INDIVIDUAL AGENT GUIDELINES
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- Edwina Chandler
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1 OVERVIEW The following agent guidelines should be used as a reference tool only to the probable underwriting outcome for the enclosed listed conditions. The listed conditions are the most commonly seen conditions and do not include every condition. Also, each application is considered based on its own medical risk characteristics. As a result, the underwriting outcome may vary from the guidelines shown. No coverage is in force, or rating final, until written approval for the product sold with rates from an Avalon Healthcare Underwriter is given. The Agent guidelines are intended for use only by agents appointed with Avalon Healthcare. BELOW IS YOUR KEY TO UNDERSTANDING THE MEANING OF POSSIBLE UNDERWRITING ACTIONS NOTED IN THIS AGENT GUIDE. : The application will be given Individual Consideration by the Underwriter and/or Medical Director. : This indicates that the applicant can be approved for coverage using Avalon Healthcare s standard premium tables without any exclusionary riders or premium surcharges. Rate-Up (numerical value): This indicates the possible medical (and/or Optional Rider) premium rating range that may be required for the medical condition. This numerical value is the percentage of the required premium increase over and above the standard premium. Rider: This indicates that an exclusionary rider is required to exclude coverage from the policy for the specific medical condition indicated or for the part of the anatomy affected by the medical condition. Decline: This indicates that due to the severity of the medical condition indicated, no offer of coverage can be extended and the applicant will be declined. Ineligible Occupation List (frequently seen but not limited to this list) Actors, Actresses, Entertainers, Escort Services, Strippers, Models and Stunt Men Asbestos and Toxic Chemical Workers Athletes (Semi-pro and professional) Aviation (high-risk - experimental or test pilots, aerial photographers, etc.) and Crop Dusters Circus and Carnival Workers Demolition, Explosive and Wrecking Workers Divers (professional skin, SCUBA or underwater excavators) Drivers (mining, racing, testing and explosive hauling) Fisherman - Commercial /Overnight Massage Parlors (exception to certified massage therapists) Meat Packing and Slaughterhouse Workers Migrant Workers Mining - Underground Oil Rig, Natural Gas Workers and On or Off-Shore Drilling Rodeo Participants Structural Steel and Iron Workers and Steeple Jacks Tattoo Artist/Tattoo Parlor Owners Tunnel and Caisson Workers INELIGIBLE BEHAVIOR OR HISTORY Alcohol dependence, abuse or addiction any time over the past 5 years Drug Dependence any time over the past 7 years Felony Convictions the longer of 5 years since conviction or three years since confinement TOBACCO USAGE used in the last 5 years RATE UP Based on age, deductible and coinsurance amounts 5-20% AVAiag-26
2 ADULT MALE BUILD CHART HEIGHT NORMAL OVERWEIGHT Percentage Rate-Up Ft. In. Std 15% 25% 40% 60% DECL HEIGHT ADULT FEMALE BUILD CHART (average Rate-Up will vary by age) NORMAL OVERWEIGHT Percentage Rate-Up Ft. In. Std 15% 25% 40% 60% DECL
3 Addison's Disease AIDS, ARC or HIV Allergy Test in progress % Weekly shots % Bi-weekly shots 15-75% Monthly shots 7-35% Seasonal shots 5-25% Anaphylaxis reaction requiring epinephrine % Non-prescription drugs ALS Alzheimer's Disease 79%-Decline Anemia, Alpastic Aneurysm Angina Pectoris Anorexia Nervosa Arteriosclerosis Asthma - mild-moderate; one inhaler 12-60% Asthma - severe Attention Deficit Disorder severe or w/counseling or behavioral problem 16-80% Attention Deficit Hyperactivity Disorder - mild-moderate 8-40% Attention Deficit Hyperactivity Disorder - severe 16-80% Autism 15-75% Baker's Cyst - present 50%-Decline Bartholin s Cyst - present Basal Cell Carcinoma - present 50%-Decline Basal Cell Carcinoma - (single incident), recovered 10-50% Bell's Palsy - present Benign Prostatic Hypertrophy (PSA normal) % Bipolar Disorder Blepharitis/Blepharospasm - (unoperated) 40%-Decline Bone Marrow Transplant Bone Spur - (unoperated) % Breast Implants - (saline implants>2yrs) Bronchitis - (<2 weeks/yr) 15-25% Bruit - (ultrasound or ct negative) Other Buerger's Disease Bulimia % Bunions or Hammer Toes 10-75% Bursitis or Tendonitis - (resolved >3 yrs) Cancer Cardiac Pacemaker Cardiomyopathy Carpal Tunnel Syndrome - mild or resolved no future surgery 15-75% Cataracts Cerebral Palsy Cholecystitis - (no surgery) % Cholecystolithiasis - (gallstones) present % Chronic Fatigue - present Cirrhosis of the Liver Colitis, Ulcerative - present Colon Polyps - present Colon Polyps - (removed) 15%-Decline Combined System Disease Condyloma Acuminatum - multiple episodes 5-25% w/rec. 1 yr., no other 's Congestive Heart Failure Coronary Artery Disease Coronary Bypass Surgery Crohn's Disease
4 Cyst-pilonidal - sebaceous or Sublingual - present 5-25% Cystic Fibrosis Cystitis - (bladder infections) Degenerative Osteoarthritis Dementia Dermatomyositis Detached Retina Deviated Nasal Septum Diabetes Dislocation of Joint Diverticulosis Down's Syndrome Drug Abuse/Addiction - (last 10 yrs) Edema Emphysema Endocarditis Endometriosis Enlarged Lymph Nodes - (multi) Epilepsy Fetal Alcohol Syndrome Fibromyalgia 20%-Decline Functional Heart Murmurs Gangrene - (recovered >1 yr) Gastritis/Hyperactivity Gaucher's Disease GERD (Reflux Disease) - mild infrequent and stable symptoms,no prescription Rx, cause unknown GERD (Reflux Disease) - mild stable symptoms controlled w/prescription Rx, cause unknown, rate for medication GERD (Reflux Disease) - moderate stable symptoms, w/or w/o hernia, and no other complications, not recommended or anticipated surgery, controlled w/prescription Rx, rate for medication GERD (Reflux Disease) - severe, frequent sxs, uncontrolled, pending further workup Glaucoma Gout - mild -30% Headaches - (incl. migraines); once evaluation is completed Heart Attack/Disease Hemophilia Hemorrhoids Hepatitis Hernia - (asymptomatic) incidental finding only, abdominal or inguinal,no recommendation of surgery -30% Herniated Disc Disease/Back Disorders HIV Disease Hodgkin's Disease Huntington's Chorea Hydrocephalus Hypercholesterolemia - (controlled) -15% Hypertension (high blood pressure) - (controlled with medication) Hypertension (high blood pressure)- (uncontrolled) Hyperthyroidism - (w/o) goiter), controlled w/replacement med., diffused> 1 yr. since I-131 or operated, no other cond. Indigestion - occasional mild attacks, evaluation of symptoms fail to reveal cause Infertility Testing or Treatment - (w/in last 12 mos.) Irritable Bowel Syndrome - present complete recovery, mild 8-40% Irritable Bowel Syndrome - present complete recovery, mild 8-40%
5 Juvenile Arthritis Kidney Stones/Renal Calculi Kidney Stone - (one side only), passed spontaneously, single incident -30% Kidney Transplant Leukemia Lipoma (benign growth) - of the head, neck, arm, trunk, or leg; small (<5cm) asymptomatic -40% Liver Transplant Lupus Erythematosus Lymphoma Malignant Melanoma Marfan's Syndrome Menopausal Syndrome - mild Menstrual Disorders Mental Retardation Mental/Nervous Disorder Counseling - (current) Mitral Valve Prolapse - (asymptomatic), incidental finding, no other cardiac findings Multiple Sclerosis Muscular Dystrophy Myasthenia Gravis Myelofibrosis Myocardial Infarction Narcolepsy 40%-Decline Nephrosclerosis Organic Brain Syndrome Osteoarthritis Osteopenia/Osteoporosis Otitis Media Ovarian Cysts Pancreatitis Paralysis Parkinson's Disease - (non progressive or controlled) Pelvic Inflammatory Disease Pemphigus Peptic Ulcer Disease Phlebitis/Embolism Pulmonic Stenosis Pyelonephritis, Glomerulonephritis Rheumatoid Arthritis Sarcoidosis Scleroderma Sickle Cell Anemia Simmond's Disease Sinusitis - (chronic or acute), no other respiratory conditions Sleep Apnea Spinal Manipulation 4-12 visits per year, adequate investigation to rule out significant spinal disease or disorder Stroke (CVA, TIA) St. Vitus Dance Syncopal Spells - (unknown cause) Syphilis Tonsillitis (recurrent) Tuberculosis Uterine Bleeding/Fibroids Varicose Veins - mild, asymptomatic Ventricular Fibrillation Whipple's Disease Wilson's Disease Wiskott-Aldrich Syndrome Department reserves the right to determine the final disposition of the application
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