new business - solve ur puzzles...x-press testing is a method of assessing standard tobacco and...

New Business Team: Toll Free Phone: Fax: Toll Free Fax:Red Team............877-526-1482........605-373-8571........877-212-1057Green Team.........877-526-1523........605-373-8573........877-212-1703Blue Team............877-526-1522........605-335-7583........877-212-1704

ExpressLINE.....................800-533-1373Message Recorder.............800-843-9935Local Direct Line...............605-335-5700Administrative Office Fax.....877-208-6136 (All Areas Except New Business & Policy Change)

Policy Change Fax.............877-841-6710Policyowner.....................800-923-3223 (All Areas Except New Business)

Pending Business Report: Accessible 24 hours a day, seven days a week, at MidlandNational.com

Medical Reference Library: Reference for evaluating medical impairments, at MidlandNational.com

4379 2/13 FOR AGENT/REGISTERED REPRESENTATIVE USE ONLY. NOT TO BE USED FOR CONSUMER SOLICITATION PURPOSES.

4379 2/13 FOR AGENT/REGISTERED REPRESENTATIVE USE ONLY. NOT TO BE USED FOR CONSUMER SOLICITATION PURPOSES 1

Approved Paramedical ServicesUse an approved paramedical service for Traditional and Tele-Underwriting applications. These paramedical services provide a full range of services throughout the U.S. Examiners associated with approved paramedical organizations will be aware of Midland National requirements for the age and amount applied for. Advise your local examiner of the total amount of life insurance applied for and in force with Midland National, so requirements are completed accordingly. They will have the necessary supplies including the kits for blood and urine. If the service is not listed in your local telephone directory white pages, call the 800 number or visit the website for the paramedical services listed below.

X-Press Testing (Common Q & A – Refer to MidlandNational.com)

X-Press Testing is a method of assessing standard tobacco and standard non-tobacco risks for life insurance applicants. Through a single, painless sample, it allows the laboratory to check for drugs, nicotine use, and HIV.

Use the oral fluid test for cases applying for standard coverage only. X-Press can be used with both Traditional and Tele-Underwriting applications using age/amount guidelines. The agent collects the sample (at the time of the application) using a swab that is inserted between the cheek and lower gum for two minutes. The applicant then places the swab in a vial, and the agent mails it to the Preferred Lab.

CertificationIn order to collect the oral-fluid specimen, some very basic training (certification) is necessary. This training is available on Midland National’s website at MidlandNational.com. After logging in, select New Business from the menu and click X-Press Testing. X-Press Testing consists of reviewing a brief training script and completion of a certification quiz.

X-Press Limits Applies to Non-Preferred ClassesThe agent-collected oral fluid test is fast and easy to administer on standard cases not otherwise qualifying for preferred rates due to age, plan of insurance, weight, or medical history (for example: diabetes and high blood pressure). Use traditional or tele-underwriting requirements for Preferred and rated cases.

Amount Ages 16-35 Ages 36-50

$25,000to

$100,000

$100,001to

$300,000

Oral Fluid MVR

Oral FluidMVR

Oral Fluid MVR

Use Traditional Requirements or Tele-Underwriting

Requirements.

American Para Professional Systems, Inc. APPS® .....................(www.appslive.com) 800-727-2999

Examination Management Services, Inc. EMSI® ..................... (www.emsinet.com) 800-872-3674

ExamOne ExamOne ................ (www.examone.com) 800-768-2061

Portamedic/Hooper Holmes Portamedic ...........(www.portamedic.com) 866-335-5575

Superior Mobile Medics Superior ..(www.superiormobilemedics.com) 800-898-3926

Approved Lab (blood, urine, and oral fluid):Clinical Reference® Laboratory CRL .................. (www.crlcorp.com) 800-882-1922

Form 7608 is available from Supply Online for clients to request lab test results.

Hooper Holmes Underwriting Solutions Customer Interview and Tele-Underwriting:Hours (Central Time): Monday-Thursday: 8:00 AM to 9:00 PM, Friday: 8:00 AM to 5:00 PM

Customer Interviews: 877-844-5041

Tele-Underwriting: 888-320-5019

Interview by Underwriter (IBU): 888-856-4589

2 FOR AGENT/REGISTERED REPRESENTATIVE USE ONLY. NOT TO BE USED FOR CONSUMER SOLICITATION PURPOSES. 4379 2/13

1If a health assessment has been completed by the primary care physician within the past six months, a Paramed Exam may be used in lieu of an MD Exam.2Any stress testing completed within the past 12 months may be substituted in lieu of a current Treadmill EKG.See page 12 for definitions.

Traditional Underwriting Requirements – for Term, UL, VUL, WL, and IUL Products

•PhysicalMeasurements•BLOOD/HOS•MVR

•PhysicalMeasurements•BLOOD/HOS•MVR

•Paramed•BLOOD/HOS•MVR


•Paramed•BLOOD/HOS•MVR•CustomerInterview

•Paramed•BLOOD/HOS•EKG•CustomerInterview•MVR•FinancialSupplement

•Paramed•BLOOD/HOS•MVR•EKG•CustomerInterview•ThirdPartyFinancial

Report

•MDExam1

•BLOOD/HOS•MVR•EKG•CustomerInterview•ThirdPartyFinancial

Report

•PhysicalMeasurements•BLOOD/HOS



•Paramed•BLOOD/HOS•MVR•EKG

•Paramed•BLOOD/HOS•MVR•EKG•CustomerInterview



Report

•MDExam1

•BLOOD/HOS•MVR•Treadmill2•CustomerInterview•ThirdPartyFinancial

Report

•Paramed•BLOOD/HOS




•Paramed•BLOOD/HOS•MVR•EKG•CustomerInterview



Report

•MDExam1

•BLOOD/HOS•MVR•Treadmill2•CustomerInterview•ThirdPartyFinancial

Report

•Paramed•BLOOD/HOS•MVR•SQ


•Paramed•BLOOD/HOS•MVR•SQ•EKG

•Paramed•BLOOD/HOS•MVR•EKG•SQ•CustomerInterview


•Paramed•BLOOD/HOS•MVR•EKG•SQ•CustomerInterview•FinancialSupplement

•Paramed•BLOOD/HOS•MVR•EKG•SQ•CustomerInterview•ThirdPartyFinancial

Report

•Paramed•BLOOD/HOS•MVR•Treadmill2•SQ•CustomerInterview•ThirdPartyFinancial

Report







•Paramed•BLOOD/HOS•MVR•EKG•SQ•CustomerInterview•ThirdPartyFinancial

Report

•Paramed•BLOOD/HOS•MVR•Treadmill2•SQ•CustomerInterview•ThirdPartyFinancial

Report

Ages 16–45

Ages 46–55

Ages56–70

Ages 71–75

Ages 76+

0 to

99,999

100,000 to

250,000

250,001to

500,000

500,001to

999,999

1,000,000to

2,000,000

2,000,001to

5,000,000

5,000,001to

10,000,000

10,000,001and up

AMOUNT

Preparing the Applicant for a Paramed Visit(Refer to form 6038)

In order to obtain accurate information, it is recommended that the applicant...• Fast for 8 hours prior to the appointment.• Limit coffee and smoking one hour prior to the

appointment.• Drinkaglassofwateronehourpriortotheappointment.• Refrain from drinking alcoholic beverages for at least

12 hours prior to the appointment.• Provide names and dosages of current medications.• Provide any history of problems associated with providing

a blood sample.• Have available member number(s) of any current health

insurance plan.• Have available names, addresses, and phone numbers of

any doctors or clinics visited in the last five years.

Medical Evidence for Ages 0-15$0 – $250,000 Fully completed application with medical

questions completed by agent.$250,001 and up Individual consideration. Contact

Underwriting for requirements.

Age and Amount APS GuidelinesAges 16-50 Risk amounts $2,000,001 and up: APS

requiredifM.D.consultedwithinpastyear.Ages 51-60 Risk amounts $1,000,001 and up: APS

requiredifM.D.consultedwithinpastyear.Ages 61-70 Risk amounts $250,001-$2,000,000: APS

requiredifM.D.consultedwithinpastyear. Risk amounts $2,000,001 and up: APS

requiredifM.D.consultedwithinpast two years.

Ages 71 and up All amounts, APS required.

Attending Physician Statements may be requested on any risk amount and all ages at the Underwriter’s discretion.


1Any stress testing completed within the past 12 months may be substituted in lieu of a current Treadmill EKG.See page 12 for definitions.

TELE-Underwriting Requirements – for Term, UL, VUL, WL, and IUL Products

•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR





•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•EKG•FinancialSupplement

•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•EKG•ThirdPartyFinancial

Report


Report

•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS



•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•EKG




Report

•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•Treadmill1•ThirdPartyFinancial

Report

•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS







Report

•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•Treadmill1•ThirdPartyFinancial

Report

•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•SQ


•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•EKG•SQ



•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•EKG•SQ•FinancialSupplement

•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•EKG•SQ•ThirdPartyFinancial

Report

•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•Treadmill1•SQ•ThirdPartyFinancial

Report


•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•SQ•EKG





•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•EKG•SQ•ThirdPartyFinancial

Report

•Tele-Underwriting•PhysicalMeasurements•BLOOD/HOS•MVR•Treadmill1•SQ•ThirdPartyFinancial

Report

Ages 16–45

Ages 46–55

Ages56–70

Ages 71–75

Ages 76+

0 to

99,999

100,000 to

250,000

250,001to

500,000

500,001to

999,999

1,000,000to

2,000,000

2,000,001to

5,000,000

5,000,001to

10,000,000

10,000,001and up

AMOUNT

Tele-Underwriting (Common Q & A – Refer to MidlandNational.com)

Tele-Underwriting is available for applicants age 16 and over on any face amount. Complete the State Appropriate short-form Tele-Underwriting Application 8807. On the application, indicate whether you have completed an X-Press test, will schedule the paramedical visit, or whether the company should schedule the visit. (If your preference is not indicated, we will assume you are making arrangements with the paramedical service.) Follow the age and amount chart for Tele-Underwriting requirements (see chart). Upon receipt of the application, New Business sends the information to the Tele-Underwriting Unit. The paramedical visit is arranged immediately with the agent’s preferred paramedical service (when the agent wants the company to make the arrangements). When the Tele-Underwriting interview is completed, and voice signature permission granted, documents are scanned and sent to New Business electronically. Status of your Tele-Underwriting cases can be followed by clicking on the Tele-Underwriting requirement under the case information on your Pending Business Report.

Medical Evidence for Ages 0-15$0 – $250,000 Fully completed application with medical

questions completed by agent.$250,001 and up Individual consideration. Contact

Underwriting for requirements.

Age and Amount APS GuidelinesAges 16-50 Risk amounts $2,000,001 and up: APS

requiredifM.D.consultedwithinpastyear.Ages 51-60 Risk amounts $1,000,001 and up: APS

requiredifM.D.consultedwithinpastyear.Ages 61-70 Risk amounts $250,001-$2,000,000: APS

requiredifM.D.consultedwithinpastyear. Risk amounts $2,000,001 and up: APS

requiredifM.D.consultedwithinpast two years.

Ages 71 and up All amounts, APS required.

Attending Physician Statements may be requested on any risk amount and all ages at the Underwriter’s discretion.


General Guidelines • Requirements are based on the face amount total of current applications and all amounts in force

with Midland National.• Midland National reserves the right to require examinations and other testing of any person

proposed for coverage.• All customer interviews will be initiated from the Administrative Office.• Applications must be completed in ink. Any changes and corrections must be initialed by the

proposed insured/applicant.• All New Business paperwork (applications, state required forms, and Health Statements for

example) may be faxed to the appropriate New Business team fax number. Premium checks and original 1035 forms are to be sent through the mail. Please contact your Case Manager for questions regarding state form requirements.

• Use the Agent’s Report (5520) or a cover letter to provide supporting information. This will help expedite application processing, policy issue and commission payment.

• ThemaximumparticipationlimitforWaiverofPremiumandAccidentalDeathBenefit(ADB)withALL companies:- $250,000onADB(ADBamountsarenotincludedindeterminingunderwritingrequirements).- $5,000,000 on Waiver of Premium or Waiver of Charges.

Temporary Insurance Agreement The Temporary Insurance Agreement (TIA) provides a solid guarantee for your clients because they have coverage in place as long as the conditions in the Agreement have been met. The TIA is available on face amounts to $1,000,000 (total in force and applied for with Midland National) and ages 16 days to age 70 (age nearest birthday).

• If the applicant elects to have coverage under the Temporary Insurance Agreement, the TIA form (7218) MUST be completed at the time of the application, bearing the same date as the application signed date, and submitted with the application (no exceptions).

• One full monthly premium (check or EFT) must be collected with the application and TIA.• With the TIA, premium is accepted ONLY at the time of application.• For the TIA to be effective with allotments, list bills, or CSAs, a check (one full monthly premium)

must be collected and submitted with the application and the completed TIA form.

Tobacco Use Definitions Underwriting classes vary by product. Please refer to the Preferred Criteria, product feature cards, and plan description for rate classes available.

Preferred Plus (PPN)Must not have used any tobacco or nicotine based products (including “patches” and “nicotine gum”) as outlined in the product Preferred Criteria chart.

Preferred Non-Tobacco (PN)Must not have used any tobacco or nicotine based products (including “patches” and “nicotine gum”) as outlined in the product Preferred Criteria chart.

Preferred Tobacco (PT)InadditiontothePreferredUnderwritingGuidelineslisted, all forms of tobacco allowed.

Non-Tobacco (NT)Proposed insureds who have not used tobacco in any form and have not used any product containing nicotine within the past 12 months. Lab test results must be negative for nicotine byproducts.

Tobacco (ST)Proposed insureds who have smoked cigarettes or used other tobacco products, including patches, gum, inhalers or other stop-smoking products within the past 12 months or are found to have nicotine byproducts in their lab test results.


Financial Underwriting Guidelines

Purpose of Insurance Formulas and Guidelines Information Required

P e r s o n a l C o v e r a g e

B u s i n e s s C o v e r a g e

Income Replacement

Estate Preservation Estate value appreciation at interest rate of 7.5% x 1/2 of life expectancy x maximum tax rate of 50%.

•Coverletterexplainingpurposeofcoverageandhowtheamountwasdetermined.•FinancialSupplement•Amountsover$5,000,000–financialsverifiedbythirdparty.

Juvenile Coverage Death Benefit Guidelines:- $100,000 for pre-high school age and younger (minimum age 15 days)- $250,000 for high school through college ages.

•Both parents are insured for twice the child’s death benefit. Please list this information on the agent’s report or cover letter.

•All siblings are insured equally – list names and death benefits on the agent’s report or cover letter.•Applications for minors must be signed by the parent or guardian with whom the child lives on a

regular basis.Agent cover letters are required for the following applications:•Tonotethereason why both parents are not insured for twice the child’s death benefit.•To note why all the siblings are not insured equally.•Deathbenefitsovertheaboveguidelinesexplainingtheadditionalfinanciallosstothebeneficiary.•For grandparent-owned insurance, list each grandchild and their death benefit as well as the parent’s in force insurance. A parent’s signature is required on the application. Please consult with the

underwriter as necessary.

Key Person Up to 10 times annual income derived from the business covered.

•FinancialSupplementdemonstratingincomederivedfromthebusinessbeingcovered.•Listofotherkeypersonsandtheircoverageinfavorofthebusiness.•Amountsover$5,000,000–copyofbusinessfinancials.

Buy/Sell or Stock Repurchase

Ownership % x value of company.

•Explanationregardingthepurposeofthecoverageandhowtheamountwasdetermined.•Detailsofbuy/sellagreementand%ofownershipinthebusiness.•Marketvalueofthebusinesswithsupportingcorporatefinancials.

Maximum Coverage

Factor times Ages earned income

Grossannualearnedincome*

20 - 30 3031 - 40 2541 - 50 2051 - 60 1561 - 70 1071 & Up 5

Risk Amounts $2,000,001 and up Financial Supplement.Risk Amounts $5,000,001 and up Third Party Financials.

*Earned income includes salary, wages, tips, regular bonus, regular commission, deferred compensation, and other employee benefits that are the direct result of the proposed insured’s effort and abilities that will cease at their death. Where income fluctuates from year to year, use a three year average.

Tobacco Use

Alcohol/Drug

Aviation

Blood Pressure

Cholesterol

Citizenship

Driving Record

Family History

Foreign Travel

Personal History

Physical Measurements

Ratings

Recreation

Ages 70 and Under – Essential Guaranteed® and Term Products1

Underwriting Criteria for Preferred Plus, Preferred Non-Tobacco, and Preferred Tobacco

No tobacco use or nicotine based products (including patches and nicorette gum) within the last five years. Occasional cigar (up to 12 per year) if admitted on the application and lab test results are negative for nicotine by-products.

No tobacco use or nicotine based products (including patches and nicorette gum) within the last three years. Occasional cigar (up to 12 per year) if admitted on the application and lab test results are negative for nicotine by-products.

All tobacco allowed.

No history of alcohol/drug abuse or treatment in ten years.



Non ratable pilots for major airlines only, or aviation exclusion rider.

Non ratable commercial and private pilots acceptable. Non ratable commercial and private pilots acceptable.

To age 50: 135/85 51-60: 140/85 61-70: 145/85 (without treatment)

To age 50: 140/85 51-60: 145/85 61-70: 145/90 (with or without treatment)

To age 50: 140/85 51-60: 145/85 61 -70: 145/90 (with or without treatment)

Cholesterol220orlessandcholesterol/HDLratio4.5 or less. (with or without treatment)



Is a US citizen or has had permanent resident status for at least two years.



No more than one moving violation in past three years; noDWI,DUI,orrecklessdrivingconvictionornon-administrative license suspension in past five years.

No more than two moving violations in past three years; noDWI,DUI,orrecklessdrivingconvictionornon-administrative license suspension in past five years.


No death or diagnosis of natural parent or sibling from coronary artery disease or cancer prior to age 60.

No death of natural parent from coronary artery disease or cancer prior to age 60.


No travel to countries or areas that are politically unstable or underdeveloped.



No history of cancer (excluding non-melanoma skin cancers), diabetes, cardiovascular disease, coronary artery disease, or other significant health problems.



Weight within range shown in Preferred Plus build chart. Weight within range shown in Preferred build chart. Weight within range shown in Preferred build chart.

Must not be substandard for any reason. Must not be substandard for any reason. Must not be substandard for any reason.

No participation in hazardous sports within past 24 months, with no future plans. Non-technical scuba (50 ft. max.) acceptable.

Non-ratable hazardous sports are acceptable. Non-ratable hazardous sports are acceptable.

Preferred Plus Preferred Non-Tobacco Preferred Tobacco


M a l e & F e m a l e

Preferred Plus(PPN)

Preferred(PN and PT)

Standard(NT and ST) T a b l e R a t i n g s f o r B u i l d

4’ 10”4’ 11”5’ 0”5’ 1”5’ 2”5’ 3”5’ 4”5’ 5”5’ 6”5’ 7”5’ 8”5’ 9”5’ 10”5’ 11”6’ 0”6’ 1”6’ 2”6’ 3”6’ 4”6’ 5”

4’ 10”4’ 11”5’ 0”5’ 1”5’ 2”5’ 3”5’ 4”5’ 5”5’ 6”5’ 7”5’ 8”5’ 9”5’ 10”5’ 11”6’ 0”6’ 1”6’ 2”6’ 3”6’ 4”6’ 5”

919497

100104107110114118121125128132136140144148152156160

134138143148153158163168173178184189195200206212218224230236

124128133137142146151156161166171176181186191197202208213219

143148153158164169174180186191197203209215221227233240246253

134138143148153158163168173178184189195200206212218224230236

919497

100104107110114118121125128132136140144148152156160

171177183190196202209215222229236243250257264272279287295303

187193200206213220227234242249256264272280288296304312320329

172178184191197203210216223230237244251258265273280288296304

196203210217224231239246254262270278286294302311319328337346

201208215222230237245252260268276284293301310318327336345354

206213220228235243251258266275283291300308317326335344353363

211218225233241248256264273281289298307315324334343352361371

215223230238246254262270279287296305314323332341350360370379

220228236244252260268277285294303312321330339349358368378388

Height Minimum Maximum Maximum Maximum Maximum Minimum Maximum HeightTable AWeight

Table BWeight

Table CWeight

TableDWeight

Table EWeight

Table FWeight

Table HWeight

Table JWeight

Male and FemaleMale Female Male Female

Ages 70 and Under – Essential Guaranteed® and Term Products

Build Chart


Male and

Female

Tobacco Use

Alcohol/Drug

Aviation

Blood Pressure

Cholesterol

Citizenship

Driving Record

Family History

Foreign Travel

Personal History

Physical Measurements

Ratings

Recreation

Ages 70 and Under – UL (except Essential Guaranteed), VUL and IUL ProductsUnderwriting Criteria for Preferred Plus, Preferred Non-Tobacco and Preferred Tobacco

No tobacco use or nicotine based products (including patches and nicorette gum) within the last three years. Occasional cigar (up to 12 per year) if admitted on the application and lab test results are negative for nicotine by-products.

No tobacco use or nicotine based products (including patches and nicorette gum) within the last two years. Occasional cigar (up to 12 per year) if admitted on the application and lab test results are negative for nicotine by-products.


No history of alcohol/drug abuse or treatment in ten years. No history of alcohol/drug abuse or treatment in ten years. No history of alcohol/drug abuse or treatment in ten years

Private pilots acceptable with 300+ solo hours experience, IFR, flying 50-150 hrs per year, all flights within the USA.

Flat extra allowed for aviation. Flat extra allowed for aviation.

Cholesterol220orlessandcholesterol/HDLratio 5.0 or less. (with or without treatment)






No more than one moving violation in past three years; noDWI,DUI,orrecklessdrivingconvictionornon-administrative license suspension in past five years.



No death or diagnosis of natural parent or sibling from coronary artery disease or cancer prior to age 60.









Weight within range shown in Preferred Plus build chart. Weight within range shown in Preferred build chart. Weight within range shown in Preferred build chart.

Must not be substandard for any reason. Must not be substandard for any reason other than flat extra for aviation or avocation.

Must not be substandard for any reason other than flat extra for aviation or avocation.



To age 50: 140/85 51-60: 145/85 61-70: 150/85 (without treatment)

To age 50: 140/90 51-60: 145/90 61-70: 150/90 (with or without treatment)

To age 50: 140/90 51-60: 145/90 61 -70: 150/90 (with or without treatment)




Preferred Plus(PPN)



4’ 10”4’ 11”5’ 0”5’ 1”5’ 2”5’ 3”5’ 4”5’ 5”5’ 6”5’ 7”5’ 8”5’ 9”5’ 10”5’ 11”6’ 0”6’ 1”6’ 2”6’ 3”6’ 4”6’ 5”

4’ 10”4’ 11”5’ 0”5’ 1”5’ 2”5’ 3”5’ 4”5’ 5”5’ 6”5’ 7”5’ 8”5’ 9”5’ 10”5’ 11”6’ 0”6’ 1”6’ 2”6’ 3”6’ 4”6’ 5”

919497

100104107110114118121125128132136140144148152156160

137141146151156161166171176181187192198203209215221227233239

127131136140145149154159164169174179184189194200205211216222

146151156161167172177183189194200206212218224230236243249256

137141146151156161166171176181187192198203209215221227233239

919497

100104107110114118121125128132136140144148152156160

171177183190196202209215222229236243250257264272279287295303

187193200206213220227234242249256264272280288296304312320329

172178184191197203210216223230237244251258265273280288296304

196203210217224231239246254262270278286294302311319328337346

201208215222230237245252260268276284293301310318327336345354

206213220228235243251258266275283291300308317326335344353363

211218225233241248256264273281289298307315324334343352361371

215223230238246254262270279287296305314323332341350360370379

220228236244252260268277285294303312321330339349358368378388

Maximum Maximum Maximum Maximum Minimum Maximum HeightTable AWeight

Table BWeight

Table CWeight

TableDWeight

Table EWeight

Table FWeight

Table HWeight

Table JWeightHeight Minimum


Ages 70 and Under – UL (except Essential Guaranteed), VUL and IUL Products

Build Chart


Male and

Female

Tobacco Use

Alcohol/Drug

Aviation

Blood Pressure

Cholesterol

Citizenship

Cognitive Function

Driving Record

Falls

Kidney Function

Personal History

Physical Measurments

Physical/Social Activity

Ratings

Recreation

Serum Albumin

Ages 71+Underwriting Criteria for Preferred Plus, Preferred Non-Tobacco, and Preferred Tobacco

No tobacco use or nicotine based products (including patches and nicorette gum) within the last five years. Occasional cigar (up to 12 per year) if admitted on the application and lab test results are negative for Nicotine by-products.

No tobacco use or nicotine based products (including patches and nicorette gum) within the last three years. Occasional cigar (up to 12 per year) if admitted on the application and lab test results are negative for Nicotine by-products.


No history of alcohol/drug abuse or treatment in ten years. No history of alcohol/drug abuse or treatment in ten years. No history of alcohol/drug abuse or treatment in ten years.

No participation in past 12 months or plans to participate in the future.

No participation in past 12 months or plans to participate in the future.

No participation in past 12 months or plans to participate in the future

150/85 (without treatment) and no pulse pressure greater than 75

150/90 (with or without treatment) and no pulse pressure greater than 75

150/90 (with or without treatment) and no pulse pressure greater than 75




No evidence of cognitive impairment. No evidence of cognitive impairment. No evidence of cognitive impairment.

No more than one moving violation in past three years; noDWI,DUI,orrecklessdrivingconvictionor non-administrative license suspension in past five years.

No more than two moving violations in past three years; noDWI,DUI,orrecklessdrivingconvictionor non-administrative license suspension in past five years.

No more than two moving violations in past three years; noDWI,DUI,orrecklessdrivingconvictionor non-administrative license suspension in past five years.

No history of falls within past five years. No history of falls within past five years. No history of falls within past five years.

eGFRgreaterthan70 eGFRgreaterthan60 eGFRgreaterthan60

APS demonstrating regular health care. Must be a standard risk before credits. No history of chronic or recurring mental illness or depression. No history of cancer (excluding non-melanoma skin cancers), heart disease or stroke.



Weight within range shown in Preferred Plus build chart and stable for the past two years.

Weight within range shown in Preferred build chart and stable for the past two years.

Weight within range shown in Preferred build chart and stable for the past two years.

Physically active including but not limited to travel, exercise, andsocialactivities.IndependentinallADL’s*andIADL’s.**



Must not be substandard for any reason. Must not be substandard for any reason. Must not be substandard for any reason.



greater than 3.9 g/dl greater than 3.8 g/dl greater than 3.8 g/dl


Cholesterol150-250andHDLatleast45(with or without treatment)

Cholesterol150-260andHDLatleast40 (with or without treatment)

Cholesterol150-260andHDLatleast40 (with or without treatment)



Preferred Plus(PPN)



4’ 10”

4’ 11”

5’ 0”

5’ 1”

5’ 2”

5’ 3”

5’ 4”

5’ 5”

5’ 6”

5’ 7”

5’ 8”

5’ 9”

5’ 10”

5’ 11”

6’ 0”

6’ 1”

6’ 2”

6’ 3”

6’ 4”

6’ 5”

4’ 10”

4’ 11”

5’ 0”

5’ 1”

5’ 2”

5’ 3”

5’ 4”

5’ 5”

5’ 6”

5’ 7”

5’ 8”

5’ 9”

5’ 10”

5’ 11”

6’ 0”

6’ 1”

6’ 2”

6’ 3”

6’ 4”

6’ 5”

100

104

107

111

115

118

122

126

130

134

138

142

146

150

154

158

163

168

172

176

143

148

153

158

164

169

174

180

186

191

197

203

209

215

221

227

233

240

246

253

134

138

143

148

153

158

163

168

173

178

184

189

195

200

206

212

218

224

230

236

153

158

163

169

175

180

186

192

198

204

210

216

222

229

235

242

249

256

263

270

143

148

153

158

164

169

174

180

186

191

197

203

209

215

221

227

233

240

246

253

86

89

92

95

98

102

105

108

112

115

118

122

125

129

133

136

140

144

148

152

176

182

188

194

201

207

214

221

228

235

242

249

256

264

271

279

286

294

303

312

187

193

200

206

213

220

227

234

242

249

256

264

272

280

288

296

304

312

320

329

177

183

189

195

202

208

215

222

229

236

243

250

257

265

272

280

287

295

304

313

196

203

210

217

224

231

239

246

254

262

270

278

286

294

302

311

319

328

337

346

201

208

215

222

230

237

245

252

260

268

276

284

293

301

310

318

327

336

345

354

206213220228235243251258266275283291300308317326335344353363

211

218

225

233

241

248

256

264

273

281

289

298

307

315

324

334

343

352

361

371

215

223

230

238

246

254

262

270

279

287

296

305

314

323

332

341

350

360

370

379

220

228

236

244

252

260

268

277

285

294

303

312

321

330

339

349

358

368

378

388

Height Minimum Maximum Maximum Maximum Maximum Minimum Maximum HeightTable AWeight

Table BWeight

Table CWeight

TableDWeight

Table EWeight

Table FWeight

Table HWeight

Table JWeight


Ages 71+

Build Chart*Activities of Daily Living (ADL)1. Hygiene (bathing, grooming, shaving

and oral care).2. Continence.3. Dressing.4. Eating (ability to feed oneself).5. Toileting (ability to use a restroom).6. Transferring (actions such as going from

a seated to standing position and getting in/out of bed).

Albumin: Routinely performed as a part of the blood chemistry testing, serum albumin is an independent marker for mortality, especially at the older ages. Albumin may be decreased in liver disease, kidney disese, malnutrition, chronic inflammatory disease, malignant disease, and multiple myeloma among other conditions.Cognitive Function: Refers to the ability to learn and remember information; organize, plan, and problem-solve; focus, maintain, and shift attention as necessary; understand and use language; accurately percieve the environment, and perform calculations.eGFR (Estimated Gomerular Filtration Rate): Obtained through routine blood testing, the eGFRtakesintoconsiderationgender,height,weight, and age to assess kidney function.**Instrumental Activities of Daily Living (IADL):1. Finding and utilizing resources (looking up

phone numbers, using a telephone, making and keeping doctors appointments).

2. Drivingorarrangingtravel(either by public transportation such as Paratransit, or private car).

3. Preparing meals (opening containers, using kitchen equipment).

4. Shopping (getting to stores and purchasing necessities like food or clothing).

5. Doinghousework(doinglaundry,cleaningup spills and maintaining a clean living space).

6. Managing medication (taking prescribed dosages at correct times and keeping track of medications).

7. Managing finances (basic budgeting, paying bills and writing checks).

Pulse Pressure: The difference between systolic and a diastolic reading and represents the force that your heart generates each time it contracts. In a person with a systolic blood pressure of 120 mmHg and a diastolic pressure of 80 mmHg, the pulse pressure would be 40 mmHg.

Ages 71+ Definitions


Male and

Female

DefinitionsAPS (Attending Physicians Statement)–Generallyrequestingthelastfiveyearsof medical and/or clinical records on the proposed insured – obtained by the Administrative Office. Blood Chemistry Panel – (full blood draw) obtained by a preferred vendor.Customer Interview – An interview with the proposed insured conducted by an approved vendor. All customer interviews are initiated by the Administrative Office.Dr. Direct – Initiated by the Administrative Office. An impairment specific questionnaire is completed by the doctor’s office to obtain additional information on moderate impairments. EKG – A 12-lead resting electrocardiogram (without interpretation) obtained through a preferred paramedical service.Financial Supplement (form 6048) – A financial statement on the proposed insured, completed by the agent.HOS – Urine specimen obtained through a preferred paramedical service and mailed to a preferred lab.IBU (Interview by Underwriter) – A phone interview conducted by an experienced life insurance underwriter. Initiated by the Administrative Office, these interviews are requested to obtain additional information regarding mild impairments. (Refer to form 8879.) MD Exam – Midland National’s preferred paramedical service can help arrange forMDexamsinmostareas.Anyphysician,excepttheproposedinsuredspersonalphysician,mayperformMDexaminations.MVR – Motor Vehicle Report obtained through the Administrative Office.Paramed Exam – A basic paramedical examination includes medical history, height, weight, blood pressure, and pulse.Physical measurements – Physical measurements comprise of height, weight, blood pressure, and pulse conducted by a preferred paramedical service; please note medical history is not acquired. SQ (Senior Questionnaire) – Cognitive testing must be scheduled with a preferred paramedical service.Tele-Underwriting – A simplified application is obtained by the agent. The medical history is acquired through a phone interview with the proposed insured. Underwriting requirements (example: physical measurements, blood and urine samples) can be scheduled by the agent or through the Administrative Office at the agent’s request.Third Party Financial Report – Certified Public Accountant prepared net income statement and balance sheet.Treadmill EKG – Exercise electrocardiogram to include the protocol but without interpretation. This may include a treadmill or a bicycle ergometer test and arranged through our preferred vendors.X-Press – Agent collected oral fluid testing.

Commonly Used Application Supplements• Agent’s Report (5520) – Complete this form to provide supporting information on

the sale.• Alcohol Questionnaire (8315) – Complete this questionnaire when substance

dependenceisnotedorDUIviolationwithinfiveyears.• Civilian Aviation Questionnaire (8143A) – Complete this form when the proposed

insured is a pilot or crew member (private, commercial, or military).• Customer Identification Program Notice U.S.A. Patriot Act (7515) – Complete this

form with any tele-interviewing applications on each applicant (or owner), obtain signatures, and forward all pages with the application.

• Drug Questionnaire (9542) – Complete this questionnaire when there is a history of controlled substance use or treatment is noted.

• Financial Supplement (6048) – Complete this questionnaire to clarify the financial background of the proposed insured or when requested in the Underwriting Requirements Charts.

• Foreign Travel and Residence Questionnaire (8142R) – Complete this form to clarify foreign citizenship, naturalized citizenship, or when foreign travel or residency is noted on the application within the last twelve months.

• Important Notice: Replacement of Life Insurance or Annuities (2477) – Complete this state specific form where an existing life insurance policy or annuity contract will be discontinued, changed, or will be financing new coverage.

• Informed Consent for the Human Immunodeficiency Virus (HIV) Antibody Test (4913) – Complete this state specific form on each applicant, obtain signatures, and forward all pages with the application. Note this form follows the applicant’s state of residence.

• Racing Questionnaire (9544) – Complete this questionnaire when the proposed insured participates in any motor sport.

• Scuba and Skin Diving Questionnaire (9545R) – Complete this questionnaire when the proposed insured participates or contemplates any form of skin or scuba diving.

• Temporary Life Insurance Agreement (7218) – Complete this form at the time of the application (bearing the same date as the application) and submit with the premium to provide coverage during the underwriting process (if all conditions in the agreement are met).

• Tobacco Use Statement (5054) – At the Underwriter’s request, complete this form to clarify tobacco use when nicotine is present in the lab test results and tobacco use is not noted on the application.

• Statements About Life Insurance Illustrations (6293) – Complete this form when a full illustration is not used on interest sensitive life insurance applications. Note: When an illustration is used, obtain signatures and forward all pages with the application.

• HIPAA Authorization (8701) – This form allows the proposed insured to authorize the release of health-related information. It must be signed and returned with the application.


At Midland National, our underwriters strive to create enduring relationships with you through effective communication and excellent support.

With Midland National, you’ll experience:• Directaccesstoyourunderwriterandcasemanager • Fast, fair and consistent underwriting• Average of less than 30 calendar days turnaround time We’re here to help you grow your business by building an enduring relationship with you.

Contact Sales Support today to learn more.

Call 800-843-3316 ext. 32150 or Email: [email protected]

1.EssentialGuaranteedUL2and3areissuedonpolicyformseriesL138byMidlandNationalLife Insurance Company. Not all products, features, riders, endorsements or issue ages are available in all jurisdictions. Limitations or restrictions may apply.

The broker/dealer for Midland National’s variable products is Sammons Securities Co.®, member FINRA/SIPC. Sammons Securities Co.® is a registered broker/dealer under the Securities Exchange Act of 1934. Sammons Securities Co.® is an indirect wholly-owned subsidiary of Sammons Enterprises,Inc.ofDallas,Texas,theultimateparentcompanyofMidlandNational.

Indexed Universal Life products are not an investment in the “market” or in the applicable index and are subject to all policy fees and charges normally associated with most universal life insurance.

JudySenior Underwriter

NealSenior Underwriter

AdministrativeOffice•OneSammonsPlaza•SiouxFalls,SD57193

MidlandNational.com4379 2/13 FOR AGENT/REGISTERED REPRESENTATIVE USE ONLY. NOT TO BE USED FOR CONSUMER SOLICITATION PURPOSES

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