additional premium. Not available on the Standard Plus or Standard plans. Remember to leave the disclosure statement Form 9761 with the applicant when applying for the Preferred lus and Preferred Plans. (Rider not available in CA, CT, DC, FL, IL, IN, MA, NJ, OH, SD, VA or WA)

Rider availability can vary by death benefit plan. See chart below for availability.

RIDER AVAILABILITY CHARTRider availability can vary by death benefit plan. See chart below for availability.

Rider NameSuper Preferred, Preferred Plus

and PreferredStandard Plus Standard

Waiver of Premium Yes No NoNursing Home Waiver of Premium Yes No NoChildrens Yes Yes YesAccidental Death Yes Yes NoTerminal Illness Yes Yes YesConfined Care Yes No No

Monthly Income Replacement Option• At death, the beneficiary may opt for a monthly payment option rather than a lump sum benefit. The monthly

income replacement option may be chosen from a range of monthly benefits and benefit amounts: — Benefit Amounts - from $100 to $1,000 per month* — Benefit Periods - from 12 to 60 months*• If you choose to present this option to your client: — There is a version of the product brochure (Form # 3183) which helps to present this option. — Complete the “Monthly Income Replacement Worksheet” (Form # 3202). Provide the client with a copy

and send a copy along with the life application. — Refer to the pre-calculated rate sheets (Form # 3204) which calculate the monthly premium to coincide

with the income replacement option desired. — On the life insurance application in blank for the “Face Amount of Insurance $”, enter the total death

benefit amount and not the amount of the monthly benefit.* Availability varies by age and plan.

—16—

ALPHABETICAL DRUG LISTWhere medications that can be used for more than one condition exist, the alternate uses and appropriate level of coverage has been indicated.The “Rx Fill Within” column means the drug was prescribed within the time period noted. For some circulatory/heart medications, the “Rx Fill Within” column notes “First Fill”. “First Fill” refers to when the medication was originally prescribed.Medication Common Uses RX Fill Within Plan EligibilityAbilify Psychotic Disorder N/A PreferredAccupril Hypertension

CHF N/AN/A

Preferred No Coverage

Accuretic Hypertension CHF

N/AN/A


Acebutolol HCL Hypertension CHF

N/AN/A


Aceon Hypertension CHF

N/AN/A


Actoplus Diabetes * N/A PreferredActos Diabetes * N/A PreferredAdvair Asthma N/A Preferred

COPD / Emphysema 2 years3 years> 3 years

StandardStandard Plus Preferred

Aggrenox Stroke / TIA 2 years3 years > 3 years

Standard Standard Plus Preferred

Albuterol Asthma N/A PreferredCOPD / Emphysema 2 years

3 years> 3 years


Aldactazide Hypertension CHF

N/AN/A


Aldactone Hypertension CHF

N/AN/A


Allopurinol Gout N/A Preferred Altace Hypertension

CHF N/AN/A


Amantadine HCL Parkinson’s N/A Standard Plus Amaryl Diabetes * N/A PreferredAmbisome AIDS N/A No Coverage Amiloride HCL Hypertension

CHF N/AN/A


Amlodipine Besylate/Benaz Hypertension CHF

N/AN/A


NOTE: Proposed Insureds taking both a medication marked with an asterisk (*) representing "diabetes" and a number sign (#) representing "retinopathy, nephropathy, neuropathy" should answer question # 4 on the application as YES (Return of Premium section). Question #4 asks – “Have you ever been medically diagnosed or treated for complications of diabetes, including insulin shock, diabetic coma, retinopathy (eye), nephropathy (kidney), neuropathy (nerve damage/pain), or used insulin prior to age 50?”

—17—

Medication Common Uses RX Fill Within Plan EligibilityAmyl Nitrate Angina 2 years

3 years> 3 years

StandardStandard PlusPreferred

CHF N/A No CoverageAntabuse Alcohol / Drugs 2 years Standard Apokyn Parkinson’s N/A Standard Plus Apresoline Hypertension

CHF N/AN/A


Aptivus AIDS N/A No Coverage Aranesp Kidney Dialysis

Renal Insufficency/Failure Diabetic Nephropathy #

N/AN/AN/A

No Coverage Standard Standard

Aricept Alzheimer’s / Dementia N/A No Coverage Arimidex Cancer 2 years

3 years> 3 years


Atacand Hypertension CHF

N/AN/A


Atamet Parkinson’s N/A Standard Plus Atenolol Hypertension

CHF N/AN/A

PreferredNo Coverage

Atgam Organ / Tissue Transplant N/A No Coverage Atripla AIDS N/A No Coverage Atrovent/Atrovent HFA Atrovent (Nasal)

Allergies N/A Preferred COPD 2 years

3 years> 3 years


Avalide Hypertension CHF

N/AN/A


Avandia Diabetes * N/A PreferredAvapro Hypertension

CHF N/AN/A


Avonex Multiple Sclerosis N/A Standard PlusAzasan Organ / Tissue Transplant

Rheumatoid ArthritisSystemic Lupus

N/AN/AN/A

No CoveragePreferredStandard

Azathioprine Organ / Tissue TransplantRheumatoid ArthritisSystemic Lupus

N/AN/AN/A


Azilect Parkinson’s N/A Standard Plus Azmacort Asthma N/A Preferred




—18—

Medication Common Uses RX Fill Within Plan EligibilityAzor Hypertension

CHF N/AN/A


Baclofen Multiple Sclerosis N/A Standard PlusBaraclude Liver Disorder / Hepatitis 2 years

3 years> 3 years


Benazepril HCL Hypertension CHF

N/AN/A


Benicar Hypertension CHF

N/AN/A


Benlysta Systemic Lupus N/A StandardBenztropine Mesylate Parkinson’s

Other Use N/AN/A

Standard PlusPreferred

Betapace Heart ArrhythmiaCHF

N/AN/A


Betaseron Multiple Sclerosis N/A Standard PlusBetaxolol HCL Hypertension

CHF N/AN/A


BiDil CHF N/A No CoverageBisoprolol Fumarate Hypertension

CHF N/A N/A


Bromocriptine Mesylate Parkinson’s N/A Standard Plus Bumetadine Hypertension

CHF N/AN/A


Bumex Hypertension CHF

N/AN/A


Buprenex Alcohol / Drugs 2 years Standard Bystolic Hypertension

CHF N/AN/A


Calcium Acetate Kidney DialysisRenal Insufficency/Failure Diabetic Nephropathy #

N/AN/AN/A

No CoverageStandardStandard

Campath Cancer 2 years3 years> 3 years


Campral Alcohol / Drugs 2 years Standard Capoten Hypertension

CHF N/AN/A


Capozide Hypertension CHF

N/AN/A


Captopril Hypertension CHF

N/AN/A


Carbamazepine SeizuresDiabetic Neuropathy #

3 yearsN/A

Standard PlusStandard


—19—

Medication Common Uses RX Fill Within Plan EligibilityCarbatrol Seizures

Diabetic Neuropathy #3 yearsN/A


Carbidopa Parkinson’s N/A Standard Plus Carvedilol Hypertension

CHF N/AN/A


Casodex Cancer 2 years3 years> 3 years


Celebrex Arthritis N/A Preferred Cellcept Organ / Tissue Transplant N/A No Coverage Clopidogrel Stroke/TIA/Heart Attack

Stroke/Heart AttackStroke/Heart Attack

First Fill 2 yearsFirst Fill 3 years First Fill > 3 years


Cogentin Parkinson’sOther Use

N/AN/A


Cognex Alzheimer’s/Dementia N/A No Coverage Combivent COPD 2 years

3 years> 3 years


Combivir AIDS N/A No Coverage Complera AIDS N/A No Coverage Copaxone Multiple Sclerosis N/A Standard PlusCopegus Liver Disorder / Hepatitis C 2 years

3 years> 3 years


Cordarone Arrythmia N/A Preferred Coreg Hypertension

CHF N/AN/A


Corgard Hypertension CHF

N/AN/A


Corzide Hypertension CHF

N/AN/A


Coumadin Pulmonary Embolism Thrombosis

NANA

PreferredPreferred

Cardiac Valve Replacement/TIA/Stroke/Heart Attack

First Fill 2 years Standard

Cardiac Valve Replacement/Stroke/Heart Attack

First Fill 3 yearsFirst Fill > 3 years


Cozaar Hypertension CHF

N/AN/A


Cyclosporine Organ / Tissue Transplant N/A No Coverage Cyclosporine Modified Organ / Tissue Transplant N/A No Coverage NOTE: Proposed Insureds taking both a medication marked with an asterisk (*) representing "diabetes" and a number sign (#) representing "retinopathy, nephropathy, neuropathy" should answer question # 4 on the application as YES (Return of Premium section). Question #4 asks – “Have you ever been medically diagnosed or treated for complications of diabetes, including insulin shock, diabetic coma, retinopathy (eye), nephropathy (kidney), neuropathy (nerve damage/pain), or used insulin prior to age 50?”

—20—

Medication Common Uses RX Fill Within Plan EligibilityCytoxan Cancer 2 years

3 years > 3 years


Demadex Hypertension CHF

N/AN/A


Depacon SeizuresDiabetic Neuropathy #

3 yearsN/A


Depade Alcohol / Drugs 2 years Standard Depakene Seizures



Depakote Seizure Disorder 3 years Standard PlusDiabeta Diabetes * N/A PreferredDiabinese Diabetes * N/A PreferredDigitek Atrial Fibrillation

CHF N/AN/A


Digoxin Atrial FibrillationCHF

N/AN/A


Dilantin Seizure Disorder N/A Standard PlusDilatrate SR Angina 2 years

3 years> 3 years


CHF N/A No CoverageDilor Asthma N/A Preferred



Diovan Hypertension CHF

N/AN/A


Disulfiram Alcohol / Drugs 2 years Standard Dolophine Opioid Dependence 2 years Standard Donepezil HCL Alzheimer’s / Dementia N/A No Coverage Duoneb COPD 2 years

3 years > 3 years


Dyazide Hypertension CHF

N/AN/A


Dynacirc Hypertension N/A Preferred Dyrenium Hypertension

CHF N/AN/A


Edecrin Hypertension CHF

N/AN/A


Edurant AIDS N/A No Coverage Eldepryl Parkinson’s N/A Standard Plus NOTE: Proposed Insureds taking both a medication marked with an asterisk (*) representing "diabetes" and a number sign (#) representing "retinopathy, nephropathy, neuropathy" should answer question # 4 on the application as YES (Return of Premium section). Question #4 asks – “Have you ever been medically diagnosed or treated for complications of diabetes, including insulin shock, diabetic coma, retinopathy (eye), nephropathy (kidney), neuropathy (nerve damage/pain), or used insulin prior to age 50?”

—21—

Medication Common Uses RX Fill Within Plan EligibilityEmtriva AIDS N/A No Coverage Enalapril Maleate Hypertension

CHF N/AN/A


Enalaprilat Hypertension CHF

N/AN/A


Epitol SeizuresDiabetic Neuropathy #

3 yearsN/A


Epivir AIDS N/A No Coverage Eskalith Bipolar Disorder N/A Preferred Esmolol HCL Hypertension

CHF N/AN/A


Exelon Alzheimer’s / Dementia N/A No Coverage Exforge Hypertension

CHF N/AN/A

PreferredStandard

Femara Cancer 2 years3 years> 3 years


Foscavir AIDS N/A No Coverage Fosinopril Sodium Hypertension

CHF N/AN/A


Fosrenol Kidney DialysisRenal Insufficency/Failure Diabetic Nephropathy #

N/AN/AN/A


Furosemide Hypertension CHF

N/AN/A


Gabapentin SeizuresDiabetic Neuropathy #

3 yearsN/A


Galantamine Alzheimer’s / Dementia N/A No Coverage Gleevec Cancer 2 years

3 years> 3 years


Glipizide Diabetes * N/A PreferredGlucophage Diabetes * N/A PreferredGlucotrol Diabetes * N/A PreferredGlyburide Diabetes * N/A PreferredGlynase Diabetes * N/A PreferredHaldol Psychotic Disorder N/A Preferred Haloperidol Psychotic Disorder N/A Preferred HCTZ Hypertension N/A Preferred HCTZ/Triamterene Hypertension

CHF N/AN/A



—22—

Medication Common Uses RX Fill Within Plan EligibilityHectoral Kidney Dialysis


N/AN/AN/A


Heparin Pulmonary Embolism Thrombosis

N/AN/A

PreferredPreferred

Hepsera Liver Disorder / Hepatitis 2 years3 years> 3 years


Humalog Diabetes * N/A PreferredHumulin Diabetes * N/A PreferredHydralazine HCL Hypertension

CHF N/AN/A


Hydroxyurea Cancer 2 years 3 years> 3 years


Hydergine Alzheimer’s /Dementia N/A No Coverage Hydroxychloroquine Systemic Lupus

MalariaRheumatoid Arthritis

N/AN/AN/A

StandardPreferredPreferred

Hyzaar Hypertension CHF

N/AN/A


Imdur Angina 2 years3 years> 3 years


CHF N/A No CoverageImuran Organ / Tissue Transplant

Rheumatoid ArthritisSystemic Lupus

N/AN/AN/A


Inamrinone CHF N/A No CoverageInderal Hypertension

CHF N/AN/A


Inderide Hypertension CHF

N/AN/A


Innopran XL Hypertension CHF

N/AN/A


Inspra CHF N/A No CoverageInsulin Diabetes * N/A PreferredIntron-A Cancer 2 years

3 years> 3 years


Hepatitis C 2 year3 years> 3 years


Invirase AIDS N/A No Coverage NOTE: Proposed Insureds taking both a medication marked with an asterisk (*) representing "diabetes" and a number sign (#) representing "retinopathy, nephropathy, neuropathy" should answer question # 4 on the application as YES (Return of Premium section). Question #4 asks – “Have you ever been medically diagnosed or treated for complications of diabetes, including insulin shock, diabetic coma, retinopathy (eye), nephropathy (kidney), neuropathy (nerve damage/pain), or used insulin prior to age 50?”

—23—

Medication Common Uses RX Fill Within Plan EligibilityIpratropium Bromide Allergies N/A Preferred



Isordil Angina 2 years3 years> 3 years


CHF N/A No CoverageIsosorbide Dinitrate/Mononitrate

Angina 2 years 3 years> 3 years


CHF N/A No CoverageJanumet Diabetes * N/A PreferredJanuvia Diabetes * N/A PreferredKaletra AIDS N/A No Coverage Kemadrin Parkinson’s

Other Use N/AN/A


Kerlone Hypertension CHF

N/AN/A


Labetaolol Hypertension CHF

N/AN/A


Lamictal SeizuresDiabetic Neuropathy #

3 yearsN/A


Lamtrogine SeizuresDiabetic Neuropathy #

3 yearsN/A


Lanoxicaps Atrial FibrillationCHF

N/AN/A


Lanoxin Atrial FibrillationCHF

N/AN/A


Lantus Diabetes * N/A PreferredLarodopa Parkinson’s N/A Standard Plus Lasix Hypertension

CHF N/AN/A


Leukeran Cancer 2 years3 years > 3 years


Levatol Hypertension CHF

N/AN/A


Levemir Diabetes * N/A PreferredLevocarnitine Kidney Dialysis

Renal Insufficency/FailureDiabetic Nephropathy #

N/AN/AN/A


Levodopa Parkinson’s N/A Standard Plus Lexiva AIDS N/A No Coverage NOTE: Proposed Insureds taking both a medication marked with an asterisk (*) representing "diabetes" and a number sign (#) representing "retinopathy, nephropathy, neuropathy" should answer question # 4 on the application as YES (Return of Premium section). Question #4 asks – “Have you ever been medically diagnosed or treated for complications of diabetes, including insulin shock, diabetic coma, retinopathy (eye), nephropathy (kidney), neuropathy (nerve damage/pain), or used insulin prior to age 50?”

—24—

Medication Common Uses RX Fill Within Plan EligibilityLexxel Hypertension

CHF N/AN/A


Lipitor Cholesterol N/A Preferred Lisinopril Hypertension

CHF N/AN/A


Lithium Bipolar Disorder N/A Preferred Lodosyn Parkinson’s N/A Standard Plus Losartan Potassium Hypertension

CHF N/AN/A


Lotensin Hypertension CHF

N/AN/A


Loxapine Psychotic Disorder N/A Preferred Loxitane Psychotic Disorder N/A Preferred Lupron Cancer 2 years

3 years> 3 years


Lyrica SeizuresDiabetic Neuropathy #

3 yearsN/A


Mavik Hypertension CHF

N/AN/A


Maxzide Hypertension CHF

N/AN/A


Mellaril Psychotic Disorder N/A Preferred Mepron AIDS N/A No Coverage Metformin Diabetes * N/A PreferredMethadone Opioid Dependence 2 years Standard Methadose Opioid Dependence 2 year Standard Methotrexate Cancer 2 years

3 years> 3 years


Rheumatoid Arthritis N/A PreferredMetolazone Hypertension

CHF N/AN/A


Metoprolol HCTZ Hypertension CHF

N/AN/A


Metoprolol Tartrate/Suc-cinate

Hypertension CHF

N/AN/A


Micardis Hypertension CHF

N/AN/A


Micronase Diabetes * N/A PreferredMidamor Hypertension

CHF N/AN/A


Milrinone CHF N/A No Coverage NOTE: Proposed Insureds taking both a medication marked with an asterisk (*) representing "diabetes" and a number sign (#) representing "retinopathy, nephropathy, neuropathy" should answer question # 4 on the application as YES (Return of Premium section). Question #4 asks – “Have you ever been medically diagnosed or treated for complications of diabetes, including insulin shock, diabetic coma, retinopathy (eye), nephropathy (kidney), neuropathy (nerve damage/pain), or used insulin prior to age 50?”

—25—

Medication Common Uses RX Fill Within Plan EligibilityMinitran Angina 2 years

3 years> 3 years


CHF N/A No CoverageMirapex Parkinson’s

Other Use N/AN/A


Moban Psychotic Disorder N/A Preferred Moduretic Hypertension

CHF N/AN/A


Moexipril HCL Hypertension CHF

N/AN/A


Monoket Angina 2 years3 years> 3 years


CHF N/A No CoverageMonopril Hypertension

CHF N/AN/A


Mykrok Hypertension CHF

N/AN/A


Mysoline Seizure Disorder N/A Standard PlusNadolol Hypertension

CHF N/AN/A


Naloxone Alcohol / Drugs 2 years Standard Naltrexone Alcohol / Drugs 2 years Standard Namenda Alzheimer’s /Dementia N/A No Coverage Narcan Alcohol / Drugs 2 years Standard Natrecor CHF N/A No CoverageNavane Psychotic Disorder N/A Preferred Neurontin Seizures



Nimodipine Stroke/TIA/Heart AttackStroke/Heart AttackStroke/Heart Attack

First Fill 2 yearsFirst Fill 3 years First Fill > 3 years


Nimotop Stroke/TIA/Heart AttackStroke/Heart AttackStroke/Heart Attack

First Fill 2 yearFirst Fill 3 yearsFirst Fill > 3 years


Nitrek Angina 2 years3 years> 3 years


CHF N/A No CoverageNitro-bid Angina 2 year

3 years> 3 years


CHF N/A No CoverageNOTE: Proposed Insureds taking both a medication marked with an asterisk (*) representing "diabetes" and a number sign (#) representing "retinopathy, nephropathy, neuropathy" should answer question # 4 on the application as YES (Return of Premium section). Question #4 asks – “Have you ever been medically diagnosed or treated for complications of diabetes, including insulin shock, diabetic coma, retinopathy (eye), nephropathy (kidney), neuropathy (nerve damage/pain), or used insulin prior to age 50?”

—26—

Medication Common Uses RX Fill Within Plan EligibilityNitro-dur Angina 2 years

3 years > 3 years


CHF N/A No CoverageNitroglycerine/Nitrota b/ Nitroquick/Nitrostat

Angina 2 years3 years> 3 years


CHF N/A No CoverageNitrol Angina 2 years

3 years> 3 years


CHF N/A No CoverageNitromist Angina 2 years

3 years> 3 years


CHF N/A No CoverageNormodyne Hypertension

CHF N/AN/A


Norpace Arrythmia N/A Preferred Norvir AIDS N/A No Coverage Novolin Diabetes * N/A PreferredNovolog Diabetes * N/A PreferredPacerone Arrythmia NA Preferred Parcopa Parkinson’s N/A Standard Plus Parlodel Parkinson’s N/A Standard Plus Paxil Depressive Disorder N/A Preferred Pegasys Liver Disorder / Hepatitis C 2 years

3 years> 3 years


Peg-Intron Liver Disorder / Hepatitis C 2 years3 years> 3 years


Pentam 300 AIDS N/A No Coverage Pentamidine Isethionate AIDS N/A No Coverage Pepcid Stomach Disorder N/A Preferred Pergolide Mesylate Parkinson’s N/A Standard Plus Perindopril Erbumine Hypertension

CHF N/AN/A


Permax Parkinson’s N/A Standard Plus Phenobarbital Seizures 3 years Standard PlusNOTE: Proposed Insureds taking both a medication marked with an asterisk (*) representing "diabetes" and a number sign (#) representing "retinopathy, nephropathy, neuropathy" should answer question # 4 on the application as YES (Return of Premium section). Question #4 asks – “Have you ever been medically diagnosed or treated for complications of diabetes, including insulin shock, diabetic coma, retinopathy (eye), nephropathy (kidney), neuropathy (nerve damage/pain), or used insulin prior to age 50?”

—27—

Medication Common Uses RX Fill Within Plan EligibilityPhoslo Kidney Dialysis


N/AN/AN/A


Pindolol Hypertension CHF

N/AN/A


Plaquenil Systemic LupusMalariaRheumatoid Arthritis

N/AN/AN/A

StandardPreferredPreferred

Plavix Stroke/TIA/Heart AttackStroke/Heart AttackStroke/Heart Attack

First Fill 2 years First Fill 3 yearsFirst Fill > 3 years


Prandin Diabetes * N/A PreferredPrimacor CHF N/A No Coverage Prinivil Hypertension

CHF N/AN/A


Prinzide Hypertension CHF

N/AN/A


Prograf Organ / Tissue Transplant N/A No Coverage Proleukin Cancer 2 years

3 years> 3 years


Prolixin Psychotic Disorder N/A Preferred Propanolol HCL Hypertension

CHF N/AN/A


Proventil Asthma N/A PreferredCOPD / Emphysema 2 years

3 years> 3 years


Prozac Depressive Disorder N/A Preferred Quinapril Hypertension

CHF N/AN/A


Quinaretic Hypertension CHF

N/AN/A


Ramipril Hypertension CHF

N/AN/A

PreferredStandard

Rapamune Organ / Tissue Transplant N/A No Coverage Razadyne Alzheimer’s / Dementia N/A No Coverage Rebetol Liver Disorder / Hepatitis C 2 years

3 years > 3 years


Rebetron Liver Disorder / Hepatitis C 2 years3 years > 3 years


Rebif Multiple Sclerosis N/A Standard PlusNOTE: Proposed Insureds taking both a medication marked with an asterisk (*) representing "diabetes" and a number sign (#) representing "retinopathy, nephropathy, neuropathy" should answer question # 4 on the application as YES (Return of Premi-umsection). Question #4 asks – “Have you ever been medically diagnosed or treated for complications of diabetes, including insulin shock, diabetic coma, retinopathy (eye), nephropathy (kidney), neuropathy (nerve damage/pain), or used insulin prior to age 50?”

—28—

Medication Common Uses RX Fill Within Plan EligibilityReminyl Alzheimer’s / Dementia N/A No Coverage Renagel Kidney Dialysis


N/AN/AN/A


Renvela Kidney DialysisRenal Insufficency/Failure Diabetic Nephropathy #

N/AN/AN/A


Requip Parkinson’sOther Use

N/AN/A


Ribavirin Liver Disorder / Hepatitis C 2 year3 years > 3 years


Rilutek ALS (Lou Gehrig's Disease) N/A No Coverage Risperdal Psychotic Disorder N/A Preferred Risperidone Psychotic Disorder N/A Preferred Rituxan Cancer 2 year

3 years> 3 years


Rheumatoid Arthritis N/A PreferredRivastigmine Tartrate Alzheimer’s / Dementia N/A No Coverage Ropinirole Parkinson’s N/A Standard Plus

Diabetic Neuropathy # N/A StandardOther Use N/A Preferred

Rythmol Arrythmia N/A Preferred Sectral Hypertension

CHF N/AN/A


Serevent Asthma N/A PreferredCOPD / Emphysema 2 year

3 years> 3 years


Seroquel Psychotic Disorder N/A Preferred Sinemet/Sinemet CR Parkinson’s N/A Standard Plus Sodium Edecrin Hypertension

CHF N/AN/A


Soltalol Hydrochloride Hypertension CHF

N/AN/A


Sotalol HCL Hypertension CHF

N/AN/A


Spiriva COPD 2 year3 years> 3 years


Spironolactone Hypertension CHF

N/AN/A



—29—

Medication Common Uses RX Fill Within Plan EligibilitySprycel Cancer 2 year

3 years> 3 years


Stalevo Parkinson’s N/A Standard Plus Starlix Diabetes * N/A PreferredSuboxone Alcohol / Drugs 2 years Standard Subutex Alcohol / Drugs 2 years Standard Sustiva AIDS N/A No Coverage Symbicort Asthma N/A Preferred

COPD / Emphysema 2 year3 years> 3 years


Symmetrel Parkinson’s N/A Standard Plus Tambocor Arrythmia N/A Preferred Tamoxifen Cancer 2 years

3 years> 3 years


Tarka Hypertension CHF

N/AN/A


Tasmar Parkinson’s N/A Standard Plus Tegretol Seizures



Tenoretic Hypertension CHF

N/AN/A


Tenormin Hypertension CHF

N/AN/A


Teveten Hypertension CHF

N/AN/A


Theodur Asthma N/A PreferredCOPD / Emphysema 2 years

3 years> 3 years


Theophylline Asthma N/A PreferredCOPD / Emphysema 2 years

3 years> 3 years


Thioridazine Psychotic Disorder N/A Preferred Thiothixene Psychotic Disorder N/A Preferred Thorazine Psychotic Disorder N/A Preferred Tolazamide Diabetes * N/A PreferredTolbutamide Diabetes * N/A PreferredTolinase Diabetes * N/A PreferredNOTE: Proposed Insureds taking both a medication marked with an asterisk (*) representing "diabetes" and a number sign (#) representing "retinopathy, nephropathy, neuropathy" should answer question # 4 on the application as YES (Return of Premium section). Question #4 asks – “Have you ever been medically diagnosed or treated for complications of diabetes, including insulin shock, diabetic coma, retinopathy (eye), nephropathy (kidney), neuropathy (nerve damage/pain), or used insulin prior to age 50?”

—30—

Medication Common Uses RX Fill Within Plan EligibilityToprol XL Hypertension

CHF N/AN/A


Torsemide Hypertension CHF

N/AN/A


Trandate Hypertension CHF

N/AN/A


Trandolapril Hypertension CHF

N/AN/A


Trimterene Hypertension CHF

N/AN/A


Triamterene/HCTZ Hypertension CHF

N/AN/A


Tribenzor Hypertension CHF

N/AN/A


Trihexyphenidyl HCL Parkinson’sOther Use

N/AN/A


Truvada AIDS N/A No Coverage Twynsta Hypertension

CHF N/AN/A


Tyzeka Liver Disorder / Hepatitis 2 years3 years> 3 years


Uniretic Hypertension CHF

N/AN/A


Univasc Hypertension CHF

N/AN/A


Valcyte AIDS N/A No Coverage Valproic Acid Seizures



Valstar Cancer 2 year3 years> 3 years


Valturna Hypertension CHF

N/AN/A


Vascor Angina 2 years3 years> 3 years


Vaseretic Hypertension CHF

N/AN/A


Vasotec Hypertension CHF

N/AN/A



—31—

Medication Common Uses RX Fill Within Plan EligibilityVentolin Asthma N/A Preferred



Viaspan Organ / Tissue Transplant N/A No Coverage Viracept AIDS N/A No Coverage Viramune AIDS N/A No Coverage Viread AIDS N/A No Coverage Visken Hypertension

CHF N/AN/A


Vivitrol Alcohol / Drugs 2 years Standard Warfarin Pulmonary Embolism

ThrombosisNANA

PreferredPreferred

Cardiac Valve Replacement/ TIA/Stroke/Heart Attack

First Fill 2 years Standard

Cardiac Valve Replacement/ Stroke/Heart Attack

First Fill 3 yearsFirst Fill > 3 years


Xeloda Cancer 2 years3 years> 3 years


Xopenex Asthma N/A PreferredCOPD / Emphysema 2 years

3 years> 3 years


Zantac Stomach Disorder N/A Preferred Zaroxolyn Hypertension

CHF N/AN/A


Zebeta Hypertension CHF

N/AN/A


Zelapar Parkinson’s N/A Standard Plus Zemplar Kidney Dialysis


N/AN/AN/A


Zestoretic Hypertension CHF

N/AN/A


Zestril Hypertension CHF

N/AN/A


Ziac Hypertension CHF

N/AN/A


Zocor Cholesterol N/A Preferred Zoloft Depressive Disorder N/A Preferred Zyprexa Psychotic Disorder N/A Preferred NOTE: Proposed Insureds taking both a medication marked with an asterisk (*) representing "diabetes" and a number sign (#) representing "retinopathy, nephropathy, neuropathy" should answer question # 4 on the application as YES (Return of Premium section). Question #4 asks – “Have you ever been medically diagnosed or treated for complications of diabetes, including insulin shock, diabetic coma, retinopathy (eye), nephropathy (kidney), neuropathy (nerve damage/pain), or used insulin prior to age 50?”

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Peace of Mind Impairment GuideThe following list is intended as a guide to assist the agent in determining the appropriate plan of coverage for which the proposed insured should apply. It is not intended to replace the health questions on the life application as the ultimate means for determining client eligibility.

Condition/ Concern Criteria Plan to

Apply ForQuestion on App*

Activities of Daily Living Require assistance (from anyone) with bathing, dressing, eating, or toileting

No Coverage 1

AIDS / HIV Been medically treated or diagnosed by a medical professional as having

No Coverage 3

Alcoholism/ Alcohol Abuse

Within the past 2 years abused alcohol or had, or been recommended to have, treatment or counseling for alcohol use or been advised to discontinue use of alcohol

Standard 7d

Alzheimer’s disease Been medically diagnosed No Coverage 2Amputation Have had an amputation caused by disease No Coverage 1Amyotrophic Lateral Sclerosis (ALS) / (Lou Gehrig's Disease)

Been medically diagnosed No Coverage 2

Aneurysm Within the last 2 years Standard 7bMedically diagnosed or treated, or hospitalized within the past 3 years

Standard Plus 8a

Angina (Chest Pain)

Medically diagnosed or treated within the past 2 years Standard 7aMedically diagnosed or treated, or hospitalized within the past 3 years Standard Plus 8a

Angioplasty Within the past 2 years Standard 7bWithin the past 3 years Standard Plus 8a

Bed Confinement Currently confined to a bed No Coverage 1Cancer/ (excluding basal cell skin cancer)

Currently have cancer No Coverage 1More than one occurrence in a lifetime Standard 5Within the past 2 years been medically diagnosed, treated, or taken medication for any form of cancer

Standard 7c

Within the past 3 years been medically diagnosed or treated, or hospitalized for or taken medication for any form of cancer

Standard Plus 8b

Cardiomyopathy Have ever been medically diagnosed, treated for Standard 7aCatheterization (Heart) Within the past 2 years Standard 7bChronic Bronchitis See Chronic Obstructive Pulmonary Disease (COPD).Chronic Hepatitis Medically diagnosed or treated within the past 2 years Standard 7aChronic Kidney Disease Diagnosed, treated or taken medication for Standard 5Chronic Pancreatitis Medically diagnosed or treated within the past 2 years Standard 7aChronic Obstructive Pulmonary Disease (COPD)

Medically diagnosed or treated within the past 2 years Standard 7aBeen medically diagnosed or treated, or hospitalized for, or taken medication for within the past 3 years

Standard Plus 8b

Circulatory Surgery Within the past 2 years Standard 7bWithin the past 3 years Standard Plus 8a

Cirrhosis of the Liver Medically diagnosed or treated within the past 2 years Standard 7aMedically diagnosed or treated, or hospitalized within the past 3 years

Standard Plus 8b

Congestive Heart Failure (CHF)

Been medically diagnosed No Coverage 2

Coronary Artery Bypass Surgery

Within the last 2 years Standard 7bWithin the past 3 years Standard Plus 8a

Defibrillator Inserted within the past 2 years Standard 7bDementia Been medically diagnosed No Coverage 2Diabetes Combined with any medical history of any of the following:

Retinopathy, Nephropathy, NeuropathyStandard 4

Taken Insulin shots prior to age 50 Standard 4Treated for insulin shock or diabetic coma Standard 4

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Condition/ Concern Criteria Plan to

Apply ForQuestion on App*

Diagnostic Testing, Surgery, or Hospitalization

Recommended within the past 2 years by a medical professional which has not been completed or for which the results have not been received

Standard 6

Drug Abuse / Addiction Used illegal drugs or abused drugs or had been recommended to have treatment or counseling for drug use or been advised to discontinue use of drugs within the past 2 years

Standard 7d

Emphysema See Chronic Obstructive Pulmonary Disease (COPD)Heart Attack Within the past 2 years Standard 7b

Within the past 3 years Standard Plus 8aHeart Surgery Had or been medically advised to have within the past 2 years Standard 7b

Medically diagnosed or treated, or hospitalized within the past 3 years Standard Plus 8aHepatitis C Medically diagnosed or treated within the past 2 years Standard 7a

Been medically diagnosed or treated, or hospitalized for, or taken medication for within the past 3 years

Standard Plus 8b

Home Health Care Currently receiving No Coverage 1Hospice Care Currently receiving No Coverage 1Hospitalization Currently hospitalized No Coverage 1Kidney Dialysis Had or been medically advised to have No Coverage 2Kidney Failure Medically diagnosed, treated or taken medication for Standard 5Liver Disease Medically diagnosed, treated or taken medication for liver failure No Coverage 2

Been medically diagnosed or treated, or hospitalized for, or taken medication for within the past 3 years

Standard Plus 8b

Mental Incapacity Been medically diagnosed No Coverage 2Multiple Sclerosis (MS) Been medically diagnosed or treated, or hospitalized for within the

past 3 yearsStandard Plus 8c

Muscular Dystrophy Been medically diagnosed or treated, or hospitalized for within the past 3 years

Standard Plus 8c

Nursing Facility Currently confined No Coverage 1Organ Transplant Had or been medically advised to have No Coverage 2Oxygen Equipment Currently used to assist in breathing No Coverage 1

Have been required to use oxygen equipment to assist in breathing within the past 2 years

Standard 7a

Pacemaker Inserted within the past 2 years Standard 7bParalysis Been medically diagnosed or treated, or hospitalized for paralysis of

two or more extremities within the past 3 yearsStandard Plus 8c

Parkinson's Disease Been medically diagnosed or treated, or hospitalized for within the past 3 years

Standard Plus 8c

Renal Insufficiency Diagnosed, treated or taken medication for Standard 5Respiratory Failure Been medically diagnosed No Coverage 2Seizures Been medically diagnosed or treated, or hospitalized for within the

past 3 yearsStandard Plus 8c

Stroke Medically diagnosed within the past 2 years Standard 7aMedically diagnosed or hospitalized within the past 3 years Standard Plus 8a

Systemic Lupus (SLE) Been medically diagnosed, treated for within the past 2 years Standard 7aTerminal Medical Condition or End Stage Disease

Been diagnosed or treated with condition that is expected to result in death in the next 12 months

No Coverage 2

TIA (Transient Ischemic Attack)

Medically diagnosed within the past 2 years Standard 7aMedically diagnosed or hospitalized within the past 3 years Standard Plus 8a

Ulcerative Colitis Medically diagnosed or treated, or hospitalized for or taken medication for within the past 3 years

Standard Plus 8b

Wheelchair Use Currently confined to a wheelchair due to chronic illness or disease No Coverage 1* Applies to standard life application Form No. 9466. The question numbers on some state specific applications

may vary. Refer to the State Specifics section of this Agent Guide for plan availability.

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Peace Of Mind Super Preferred

Annual Premiums Per $1,000 of Insurance(Add $60 Annual Policy Fee)

IssueAge

Non-TobaccoMale Female

50 31.01 25.9451 32.83 27.9052 34.50 29.0653 36.82 30.6054 38.52 32.0755 39.58 33.1956 41.15 34.2657 42.21 35.4758 44.37 36.4859 46.10 37.7960 44.82 35.7261 47.30 37.6062 49.78 39.4763 53.46 41.8964 57.14 44.3165 60.82 46.7366 64.50 49.1467 68.19 51.5668 71.81 54.2069 75.43 56.8470 79.05 59.4971 82.67 62.1372 86.29 64.7773 93.86 70.7474 101.43 76.7075 109.00 82.6776 116.57 88.6477 124.13 94.6178 136.11 103.4579 148.08 112.2980 160.06 121.1481 172.03 130.8282 184.01 143.3283 196.74 154.9584 209.48 167.4785 222.21 180.00

Premium Calculation Example: Male Non-Tobacco Age 65, Monthly, $20,000 ($60.82 X 20 + $60.00) X .088 = $112.32 per Month• Issue Ages — based on age last birthday• Modal Factors — Monthly: .088 / Quarterly: .262 / Semi-Annual: .519

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Peace Of Mind Preferred Plus


IssueAge

Non-TobaccoMale Female

50 32.64 27.3151 34.56 29.3752 36.31 30.5953 38.76 32.2154 40.55 33.7555 41.66 34.9456 43.31 36.0757 44.43 37.3358 46.71 38.3959 48.53 39.7860 49.91 40.9061 51.29 42.0062 53.89 43.6363 56.40 45.5364 59.36 47.5565 61.69 49.4866 65.82 52.5467 70.14 55.2368 74.82 58.2869 79.02 61.2970 82.26 64.3271 87.50 68.1772 93.00 72.2173 99.26 77.2974 106.24 82.0575 113.83 87.2276 122.40 93.0077 131.21 98.3078 142.86 104.9679 153.93 113.1680 165.48 122.4581 178.60 131.7482 192.90 141.9483 206.32 153.4484 221.30 165.9385 236.23 180.18


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Peace Of Mind Preferred


IssueAge

Non-Tobacco TobaccoMale Female Male Female

50 35.9 30.04 46.11 34.8151 38.02 32.30 48.16 35.9652 39.94 33.65 50.37 37.7953 42.64 35.43 52.86 39.8854 44.60 37.13 55.20 41.4255 45.82 38.43 57.56 43.7956 47.64 39.68 59.95 45.1757 48.88 41.07 62.34 47.2758 51.38 42.23 65.32 49.1059 53.39 43.76 67.75 51.0160 54.91 44.98 70.39 52.4261 56.42 46.21 74.91 55.0462 59.27 47.99 78.21 57.8363 62.04 50.08 81.29 60.8064 65.30 52.31 85.18 63.9365 67.86 54.43 89.23 66.9266 72.40 57.79 94.66 70.4667 77.15 60.76 99.69 74.1468 82.30 64.11 105.75 77.1169 86.92 67.42 111.81 82.4870 90.49 70.76 116.27 84.5271 96.25 74.98 123.15 88.9872 102.31 79.43 130.41 93.7073 109.18 85.02 138.62 99.0474 116.87 90.25 147.06 104.5475 125.22 95.94 157.80 111.5476 134.64 102.31 168.54 120.3177 144.33 108.13 179.79 128.3478 157.15 115.45 193.44 136.7479 169.32 124.47 204.90 148.7380 182.03 134.70 217.68 161.0981 196.46 144.92 231.34 175.5582 212.19 156.14 245.51 191.9883 226.95 168.78 263.18 209.2984 243.43 182.53 285.17 229.6885 259.86 198.21 309.83 252.54


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Peace Of Mind Standard Plus


IssueAge


50 42.88 33.79 64.75 42.1651 45.30 35.55 68.01 44.6052 47.71 37.30 71.28 47.0553 50.44 39.28 74.96 49.8254 53.17 41.27 78.65 52.5855 55.91 43.24 82.34 55.3656 58.29 45.03 85.64 58.4257 60.81 46.93 89.11 61.6458 63.45 48.91 92.76 65.0159 66.22 50.99 96.57 68.5660 68.35 52.60 99.53 71.3161 72.00 55.35 104.56 75.9862 76.02 58.37 110.12 81.1363 80.17 61.50 115.84 86.4664 84.58 64.80 121.91 92.1065 89.23 68.30 128.34 98.0466 96.08 73.01 136.43 104.0467 103.55 78.16 145.25 110.5868 111.50 83.62 154.62 117.5369 120.05 89.52 164.72 123.3870 124.09 92.30 169.50 128.5771 132.50 98.08 179.43 136.6072 143.21 104.62 190.64 144.2373 154.22 112.12 203.51 153.7874 165.79 121.18 218.56 162.7675 177.63 129.16 232.71 175.4376 192.00 138.80 253.59 186.4177 210.41 150.37 273.53 193.3578 230.23 165.24 293.18 206.9579 250.61 179.01 316.27 221.6280 271.87 194.98 334.89 240.1581 288.62 211.51 338.13 255.4582 303.60 228.03 342.82 275.9983 317.26 243.45 348.11 297.6284 329.38 257.77 359.42 322.3485 334.06 265.76 384.73 351.69


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Peace Of Mind Standard


IssueAge


50 48.89 39.38 72.24 45.0451 51.21 41.52 75.95 47.6652 53.54 43.66 79.65 50.2953 56.17 46.08 83.86 53.2654 58.80 48.50 88.08 56.2355 61.41 50.95 92.26 59.2156 64.50 53.52 96.47 62.8757 67.77 56.21 100.90 66.7158 71.20 59.06 105.54 70.7659 74.79 62.03 110.42 74.9960 77.56 64.32 114.18 78.2561 82.30 68.25 120.60 83.8362 87.53 72.56 127.68 89.9763 92.91 77.02 134.99 96.3364 98.61 81.75 142.74 103.0565 104.65 86.75 150.92 110.1666 111.16 92.09 159.14 117.3567 118.26 97.90 168.10 125.1968 125.81 104.08 177.61 133.5369 133.94 110.74 187.87 142.5170 137.78 113.89 192.74 146.7771 145.77 120.44 202.82 155.5972 154.79 127.83 214.21 165.5673 165.14 136.31 227.27 176.9974 174.90 144.31 239.59 187.7875 188.65 155.60 256.95 202.9776 201.82 165.20 271.90 218.6777 219.93 171.28 281.37 228.6178 238.82 183.17 299.89 248.0779 258.44 196.02 319.88 269.0880 278.70 209.81 341.35 291.6381 296.10 225.63 365.98 317.5082 315.06 243.61 393.96 346.8983 335.28 262.54 423.43 377.8584 364.94 284.16 457.11 413.2285 400.16 309.83 497.10 455.24

Premium Calculation Example: Male Non-Tobacco Age 65, Monthly, $10,000 (104.65 X 10 + $60.00) X .088 = $97.37 per Month• Issue Ages — based on age last birthday• Modal Factors — Monthly: .088 / Quarterly: .262 / Semi-Annual: .519

peace of mind final expense

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