1. Underwriting and common Medical conditions

2. Considerations -Type and amount of coverage -Type and amount of coverage -Many carriers have table shaving programs for permanent insurance -Term is not as flexible -Duration of necessary death benefit -Affordability -Potential change in current class, i.e. 5 or 10 years past last cancer treatment

3. Tobacco Use Any cigarette smoking in the past year is always rated as “tobacco” Any cigarette smoking in the past year is always rated as “tobacco” Many carriers, but not all, allow occasional or ceremonial cigar smoking. The limits vary from no more than 1 per week-10 per year. Many carriers, but not all, allow occasional or ceremonial cigar smoking. The limits vary from no more than 1 per week-10 per year. Must have “clean” nicotine screen Must have “clean” nicotine screen After one year, standard non-tobacco, 3 years preferred, 5 years preferred plus. After one year, standard non-tobacco, 3 years preferred, 5 years preferred plus.

4. Better Solution Lincoln Financial and Prudential allow tobacco use, other than cigarettes to be non-smoker standard or standard plus. Lincoln Financial and Prudential allow tobacco use, other than cigarettes to be non-smoker standard or standard plus. May use nicotine substitutes (Nicorette, the patch, etc.), chewing tobacco, or cigars. May use nicotine substitutes (Nicorette, the patch, etc.), chewing tobacco, or cigars. May have positive nicotine screen May have positive nicotine screen Must have not smoked cigarettes in the past year. Must have not smoked cigarettes in the past year.

5. Another Option John Hancock offers a unique “Quit Smoking Incentive” on permanent products. John Hancock offers a unique “Quit Smoking Incentive” on permanent products. Receive non-tobacco or non tobacco referred class today. Receive non-tobacco or non tobacco referred class today. If, by the 3 rd policy anniversary, there is satisfactory evidence of smoking cessation for at least 12 months, they keep the non- tobacco class. If, by the 3 rd policy anniversary, there is satisfactory evidence of smoking cessation for at least 12 months, they keep the non- tobacco class. Otherwise, back charges are assessed at the appropriate tobacco class. Otherwise, back charges are assessed at the appropriate tobacco class.

6. Diabetes One of the most common conditions we come across today. One of the most common conditions we come across today. Gestational diabetes is a postpone, and usually will have no long-term impact on underwriting. Gestational diabetes is a postpone, and usually will have no long-term impact on underwriting. Control of diabetes is top concern of underwriters. Control of diabetes is top concern of underwriters. If diabetes is diagnosed from Paramed blood work, policy will be postponed. If diabetes is diagnosed from Paramed blood work, policy will be postponed.

7. Underwriting Diabetes We will always need the following information to start. We will always need the following information to start. Age of onset (how old was the PI when first diagnosed). Age of onset (how old was the PI when first diagnosed). A1C marker-Every diabetic will or should know this. It exhibits long term control by measuring average glucose levels. A1C marker-Every diabetic will or should know this. It exhibits long term control by measuring average glucose levels. Medications Medications Other risk factors, such as build, heart disease, tobacco use, cancer history, elevated kidney function tests and circulatory issues. Other risk factors, such as build, heart disease, tobacco use, cancer history, elevated kidney function tests and circulatory issues.

8. Diabetes continued Juvenile onset, before age 30 is more severe. Juvenile onset, before age 30 is more severe. Insulin dependency will always carry a rating. Insulin dependency will always carry a rating. Adult onset, type II diabetes, with good control (A1C below 6.5) may result in standard offers, and in rare cases preferred. Adult onset, type II diabetes, with good control (A1C below 6.5) may result in standard offers, and in rare cases preferred. Client must exhibit good control with blood work, and regular follow-up visits to doctor. Client must exhibit good control with blood work, and regular follow-up visits to doctor. Diabetics who smoke, are obese, who have numbness in the extremities, or have impaired kidney function will be declined. Diabetics who smoke, are obese, who have numbness in the extremities, or have impaired kidney function will be declined.

9. Cancer Cancer is a much wider and varying issue, due to the many types and differing severities. Cancer is a much wider and varying issue, due to the many types and differing severities. Some skin cancers such as Basil Cell are a non issue. Some skin cancers such as Basil Cell are a non issue. Others cancers require 10 years from the last treatment to be considered for standard. Others cancers require 10 years from the last treatment to be considered for standard. It is important to gather as much specific information as possible to obtain an accurate underwriting estimate. It is important to gather as much specific information as possible to obtain an accurate underwriting estimate.

10. Underwriting Cancer History Specific type and location Specific type and location Stage of cancer, and size of tumor Stage of cancer, and size of tumor Treatment and prognosis Treatment and prognosis Did the cancer metastasize (spread to surrounding tissue or lymph nodes)? Did the cancer metastasize (spread to surrounding tissue or lymph nodes)? For prostate cancer, you will need PSA at the time of diagnoses, current PSA and Gleason score For prostate cancer, you will need PSA at the time of diagnoses, current PSA and Gleason score

11. Cancer continued Elapsed remission time is calculated from the last treatment. Elapsed remission time is calculated from the last treatment. If the client can provide a Path report, this will provide the most detailed information, and be the most helpful tool. If the client can provide a Path report, this will provide the most detailed information, and be the most helpful tool. Some cancers, especially prostate cancer in older clients, and stage 1 cancers, can be standard after 5-7 years. Some cancers, especially prostate cancer in older clients, and stage 1 cancers, can be standard after 5-7 years. Typically no consideration of coverage in the first 3 years, at any class. Typically no consideration of coverage in the first 3 years, at any class.

12. Family History Family history is often overlooked when quoting class. Family history is often overlooked when quoting class. If there is a death of either parent, before age 65, from cardiovascular disease, no preferred class is available. I have seen 3 exceptions in the past 5 years, for clients with exceptional health. If there is a death of either parent, before age 65, from cardiovascular disease, no preferred class is available. I have seen 3 exceptions in the past 5 years, for clients with exceptional health. Some carriers will use age 60 instead of 65. Some carriers will use age 60 instead of 65.

13. Family History Continued Most carriers will also include cancer, and preclude any PI with a parent who died of cancer before age 65 from being preferred. Most carriers will also include cancer, and preclude any PI with a parent who died of cancer before age 65 from being preferred. Exceptions are Lincoln, Pru and ING. Lincoln adds deaths from diabetes before age 65, in lieu of cancer deaths. Exceptions are Lincoln, Pru and ING. Lincoln adds deaths from diabetes before age 65, in lieu of cancer deaths.

14. Build Each carrier has their own version of a height/weight or build chart. Each carrier has their own version of a height/weight or build chart. Lincoln uses BMI as well as height/weight, which may be helpful. Lincoln uses BMI as well as height/weight, which may be helpful. Some carriers like Pru have Unisex build tables, which are very favorable for women. Some carriers like Pru have Unisex build tables, which are very favorable for women. Clients who are approximately 10% over the standard weight guideline, may receive standard on permanent insurance, with table shaving. Clients who are approximately 10% over the standard weight guideline, may receive standard on permanent insurance, with table shaving.

15. Cardiovascular disease/ Heart Attack Most will not be considered for coverage within 3 years of MI, or surgery. Most will not be considered for coverage within 3 years of MI, or surgery. What was the diagnoses and treatment. What was the diagnoses and treatment. Medications Medications Lifestyle changes, weight loss etc. Lifestyle changes, weight loss etc. Clients who continue to smoke are a poor risk Clients who continue to smoke are a poor risk Current blood pressure and cholesterol Current blood pressure and cholesterol Build Build

16. Cardiovascular disease continued Obtain current test results such as echo cardiogram, PET, Thallium stress test etc. Obtain current test results such as echo cardiogram, PET, Thallium stress test etc. For clients who had angioplasty, obtain cath report. For clients who had angioplasty, obtain cath report. Ratings will depend on age, severity, treatment, current test results, and length of time elapsed. Ratings will depend on age, severity, treatment, current test results, and length of time elapsed. Mild cases can be table 4-6 after 3-5 years, and standard after 10 years. Mild cases can be table 4-6 after 3-5 years, and standard after 10 years.

17. Other Common Conditions Rheumatoid arthitis-Typically rated 4-6 tables due to the long-term effects of the steroidal, and biological medications used for control. Rheumatoid arthitis-Typically rated 4-6 tables due to the long-term effects of the steroidal, and biological medications used for control. Depression-Mild depression with mild meds such as Lexapro or Prozac are typically standard, and occasionally preferred. Depression-Mild depression with mild meds such as Lexapro or Prozac are typically standard, and occasionally preferred. Ulcerative Colitis-Typically 4 tables depending on control and frequency of attacks. Ulcerative Colitis-Typically 4 tables depending on control and frequency of attacks.

18. Other common conditions continued Atrial Fibulation-Depends on severity of arrhythmia, frequency, age of first attack, cause, etc. Average is table 4 Atrial Fibulation-Depends on severity of arrhythmia, frequency, age of first attack, cause, etc. Average is table 4 Asthma-Occassional or frequent? Mild, moderate or severe? Smoker? Medications? Can be standard or even preferred in mild cases. Asthma-Occassional or frequent? Mild, moderate or severe? Smoker? Medications? Can be standard or even preferred in mild cases. Hepatitis-Age, Hep A, B or C? Any alcohol use? Can be standard if in remission and liver function tests are normal. Hepatitis-Age, Hep A, B or C? Any alcohol use? Can be standard if in remission and liver function tests are normal.

19. Key Factors Manage client expectations. Manage client expectations. Gather the facts Gather the facts Call and discuss the case to get an estimate of class Call and discuss the case to get an estimate of class Consider permanent insurance vs. term Consider permanent insurance vs. term Potentially submit multiple apps Potentially submit multiple apps We have the experience and expertise to manage the process and get your clients the best result. We have the experience and expertise to manage the process and get your clients the best result.

20. Conclusion Please call or e-mail Please call or e-mail Tom at (714) 743-8428, tom@cammaranois.com or or Corine at (714) 745-9741 corine@cammaranois.com to obtain quotes, discuss case design or for underwriting questions.

21. THANK YOU Questions