EquiCash UNDERWRITING GUIDE. Equitable &You. The Policy That Pays You Cash In The Event You Have To Be Hospitalized HOSPITAL PLAN
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1 UNDERWRITING GUIDE EquiCash HOSPITAL PLAN The Policy That Pays You Cash In The Event You Have To Be Hospitalized Rev. 10/13 Equitable &You... Committed To Caring
2 TABLE OF CONTENTS Contents Page EquiCash Underwriting Guide...2 General Information...2 Tips For Completing An Application...2 Replacement...3 Submitting The Application...3 Reinstatement Procedures...4 Uninsurable s...4 Cancer s...13
3 EQUICASH UNDERWRITING GUIDE We understand the importance agents place on having applications approved and issued as soon as possible! The Underwriting Division is committed to this goal and we will work with you through every step of the Underwriting process to achieve it. Please review this Underwriting Guide carefully. It has been designed to help you to complete an application and help you understand the process of Underwriting and the procedures used to underwrite an EquiCash Cash Supplement policy. GENERAL INFORMATION Eligibility: Age 50 through age 85. The age is determined as of the date the application was signed even if there is an age change before a policy is issued. Age of the application: Applications must be received in the Home Office within 14 days of the date signed. Application Date: The application date MUST be the date the application was signed. Backdated applications will NOT be accepted. Effective Dates: Policy effective dates will usually be the application date. You may request effective dates up to 60 days past the application date. No backdating is allowed (i.e., the effective date can never be before the application date.) Signature on the Application: The agent must personally ask and record all answers to the application questions. No other person, including the spouse, may sign on behalf of an applicant. The agent must personally witness the applicant s signature. We do not accept Power of Attorney signatures. C.O.D Business: Equitable does not accept C.O.D business. TIPS FOR COMPLETING AN APPLICATION It is important to complete the application in its entirety because it becomes the basis for the policy (which is a legal contract). If the applicant answers yes to any of the medical questions, the policy will be declined; do not submit the application. Always: Ask each question, exactly as written (don t paraphrase). Record each answer exactly as given. Complete the application legibly and in black ink. Have each applicant initial and date any corrections or mistakes. Use an additional sheet to record any pertinent information you feel would be helpful in evaluating the risk. Have the applicant sign and date any additional sheets. Page 2
4 TIPS FOR COMPLETING AN APPLICATION (CONT.) Never: Use white out or similar substances for corrections or mistakes. Lead" the applicant when they are responding to a question. Ask a general question (i.e. Are you in good health? ) and then answer all of the medical questions on the application as no. Complete an application by telephone or correspondence. The writing agent must be present at the time of application. Allow someone other than the applicant to answer the application questions, unless it is a parent speaking for a child. Answer questions with ditto marks (") or dashes (-). Answer questions with N/A (not applicable). Use abbreviations unless you are sure they are correct. REPLACEMENT If this policy is replacing any other accident and sickness insurance policy, record the policy number and company name on the application, and complete and include a Replacement Notice with the application. SUBMITTING THE APPLICATION The following is required for the EquiCash Cash Supplement application: Page 3 Application Premium (including the $25 application fee) Replacement form if replacing any accident and sickness insurance policy (if required in your state) Notice of Our Privacy Policy/Health Information Authorization (HHA & HPN) Medicare Duplication Notice (MDN-10) There may be other forms not listed above that are required in your state. Drafting the Initial Premium Rather than submitting premium with the application, an agent can request to draft the initial monthly premium in the Premium Payment section of the application. When this is selected, unless indicated otherwise, the first premium will be drafted when the policy is issued. Please note: the first premium is drafted when the policy is issued, regardless if the requested effective date is beyond the issue date. Rather than mailing an application, you can use two other methods to reduce time: 1. Fax the application to Use the Upload Applications feature on front page of the website. This is an easy-to-use feature that allows you to upload a copy of a scanned application. Once we receive the faxed or uploaded application, that application will be processed with that day s business received. The original application and premium must be received at the Home Office within 7 days. Upload Applications We will accept your scanned applications in either TIFF images or PDF's of the application. [ click here for multiple files ] Submit
5 REINSTATEMENT PROCEDURES All policies have a standard 31-day grace period followed by a 15-day conservation period. After 31 days, reinstatement applications will be accepted for up to one hundred and fifty (150) days from the date the policy lapsed. After one hundred and fifty (150) days, a new application will have to be completed and approved before a new policy will be issued. For more information, contact the EquiCenter at If the applicant has taken any of the medications listed below in the past 2 years for the specific condition listed, do not submit the application. Applicants who have taken any of these medications for the related condition in the past 2 years are automatically declined. UNINSURABLE MEDICATIONS Abacavir sulfate...hiv/aids Accolate...COPD AccuNeb...COPD Accupril...Congestive heart failure Accuretic...Congestive heart failure Aceon...Heart disease Acetazolamide...Congestive heart failure Actimmune...Organ transplant Adalat...Heart disease Adrenalin...COPD Advair...COPD AeroBid...COPD Aerolate...COPD Aggrenox...CVA (stroke) Airet...COPD Akineton...Parkinson s Albuterol...COPD Aldactazide...Congestive heart failure Aldactone...Congestive heart failure Altace...Congestive heart failure/heart disease Alupent...COPD Amantadine...Parkinson s Amiloride...Congestive heart failure Aminophylline...COPD Amiodarone...Heart disease Amlodipine...Heart disease Amyl Nitrite...Heart disease Antabuse...Alcoholism Apresoline...Congestive heart failure/heart disease Aprida > 50 units per day...diabetes Aptivus...HIV/AIDS Aricept...Alzheimer s, Dementia Artane...Parkinson s Atacand...Congestive heart failure Atenolol...Congestive heart failure Page 4
6 Atripla...HIV/AIDS Atrovent...COPD Avonex...Multiple sclerosis Azasan...Organ transplant Azathioprine...Organ transplant Azmacort...COPD Baclofen...Multiple sclerosis Becaplermin...Skin ulcer Beclomethasone...COPD Beclovent...COPD Beconase...COPD Bendroflumethiazide...Congestive heart failure Benztropine Mesylate...Parkinson s Bepridil...Heart disease Betapace...Heart disease Betaseron...Organ transplant Biperiden...Parkinson s Bisoprolol...Congestive heart failure Blocadren...Heart disease Brethine...COPD Bricanyl...COPD Bromocriptine...Parkinson s Brondelate...COPD Bronkosol...COPD Bumetanide...Congestive heart failure Bumex...Congestive heart failure Campral...Alcohol abuse Capoten...Congestive heart failure/heart disease Captopril...Congestive heart failure/heart disease Carbidopa...Parkinson s Cardene...Heart disease Carvedilol...Congestive heart failure/heart disease CellCept...Organ transplant Chlorothiazide...Congestive heart failure Choledyl...COPD Chymotrypsin...Organ transplant Cilostazol...Peripheral Vascular Disease Clopidogrel...CVA (stroke) Cogentin...Parkinson s Cognex...Alzheimer s, Dementia Combivent...COPD Combivir...HIV/AIDS Comtan...Parkinson s Copaxone...Multiple sclerosis Cordarone...Heart disease Coreg...Congestive heart failure/heart disease Page 5
7 Corgard...Heart disease Corzide...Heart disease Coumadin...CVA (stroke)/peripheral vascular disease Covera...Heart disease Creon...Pancreatitis Crixivan...HIV/AIDS Cromolyn...COPD Cyclosporine...Organ transplant Cymbalta...Diabetic neuropathy DG COPD Demadex...Congestive heart failure Depade...Substance abuse Diamox...Congestive heart failure Didanosine...HIV/AIDS Digitek...Congestive heart failure/heart disease Digoxin...Congestive heart failure/heart disease Dilatate...Heart disease Dilor...COPD Diovan...Congestive heart failure Dipradam...Heart disease Dipyridamole...Heart disease Disulfiram...Alcoholism Dofetilide...Heart disease Donepezil...Alzheimer s/dementia Dopar...Parkinson s Duloxetine...Diabetic neuropathy DuoNeb...COPD Dyflex...COPD Dylix...COPD Dyphylline...COPD Dyrenium...COPD Ed-Bron...COPD Efavirenz...HIV/AIDS Eldepryl...Parkinson s Elixophyllin...COPD Emtriva...HIV/AIDS Enalapril...Congestive heart failure Enalaprilat...Congestive heart failure Enduron...Congestive heart failure Entacapone...Parkinson s Ephedrine...COPD Epinephrine...COPD Epivir...HIV/AIDS Epogen...Kidney failure Epzicom...HIV/AIDS Ergoloid Mesylate...Alzheimer s/dementia Page 6
8 Esidrix...Congestive heart failure Ethmozine...Heart disease Exelon...Alzheimer s/dementia Felodipine...Peripheral Vascular Disease/CVA (stroke) Flecainide...Heart disease Flovent...COPD Flumazenil...Substance abuse Flunisolide...COPD Foradil...COPD Fortovase...HIV/AIDS Foscarnet...HIV/AIDS Fosinopril...Congestive heart failure Foscavir...HIV/AIDS Furosemide...Congestive heart failure Galantamine...Alzheimer s/dementia Gengraf...Organ transplant Hivid...HIV/AIDS Humalog > 50 units per day...diabetes Humulin > 50 units per day...diabetes Hydergine...Alzheimer s/dementia Hydralazine...Congestive heart failure/heart disease Hydrochlorothiazide...Congestive heart failure HydroDIURIL...Congestive heart failure Hydropres...Congestive heart failure Hylenex...Organ transplant Iletin > 50 units per day...diabetes Imdur...Heart disease Imuran...Organ transplant Indapamide...Congestive heart failure Inderal...Heart disease/congestive heart failure Inderide...Heart disease Indinavir...HIV/AIDS Infergen...Organ transplant InnoPran...Heart disease Insulin > 50 units per day...diabetes Intal...COPD Interfero...Organ transplant Intron...Organ transplant Invirase...HIV/AIDS Ipratropium...COPD Ismo...Heart disease Isoetharine...COPD Isoproterenol...COPD Isoptin...Heart disease Page 7
9 Isordil...Heart disease Isosorbide...Heart disease Isoxsuprine...Peripheral Vascular Disease Isuprel...COPD Jantoven...Peripheral vascular disease/heart disease/cva (stroke) Jay-Phyl...COPD Kaletra...HIV/AIDS Kemadrin...Parkinson s Ku-Zyme...Pancreatitis Lamivudine...HIV/AIDS Lanoxicaps...Heart disease/congestive heart failure Lanoxin...Heart disease/congestive heart failure Lantus > 50 units per day...diabetes Larodopa...Parkinson s disease L-Dopa...Parkinson s disease Lente > 50 units per day...diabetes Levatol...Heart disease Levemir > 50 units per day...diabetes Levodopa...Parkinson s Lexxel...Congestive heart failure Lioresal...Multiple sclerosis Lipase...Pancreatitis Lipram...Pancreatitis Lisinopril...Heart disease/congestive heart failure Lopinavir...HIV/AIDS Lopressor...Heart disease Lufyllin...COPD Lyrica...Diabetic neuropathy Maxair...COPD Memantine...Alzheimer s/dementia Metaproterenol...COPD Methyclothiazide...Congestive heart failure Metoprolol...Heart disease MicroNefrin...COPD Microzide...Congestive heart failure Midamor...Congestive heart failure Minitran...Heart disease Mirapex...Parkinson s Moduretic...Congestive heart failure Monoket...Heart disease Moricizine...Heart disease Mycophenolate mofetil...organ transplant Myfortic...Organ transplant Myotrophin...ALS/Lou Gehrig s disease Page 8
10 Nadolol...Heart disease Naloxone...Substance abuse Naltrexone...Substance abuse Namenda...Alzheimer s/dementia Narcan...Substance abuse Nelfinavir...HIV/AIDS Neoral...Organ transplant Neurontin...Neuropathy Nevirapine...HIV/AIDS Nicardipine...Heart disease Nifediac...Heart disease Nifedical...Heart disease Nifedipine...Heart disease Nitrek...Heart disease Nitro-Bid...Heart disease Nitro-Dur...Heart disease Nitrogard...Heart disease Nitroglycerin...Heart disease Nitrol...Heart disease Nitrong...Heart disease Nitro paste...heart disease Nitro patch...heart disease Nitropress...Heart disease NitroQuick...Heart disease Nitrostat...Heart disease NitroTab...Heart disease Nitro-Time...Heart disease Norpace...Heart disease Norvasc...Congestive heart failure Norvir...HIV/AIDS Novolin > 50 units per day...diabetes NovoLog > 50 units per day...diabetes Nylidrin...Peripheral Vascular Disease Orphenadrine...Parkinson s Orthoclone...Organ transplant Pacerone...Heart disease Palcaps...Pancreatitis Pancrease...Pancreatitis Pancreatin...Pancreatitis Pancrecarb...Pancreatitis Pancrelipase...Pancreatitis Panfil...COPD Panocaps...Pancreatitis Panokase...Pancreatitis Papaverine...Peripheral vascular disease Para-Time...Peripheral vascular disease Page 9
11 Parlodel...Parkinson s Paridol...Parkinson s Pentoxifylline...Peripheral vascular disease Pergolide...Parkinson s Permax...Parkinson s Persantine...Heart disease Plaretase...Pancreatitis Plavix...Peripheral vascular disease/cva (stroke) Plendil...Peripheral vascular disease Pletal...Peripheral vascular disease Pramipexole...Parkinson s Pregabalin...Diabetic neuropathy Prinivil...Heart disease/congestive heart failure ProAir...COPD Procainamide...Heart disease Procanbid...Heart disease Procardia...Heart disease Procyclidine...Parkinson s Prograf...Organ transplant Pronestyl...Heart disease Propafenone...Heart disease Propranolol...Heart disease Proventil...COPD Pulmicort...COPD Quibron...COPD Quinapril...Heart disease Quinidex...Heart disease Quinidine...Heart disease Qvar...COPD Ranexa...Heart disease Rapamune...Organ transplant Razadyne...Alzheimer s/dementia Rebif...Organ transplant Regranex...Skin ulcer Reminyl...Alzheimer s/dementia Renese...Kidney failure Requip...Parkinson s Rescriptor...HIV/AIDS Respbid...COPD Retrovir...HIV/AIDS Revatio...Heart disease Revex...Substance abuse ReVia...Substance abuse Rilutek...ALS/Lou Gehrig s disease Riluzole...ALS/Lou Gehrig s disease Ritonavir...HIV/AIDS Page 10
12 Rivastigmine...Alzheimer s/dementia Roferon...Organ transplant Romazicon...Substance abuse Ropinirole...Parkinson s Rythmol...Heart disease Saluron...Congestive heart failure Sandimmune...Organ transplant Saquinavir...HIV/AIDS Selegiline...Parkinson s Serevent...COPD Simulect...Organ transplant Sinemet...Parkinson s Singulair...COPD Slo-Bid...COPD Slo-Phyllin...COPD Sotalol...Heart disease Spiriva...COPD Spironolactone...Congestive heart failure Stavudin...HIV/AIDS Sustiva...HIV/AIDS Symmetrel...Parkinson s Tacrine...Alzheimer s/dementia Tambocor...Heart disease Tasmar...Parkinson s Tenofovir...HIV/AIDS Terbutaline...COPD Teveten...Congestive heart failure Thalitone...Cirrhosis Thalomid...Organ transplant Theo-24...COPD Theochron...COPD Theo-Dur...COPD Theolair...COPD Theolate...COPD Theomax...COPD Theophylline...COPD Thymoglobulin...Organ transplant Tiazac...Heart disease Ticlid...CVA (stroke) Ticlopidine...CVA (stroke) Tikosyn...Heart disease Tilade...COPD Timolide...Congestive heart failure/heart disease Tolcapone...Parkinson s Toprol...Heart disease Tornalate...COPD Page 11
13 Torsemide...Congestive heart failure T-Phyl...COPD Tracleer...Heart disease Trental...Peripheral vascular disease Triamcinolone...COPD Trihexyphenidyl...Parkinson s Trizivir...HIV/AIDS Truvada...HIV/AIDS Ultra caps...pancreatitis Ultrase...Pancreatitis Uniphyl...COPD Uniretic...Congestive heart failure Valcyte...HIV/AIDS Valsartan...Congestive heart failure Vanceril...COPD Vascor...Heart disease Vasodilan...Peripheral Vascular Disease Vasotec...Congestive heart failure Veldona...Organ transplant Velosulin > 50 units per day...diabetes Ventavis...Heart disease Ventolin...COPD Verapamil...Heart disease Verelan...Heart disease Videx...HIV/AIDS Viracept...HIV/AIDS Viokase...Pancreatitis Viramune...HIV/AIDS Viread...HIV/AIDS Vitrase...Organ transplant Vivitrol...Substance abuse Volmax...COPD VoSpire...COPD Warfarin...Peripheral vascular disease/cva (stroke) Wellferon...HIV/AIDS Wydase...Organ transplant Xolair...COPD Xopenex...COPD Zalcitabine...HIV/AIDS Zaroxolyn...Congestive heart failure Zebeta...Congestive heart failure Zenapax...Organ transplant Zerit...HIV/AIDS Page 12
14 Ziac...Congestive heart failure Ziagen...HIV/AIDS Zidovudine...HIV/AIDS Zyflo...COPD CANCER MEDICATIONS If the applicant has taken any of the medications listed below for the treatment of cancer in the past 2 years, do not submit the application. Applicants who have taken any of these medications in the past 2 years are automatically declined. If the applicant is applying for the First Occurrence Cancer Rider, and has taken any of the medications listed below for the treatment of cancer in the past 10 years, do not apply for the First Occurence Cancer Rider. Applicants who have taken any of these medications in the past 10 years are not eligible for the First Occurrence Cancer Rider. Abarelix Abraxane Adriamycin Adrucil Aldesleukin Alferon Alimta Alkeran Altretamine Anastrozole Aredia Arimidex Aromasin Arranon Arsenic trioxide Asparaginase Avastin BCG Bevacizumab Bexarotene Bexxar Bicalutamide BiCNU Blenoxane Bleomycin Campath Camptosar Capecitabine Capromab pendetide Carac Carboplatin Carmustine Casodex CeeNU Cerubidine Cetuximab Cinacalcet Cisplatin Cladribine Clolar Cosmegen Cytarabine Cytomel Cytosar Cytoxan Dacarbazine Dactinomycin Dasatinib DaunoXome Daunorubicin Delatestryl Denileukin Diftitox DepoCyt Docetaxel Doxil Doxorubicin DTIC-dome Efudex Eligard Ellence Eloxatin Elspar Emcyt Epirubicin Erbitux Erlotinib Estramustine Etopophos Etoposide Eulexin Exemestane Fareston Faslodex Femara Floxuridine Fludara Fludarabine phosphate Fluoroplex Fluorouracil Flutamide FUDR Fulvestrant Gefitinib Gemcitabine Gemzar Gleevec Gliadel Goserelin Herceptin Hexalen Histrelin Hycamtin Hydrea Hydroxyurea Idamycin Idarubicin Ifex Ifex/Mesnex Ifosfamide Imatinib Interferon Intron Iressa Irinotecan Ketoconazole Lapatinib Letrozole Leucovorin Leukeran Leuprolide Leustatin Levamisole Liothyronine Page 13
15 Page 14 CANCER MEDICATIONS (CONT.) Liotrix Lomustine Lupron Lysodren Matulane Mechlorethamine Megace Megestrol Melphalan Menest Meprolone Mercaptopurine Methitest Methotrexate Methoxsalen Mithracin Mitomycin Mitoxantrone Mustargen Mutamycin Mylocel Mylotarg Navelbine Neosar Neulasta Nexavar Nilandron Nilutamide Nipent Nizoral Nolvadex Novantrone Octreotide Oncaspar Ontak Onxol Oxaliplatin Paclitaxel Pamidronate Panretin Paraplatin Pegfilgrastim Pemetrexed Photofrin Plenaxis Porfimer Prelone Procarbazine Proleukin ProstaScint Purinethol Quadramet Raloxifene Rheumatrex Rituximab Rituxan Roferon Rubex Samarium Sensipar Soltamox Sorafenib Sprycel Stilphostrol Streptozocin Sunitinib Supprelin Sutent Tamoxifen Tarceva Targretin Taxol Taxotere Temodar Temozolomide Temsirolimus Teniposide Teslac Testolactone Testopel TheraCys Thiotepa Thyrogen Thyrolar Thyrotropin Tice BCG Toposar Topotecan Toremifene Trastuzumab Trelstar Tretinoin Trexall Triamcinolone Triptorelin pamoate Trisenox Tykerb Uvadex Vantas Velcade VePesid Vesanoid Viadur Vinblastine Vincasar Vincristine Vinorelbine Vumon Xeloda Zanosar Zevalin Zoladex Zoledronic acid Zometa
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