Accident & Health
Medicare Supplement Insurance Underwriting Guide
NGAH-MEDSUPP-UW-GUIDE 1/2021
For agent use only. Not for distribution to consumers.
National General Accident and Health markets products underwritten by National Health Insurance Company, Integon National Insurance Company, and Integon Indemnity Corporation.
NGAH-MEDSUPP-UW-GUIDE 1/2021 2
Table of Contents
Contacts ................................................................................................................................ 3
Hours of Operation ................................................................................................................ 3
Introduction ........................................................................................................................... 4
New Business Guidelines ...................................................................................................... 4
Eligibility Requirements ......................................................................................................... 4
Replacements ........................................................................................................................ 4
Open Enrollment Guidelines .................................................................................................. 5
Guaranteed Issue Guidelines ................................................................................................. 6
State Specific Guaranteed Issue Guidelines ......................................................................... 8
Medicare Advantage (MA) Guidelines ................................................................................. 15
Enrollment Guidelines ......................................................................................................... 15
Submitting the Application ................................................................................................... 16
Premium Payment ............................................................................................................... 18
Required Forms ................................................................................................................... 18
Agent Responsibilities ......................................................................................................... 19
Underwriting Concepts ....................................................................................................... 19
Underwriting Appeals .......................................................................................................... 20
Reinstatements ................................................................................................................... 20
Underwriting Guidelines ...................................................................................................... 21
Drug List Information ........................................................................................................... 24
NGAH-MEDSUPP-UW-GUIDE 1/2021 3
Contacts
Mailing & Contact Information for New Business and Delivery Receipts
New Business - Paper Applications
National General Accident & Health
PO Box 95464
Cleveland, OH 44101
Email (scanned applications): [email protected]
Phone: 888-966-2345
Hours of Operation: 7:00 AM to 4:00 PM CST
Underwriting/Home Office
National General Accident & Health
ATTN: Medicare Supplement Underwriting Department
1515 North Rivercenter Drive, Suite 135
Milwaukee, WI 53212
Email: [email protected]
Phone: 833-870-6133
Fax: 888-344-3232
Hours of Operation: 7:00 AM to 4:00 PM CST
Claims
National General
PO Box 17110
Winston-Salem, NC 27116
Phone: 833-976-2628
Hours of Operation: 7:00 AM to 4:00 PM CST
Policy Admin –
Policies issued prior to 1/1/2021
National General
PO Box 17110
Winston-Salem, NC 27116
Phone: 833-976-2628
Hours of Operation: 7:00 AM to 4:00 PM CST
Policy Admin –
Policies issued on or after 1/1/2021
National General Accident & Health
PO Box 1070
Winston-Salem, NC 27102-1070
Email: MemberSer[email protected]
Phone: 888-966-2345
Hours of Operation: 7:00 AM to 4:00 PM CST
General Correspondence
National General Accident & Health
PO Box 1070
Winston-Salem, NC 27102-1070
Email: MemberSer[email protected]
Phone: 888-966-2345
Hours of Operation: 7:00 AM to 4:00 PM CST
Agent Enrollment Portal:
EnrollNatGen.com
Agency Services Contracting or Product Training:
Phone: 833-408-5392
Hours of Operation: 8:00 AM to 4:00 PM CST
NGAH-MEDSUPP-UW-GUIDE 1/2021 4
Introduction
Thank you for partnering with National General Accident & Health for Individual Medicare Supplement
insurance. This document has been designed to help you understand the underwriting process and
guidelines used by National General Accident & Health when reviewing applications. This guide contains
a general overview of current medical underwriting guidelines and is subject to change at any time.
New Business Guidelines
Eligibility Requirements
Applicants are eligible to apply for Medicare
Supplement insurance if they:
• Are covered under Medicare Part A & B.
• Are 65 years of age or older.
• Are Medicare eligible due to disability in a
state requiring under age 65 coverage.
• Reside in any of the following states: AK, AL,
AR, AZ, CA, CO, DC, DE, FL, GA, IA, ID, IL,
IN, KS, KY, LA, MD, MI, MN, MO, MS, MT,
NC, ND, NE, NJ, NM, NV, OH, OK, OR, PA,
SC, SD, TN, TX, UT, VA, WI, WV, WY
New Business Guidelines
Applications must be submitted and received at
the home office within 30 days of the application
signature date. Once we receive the application,
it will be processed in the order in which it
was received. If there are any errors on the
application, you will be notified as they are found
and corrections will be requested. Any errors will
need to be fixed before a policy can be issued.
Effective Date
All applications must contain a requested
effective date. Effective dates must be after the
signature date of the application and is available
on the 1st through the 31st of the month.
The effective date is required when submitting an
application and must be equal to or greater than
the Medicare part B effective date, and after the
signature date of the application.
Open Enrollment:
• An application may be submitted up to 6
months prior to and 6 months following
the first day of the month of the applicant’s
65th birthday or up to 6 months prior to and
6 months following the date the applicant
becomes eligible for Medicare Part B. And;
• The coverage effective date must be on
or after the first day of the month of the
applicant’s 65th birthday.
Guaranteed Issue: An applicant applying under
guaranteed issue rights may request an effective
date up to 60 days beyond the application date.
Underwritten: An applicant applying outside of
open enrollment may request an effective date up
to 60 days beyond the application date.
Plan Selection: Refer to the state specific
application for availability.
Replacements
A replacement takes place when an applicant
is terminating existing Medicare Supplement or
Medicare Advantage insurance and replacing it
with new Medicare Supplement insurance.
National General Accident & Health requires a
fully completed application when applying for a
replacement policy; all replacements involving
Medicare Supplement, Medicare Select or
Medicare Advantage insurance MUST include a
completed Replacement Notice.
MACRA
The Medicare Access and CHIP Reauthorization Act
of 2015 (MACRA) is a Federal law that was passed
on April 16th, 2015. This law changed the available
Medicare supplement plans for those who become
newly eligible for Medicare on or after January 1,
2020. MACRA requires that Medicare supplement
plans that cover the Medicare Part B deductible cannot
be available to those who become newly eligible
for Medicare on or after January 1, 2020. Those
who become newly eligible for Medicare on or after
January 1, 2020 may not be issued a policy for Plans
C, F, or HDF. However, these plans may be available to
anyone eligible on or before December 31, 2019.
NGAH-MEDSUPP-UW-GUIDE 1/2021 5
Open Enrollment Guidelines
Applicants who purchase Medicare Supplement insurance during an Open Enrollment period are not
required to provide any health history information.
An Open Enrollment period is available for applicants who are:
• Within 6 months of turning age 65 and enrolling in Medicare Part B.
• Within 6 months of first enrolling in Medicare Part B.
• Now age 65, previously qualified for Medicare due to disability and enrolled in Medicare Part B, now
eligible for a second enrollment period.
During this period, National General Accident & Health cannot deny insurance coverage, place
conditions on a policy or charge a higher premium due to past medical conditions.
Open Enrollment Guidelines for Applicants Under Age 65
Some states require that Medicare Supplement Open Enrollment be offered to individuals under age
65 due to disability. Refer to the chart below for details on availability. If a state is not listed, applicants
under age 65 are not accepted in that state.
Under
65 Open
Enrollment
Plans: Medicare eligible on 01/01/2020 or after
(Post MACRA)
Plans: Medicare eligible before
01/01/2020 (Pre MACRA)
A B C D F G HDG K L M N A B C D F HDF G N
CA, CO, DE, FL,
GA, ID, IL, KS,
LA, MS, MO ,
MT, OR, SD, TN
√ √ √ √ √ √ √ √
PA
√ √ √ √ √ √ √ √ √ √
KY
√ √ √ √ √ √
NC
√ √ √
AR, MD, OK, TX
√ √
MI
√ √ √
NJ
√ √ √
NJ exception: Applicant must be age 50-64 as of the policy effective date to apply
KY: Application must be underwritten
Under 65 Open
Enrollment
Medicare eligible on 01/01/2020 or after
(Post MACRA)
Medicare eligible before 01/01/2020
(Pre MACRA)
Plans Basic
Extended
Basic
High
Deductible
Co-Pay Basic
Extended
Basic
High
Deductible
Co-Pay
MN
√ √ √ √ √ √ √ √
Optional Riders
Medicare Part A
Deductible
√ √
Medicare Part B
Excess Charges
√ √
Preventative Care
√ √
Medicare Part B
Deductible
√
MN: Applicant must be within 6 months of their Medicare Part B enrollment
NGAH-MEDSUPP-UW-GUIDE 1/2021 6
Under 65 Open
Enrollment
Medicare eligible on 01/01/2020 or after
(Post MACRA)
Medicare eligible before 01/01/2020
(Pre MACRA)
Plans Basic Basic
WI
√ √
Optional Riders
Medicare Part A
Deductible
√ √
Medicare Part B
Excess Charges
√ √
Home Heatlh Care
√ √
Foreign Travel Emergency
√ √
Medicare Part B
Deductible
√
Guaranteed Issue Guidelines
Medicare Supplement insurance has guidelines in place that allow qualified applicants to enroll in
certain plans without being medically underwritten.
An applicant who is age 65 or older may be eligible for guaranteed issue of Medicare Supplement
insurance upon the occurrence of certain events that cause the applicant to lose their existing
insurance coverage.
Certain documentation is required to be submitted for applicant’s applying for guaranteed issue.
Coverage will not be issued as guaranteed issue until the required documents are received.
Guaranteed issue rules and circumstances are complicated and can be difficult to comprehend.
Guaranteed issue scenarios and plan selection may also vary from state to state. Please reference the
guaranteed issue section of the application for state specific variations or contact our Underwriting
Department for assistance when submitting guaranteed issue business. The information below is a
summary to help you begin in identifying the federal and state guaranteed issue rules, but does
not represent the complete wording of the mandate.
To assist you in understanding the rules, we have provided a chart outlining the guaranteed issue
events and what type of proof needs to be submitted with the application when your client is applying
for guaranteed issue. Refer to the following tables regarding Federal Guidelines and State
Specific Guidelines for Guaranteed Issue.
Guaranteed issue proof should be sent to [email protected] and we strongly encourage it be
sent in an encrypted format. Indicate the following in body of email: applicant name, date of birth, and
residence ZIP code.
NGAH-MEDSUPP-UW-GUIDE 1/2021 7
Federal Guaranteed Issue Guidelines
Federal Guidelines
Plans: Medicare
eligible on
01/01/2020 or
after
(Post MACRA)
Plans: Medicare
eligible before
01/01/2020
(Pre MACRA)
Rule Required Documentation
The applicant enrolled in a Medicare
Advantage plan, Medicare Select plan or
in a program of All-Inclusive Care of the
Elderly (PACE) and the plan is terminated, is
no longer providing service in their area or
the applicant moved out of the area.
If the previous carrier terminated or
discontinued the plan:
• Letter from prior carrier that contains
reason for the discontinuation/
termination and the term date.
The applicant moved out of the provider’s
service area:
• Termination letter from prior carrier
showing termination date and
verification of address change.
A
G
N (CA, MO only)
A
C (MI, NJ only)
F
HDF (High Deductible F)
N (CA, MO only)
The applicant enrolled under an employee
welfare benefit plan that provides benefits
that supplement Medicare (such as COBRA,
retiree, etc.) and that plan terminates or
ceases to provide all such supplement
benefits.
Submit a notice of termination or
explanation of benefits for a claim denied
due to a termination, and:
If the applicant had a retiree plan, submit
one of the following:
1. Termination letter showing it is a
retiree plan;
2. Benefit booklet pages showing it is a
retiree plan; or
3. Explanation of benefits showing
Medicare paid primary.
If the applicant had a COBRA plan, submit
an election notice or COBRA bill.
If the applicant had a group plan secondary
to Medicare, submit an explanation of
benefits showing Medicare paid primary.
A
G
A
C (MI, NJ only)
F
HDF (High Deductible F)
Medicare Supplement insurance terminated
because the insurer became insolvent or
bankrupt.
Letter from provider or Insurance
Commissioner showing termination date.
A
G
N (CA, MO, OR only)
A
C (MI, NJ only)
HDF (High Deductible F)
N (CA, MO, OR only)
The Medicare Supplement, Medicare
Advantage or PACE insurer violated a
material provision of the policy or the
agent materially misrepresented the plan’s
provisions in marketing the plan.
Agent Misrepresentation:
• Letter from the carrier showing
termination date and reason.
Leaving an MA Plan:
• Letter from CMS acknowledging
misrepresentation.
Leaving a Medicare Supplement:
• Letter from the DOI acknowledging
misrepresentation and disenrollment.
A
G
N (CA, MO, OR only)
A
C (MI, NJ only)
F
HDF (High Deductible F)
N (CA, MO, OR only)
NGAH-MEDSUPP-UW-GUIDE 1/2021 8
Federal Guaranteed Issue Guidelines (continued)
Federal Guidelines
Plans: Medicare
eligible on
01/01/2020 or
after
(Post MACRA)
Plans: Medicare
eligible before
01/01/2020
(Pre MACRA)
Rule Required Documentation
The applicant terminated their National
General Accident & Health Medicare
Supplement insurance, enrolled in a
Medicare Advantage plan, and then
voluntarily disenrolled within the first 12
months of enrolling.
Note: the applicant may enroll in the
National General Accident & Health
Medicare Supplement plan they were
previously on.
Letter from the prior Medicare Advantage
carrier showing termination date.
A
G
N (CA, MO, OR only)
A
C (MI, NJ only)
F
HDF (High Deductible F)
N (CA, MO, OR only)
The applicant joined a Medicare Advantage
or PACE plan when they were first eligible
for Medicare and disenrolled within the first
12 months
Letter from prior carrier showing
termination date.
A
G
N
A
C (MI, NJ only)
F
HDF (High Deductible F)
N
Enrolled in a Medicare Part D plan during
the initial Part D enrollment period while
enrolled under a Medicare Supplement
policy that covers outpatient prescription
drugs and terminates the Medicare
Supplement policy.
Letter from prior carrier showing
termination date.
A
G
N (CA, MO only)
A
C (MI, NJ only)
F
HDF (High Deductible F)
N (CA, MO only)
Other guarantee issue rights available
under State law - refer to chart below
Letter from prior carrier showing
termination date.
A
G
N
A
C (MI, NJ only)
F
HDF
G (CA* only)
N
*CA: If birthday rule, can select only the same plan as currently in force or one with lesser benefits.
State Specific Guaranteed Issue Guidelines
State Guidelines
Plans: Medicare
eligible on
01/01/2020 or
after
(Post MACRA)
Plans: Medicare
eligible before
01/01/2020
(Pre MACRA)
Rule
OR Birthday rule - can select the same plan as currently in force or one with lesser
benefits.
A
G
N
A
F
HDF (High Deductible F)
G
N
NGAH-MEDSUPP-UW-GUIDE 1/2021 9
State Specific Guaranteed Issue Guidelines (continued)
State Guidelines
Plans: Medicare
eligible on
01/01/2020 or
after
(Post MACRA)
Plans: Medicare
eligible before
01/01/2020
(Pre MACRA)
Rule
CA Birthday rule - can select the same plan as currently in force or one with lesser
benefits.
A
G
N
A
F
HDF (High Deductible F)
G
N
CO Currently enrolled in both Medicare and Medicaid, loses eligibility for health
benefits under Title XIX of SS Act (Medicaid)
A
G
A
F
HDF (High Deductible F)
KS Loses eligibility for health benefits under title XIX of the SS Act (Medicaid) A
G
N
A
F
HDF (High Deductible F)
N
MO Terminates Medicare supp coverage within 30 days of the annual policy
anniversary - can select the same plan as currently in force.
A
G
N
A
F
HDF (High Deductible F)
G
N
NC Eligible for Medicare Part B due to disability before the age of 65 and
enrolled in Medicare Advantage plan which is terminated due to cancellation,
nonrenewal or disenrollment from the plan
A A
CA Enrolled in Medicare Advantage and premiums or copayments increase by
15% or more, benefits are reduced or provider contract terminated
A
G
N
A
F
HDF (High Deductible F)
N
NE Enrolled in a Medicare Advantage plan and the organization’s certification or
plan is terminated. Refer to the mandate for specific criteria
A
G
A
F
HDF (High Deductible F)
CO Enrolled in a Medicare Advantage plan and the organization’s certification or
plan is terminated. Refer to the mandate for additional criteria
A
G
A
F
HDF (High Deductible F)
NC Enrolled in Medicare Advantage plan, enrolled with a Program of all-Inclusive
Care for the Elderly, and the organization’s certification or plan is terminated.
Refer to the mandate for additional criteria
A
G
A
F
HDF (High Deductible F)
OR Enrolled in Medicare Advantage plan, the individual is 65 year of age or
older and enrolled with a Program of all-Inclusive Care for the Elderly and the
organization’s certification or plan is terminated. Refer to the mandate for
additional criteria
A
G
N
A
F
HDF (High Deductible F)
N
NC Enrolled in Medicare Part D while enrolled under a Medicare Supplement
policy that covers outpatient prescription drugs and terminates the Medicare
supplement policy
A
G
A
F
HDF (High Deductible F)
OR Enrolled in Medicare Part D while enrolled under a Medicare Supplement
policy that covers outpatient prescription drugs and terminates the Medicare
supplement policy
A
G
N
A
F
HDF (High Deductible F)
N
NGAH-MEDSUPP-UW-GUIDE 1/2021 10
State Specific Guaranteed Issue Guidelines (continued)
State Guidelines
Plans: Medicare
eligible on
01/01/2020 or
after
(Post MACRA)
Plans: Medicare
eligible before
01/01/2020
(Pre MACRA)
Rule
CO Enrolled in Medicare Part D while enrolled under a medicare Supplement
policy that covers outpatient prescription drugs and terminates the Medicare
supplement policy
A
G
A
F
HDF (High Deductible F)
WI Enrolled in Medicare Part D while enrolled under a medicare Supplement
policy that covers outpatient prescription drugs and terminates the Medicare
supplement policy
Basic plan +
riders:
Part A Deductible,
Part B Excess
Charges, Home
Health Care, Foreign
Travel Emergency,
Part B Copayment
Basic plan +
riders:
Part A Deductible,
Part B Deductible,
Part B Excess
Charges, Home
Health Care, Foreign
Travel Emergency,
Part B Copayment
KY Enrolled in a Medicare risk contract, healthcare prepayment plan, cost contract
or Medicare Select plan and the organization’s certification is terminated
A
G
A
F
HDF (High Deductible F)
MN Enrolled in a Medicare Supplement policy and coverage discontinues due to
insolvency, or other involuntary termination of coverage
Basic, Extended
Basic, High
Deductible, Copay
Plans + riders:
Part A Deductible,
Part B Excess
Charges,
Preventative Care
Basic, Extended
Basic, High
Deductible, Copay
Plans + riders:
Part A Deductible,
Part B Deductible,
Part B Excess
Charges,
Preventative Care
NC Enrolled in a Medicare Supplement policy and coverage discontinues due to
insolvency, substantial violation of a material policy provision, or material
misrepresentation
A
G
A
F
HDF (High Deductible F)
MT Enrolled in a Medicare Supplement policy and coverage discontinues due to
insolvency, substantial violation of a material policy provision, or material
misrepresentation, or the agent materially misrepresented the policy
A
G
A
F
HDF (High Deductible F)
NC Enrolled under a Medicare Supplement policy, terminates and enrolls for first
time in Medicare Advantage, etc. Then terminates coverage within 12 months
of enrollment. Eligible for same plan that was terminated. If not available, can
select alternate plan.
A
G
A
F
HDF (High Deductible F)
MN Enrolled under a Medicare Supplement policy, terminates and enrolls for first
time in Medicare Advantage, etc. Then terminates coverage within 12 months
of enrollment
Basic, Extended
Basic, High
Deductible, Copay
Plans + riders:
Part A Deductible,
Part B Excess
Charges,
Preventative Care
Basic, Extended
Basic, High
Deductible, Copay
Plans + riders:
Part A Deductible,
Part B Deductible,
Part B Excess
Charges,
Preventative Care
SD Enrolled under an employee welfare benefit plan or an employer based health
insurance plan and the coverage under the plan terminates for that person
A
G
A
F
HDF (High Deductible F)
NGAH-MEDSUPP-UW-GUIDE 1/2021 11
State Specific Guaranteed Issue Guidelines (continued)
State Guidelines
Plans: Medicare
eligible on
01/01/2020 or
after
(Post MACRA)
Plans: Medicare
eligible before
01/01/2020
(Pre MACRA)
Rule
IN Enrolled under an employee welfare benefit plan that either (1) provides health
benefits supplementing Medicare; and the plan terminates or reduces benefits;
or (2) is primary to Medicare and the plan terminates; or ceases to provide
health benefits
A
G
A
F
HDF (High Deductible F)
CO Enrolled under an employee welfare benefit plan that either (1) provides health
benefits supplementing Medicare; and the plan terminates or reduces benefits;
or (2) is primary to Medicare and the plan terminates; or ceases to provide
health benefits
A
G
A
F
HDF (High Deductible F)
IL Enrolled under an employee welfare benefit plan that either (1) supplements
Medicare; and the plan terminates or reduces benefits; or (2) is primary to
Medicare and the plan terminates or ceases to provide health benefits because
the individual leaves the plan
A
G
A
F
HDF (High Deductible F)
OH Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare or is primary to Medicare, and the plan terminates or
reduces benefits, or the individual leaves the plan
A
G
A
F
HDF (High Deductible F)
TX Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare or is primary to Medicare, and the plan terminates or
reduces benefits, or the individual leaves the plan
A
G
A
F
HDF (High Deductible F)
CA Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare, and the plan terminates or reduces benefits
including Medicare part B 20% coinsurance for services
A
G
N
A
F
HDF (High Deductible F)
N
NC Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare, and the plan terminates or reduces benefits
A
G
A
F
HDF (High Deductible F)
AK Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare or is primary to Medicare, and the plan terminates or
reduces benefits, or the individual leaves the plan
A
G
A
F
HDF (High Deductible F)
WI Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare or is primary to Medicare, and the plan terminates or
reduces benefits, or the individual leaves the plan
Basic plan +
riders:
Part A Deductible,
Part B Excess
Charges, Home
Health Care, Foreign
Travel Emergency,
Part B Copayment
Basic plan +
riders:
Part A Deductible,
Part B Deductible,
Part B Excess
Charges, Home
Health Care, Foreign
Travel Emergency,
Part B Copayment
MO Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare, and the plan terminates or reduces benefits, or the
individual leaves the plan
A
G
N
A
F
HDF (High Deductible F)
N
NE Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare, and the plan terminates or reduces benefits; or
enrolled due to current employment providing benefits secondary to Medicare
and individual loses eligibility for coverage
A
G
A
F
HDF (High Deductible F)
NGAH-MEDSUPP-UW-GUIDE 1/2021 12
State Specific Guaranteed Issue Guidelines (continued)
State Guidelines
Plans: Medicare
eligible on
01/01/2020 or
after
(Post MACRA)
Plans: Medicare
eligible before
01/01/2020
(Pre MACRA)
Rule
LA Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare or is primary/secondary to Medicare, and the plan
terminates or reduces benefits, or the individual leaves the plan
A
G
A
F
HDF (High Deductible F)
PA Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare or is primary to Medicare, and the plan terminates or
reduces benefits, or the individual leaves the plan
A
G
A
F
HDF (High Deductible F)
NJ Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare or is primary to Medicare, and the plan terminates or
reduces benefits, or the individual leaves the plan
A
G
A
F
HDF (High Deductible F)
AR Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare or is primary to Medicare, and the plan terminates or
reduces benefits, or the individual leaves the plan
A
G
A
F
HDF (High Deductible F)
MT Enrolled under an employee welfare benefit plan providing health benefits
supplementing Medicare or is primary to Medicare, and the plan terminates or
reduces benefits, or the individual leaves the plan
A
G
A
F
HDF (High Deductible F)
OR Enrolled under an employee welfare benefit plan, an individual, conversion, or
portability health benefit plan, or state Medicaid plan providing health benefits
supplementing Medicare or is primary to Medicare, and the plan terminates or
reduces benefits, or the individual leaves the plan
A
G
N
A
F
HDF (High Deductible F)
N
TN Enrolled under Title XIX of the SS Act (Medicaid) and enrollment involuntarily
ceases after the individual is 65 and eligible/enrolled in Medicare Part B
A
G
N
A
F
HDF (High Deductible F)
N
MT Eligible for benefits under Medicare Part A and B by reason of disability A
G
N
A
F
HDF (High Deductible F)
N
MD Under 65 and qualified for Medicare due to a disability A A
WI Eligible for benefits under Medicare Parts A and B and covered under the
medical assistance program and then loses eligibility in the medical assistance
program
Basic plan +
riders:
Part A Deductible,
Part B Excess
Charges, Home
Health Care, Foreign
Travel Emergency,
Part B Copayment
Basic plan +
riders:
Part A Deductible,
Part B Deductible,
Part B Excess
Charges, Home
Health Care, Foreign
Travel Emergency,
Part B Copayment
TX Loses eligibility for health benefits under Title XIX of the SS Act (Medicaid) A
G
A
F
HDF (High Deductible F)
WY Postponed enrollment in Medicare Part B until after 65 because working and
enrolled in a group health insurance plan
A
G
A
F
HDF (High Deductible F)
NGAH-MEDSUPP-UW-GUIDE 1/2021 13
Guaranteed Issue Guidelines (continued)
State Guidelines
Plans: Medicare
eligible on
01/01/2020 or
after
(Post MACRA)
Plans: Medicare
eligible before
01/01/2020
(Pre MACRA)
Rule
UT Involuntarily terminated from health benefits from Title XIX of the SS Act
(Medicaid)
A
G
N
A
F
HDF (High Deductible F)
N
SD Age 65, enrolled in a Medicare risk contract, or similar organization and the
plan is terminated
A
G
A
F
HDF (High Deductible F)
NC Age 65, enrolled in a Medicare risk contract, or similar organization and the
plan is terminated
A
G
A
F
HDF (High Deductible F)
PA Eligible for Part A and enrolled in Part B, if eligible, enrolls in a Medicare
Advantage then disenrolls within 12 months
A
G
A
F
HDF (High Deductible F)
OH Eligible for Part A at 65, enrolls in a Medicare Advantage then disenrolls
within 12 months
A
G
A
F
HDF (High Deductible F)
MD Eligible for Part A at 65, enrolls in a Medicare Advantage then disenrolls
within 12 months
A
G
N
A
F
HDF (High Deductible F)
N
SD Age 65, enrolled in a Medicare Advantage plan and the organization’s
certification or plan is terminated
A
G
A
F
HDF (High Deductible F)
NC Eligible for Part A at 65, enrolls in a Medicare Advantage then disenrolls
within 12 months
A
G
N
A
F
HDF (High Deductible F)
N
CO Eligible for Part A, enrolls in a Medicare Advantage then disenrolls within 12
months
A
G
A
F
HDF (High Deductible F)
OR Eligible for Part A, enrolls in a Medicare Advantage then disenrolls within 12
months
A
G
N
A
F
HDF (High Deductible F)
N
OK Eligible for Part A at 65, enrolls in a Medicare Advantage then disenrolls
within 12 months; or under 65, eligible for Medicare part B, enrolls in
Medicare Advantage and disenrolls within 12 months
A
G
N
A
F
HDF (High Deductible F)
N
IA Enrolled in Medicare Part B, enrolls in a Medicare Advantage and disenrolls
within 12 months
A
G
N
A
F
HDF (High Deductible F)
N
KS Enrolled in Medicare Part B, enrolls in a Medicare Advantage and disenrolls
within 12 months
A
G
N
A
F
HDF (High Deductible F)
N
NGAH-MEDSUPP-UW-GUIDE 1/2021 14
Guaranteed Issue Guidelines (continued)
State Guidelines
Plans: Medicare
eligible on
01/01/2020 or
after
(Post MACRA)
Plans: Medicare
eligible before
01/01/2020
(Pre MACRA)
Rule
IL Enrolled in Medicare Part B, enrolls in a Medicare Advantage and disenrolls
within 12 months
A
G
A
F
HDF (High Deductible F)
IN Enrolled in Medicare Part B, enrolls in a Medicare Advantage and disenrolls
within 12 months
A
G
N
A
F
HDF (High Deductible F)
N
MT Eligible for Medicare Part A and B, enrolled in qualified medicare beneficiary
Program and no longer qualifies due to income or eligibility
A
G
N
A
F
HDF (High Deductible F)
N
MN Eligible for Part A, enrolls in a Medicare Advantage then disenrolls within 12
months
Basic, Extended
Basic, High
Deductible, Copay
Plans + riders:
Part A Deductible,
Part B Excess
Charges,
Preventative Care
Basic, Extended
Basic, High
Deductible, Copay
Plans + riders:
Part A Deductible,
Part B Deductible,
Part B Excess
Charges,
Preventative Care
ID Eligible for Part A, enrolls in a Medicare Advantage then disenrolls within 12
months
A
G
N
A
F
HDF (High Deductible F)
N
AK Enrolled in Medicare part B at age 65 or older, enrolls in a Medicare Advantage
and disenrolls within 12 months
A
G
N
A
F
HDF (High Deductible F)
N
LA Enrolled in Medicare part B, enrolls in a Medicare Advantage and disenrolls
within 12 months
A
G
N
A
F
HDF (High Deductible F)
N
TX Enrolled in Medicare part B at age 65 or older, enrolls in a Medicare Advantage
and disenrolls within 12 months
A
G
A
F
HDF (High Deductible F)
NGAH-MEDSUPP-UW-GUIDE 1/2021 15
Medicare Advantage (MA) Guidelines
Medicare Advantage Disenrollment
If applying for Medicare Supplement insurance, there are certain requirements that must be met when
the applicant is disenrolling from a Medicare Advantage plan. Underwriting cannot issue a policy unless
the specified requirements are met. Refer to the following guidelines to determine what requirements
must be satisfied.
Disenrolling during AEP/MADP Disenrolling outside of AEP/MADP
• Complete Medicare and Insurance information section on the
application
• Complete a replacement form (NRN-2017)
• Complete Medicare and Insurance information section on the
application
• Provide the home office with a copy of the applicant’s MA
disenrollment notice
• Complete a replacement form (NRN-2017)
National General Accident & Health is not able to issue a policy until the applicant’s disenrollment letter
has been received in the home office; it must be received within 30 days of the application or the policy
will be canceled.
For any further questions regarding MA disenrollment eligibility, contact the State Health Insurance
Assistance Program (SHIP) office or call 1-800-Medicare, as each situation presents its own unique set
of circumstances.
Enrollment Guidelines
Premium
When calculating the premium, utilize the outline of coverage. Age is calculated based on the
requested policy effective date. Premium is calculated based on the application date.
Risk Classes
There are two separate underwriting risk classes: Preferred and Standard. Each risk class has a
separate premium rate. See table below.
Preferred Standard
Qualify for Coverage; Qualify for Coverage;
Fall Within Preferred HT/WT Standards Fall Outside of Preferred HT/WT Standards
AND AND/OR
No Tobacco or Nicotine Use* Use Tobacco or Nicotine Products*
*Use of tobacco or nicotine in any form is considered tobacco use (examples: nicotine patch or gum,
electronic cigarettes). This rate can be applied for applicants during open enrollment or for those who
qualify for guarantee issue in certain states.
NGAH-MEDSUPP-UW-GUIDE 1/2021 16
Standard rates DO NOT apply during Open Enrollment or guaranteed issue in the following
states:
Arkansas, California, Colorado, District of Columbia, Illinois, Iowa, Kentucky, Louisiana, Michigan, North
Carolina, North Dakota, New Jersey, New Mexico, Ohio, Pennsylvania, Tennessee, Utah, Virginia, and
Wisconsin.
Policy Discount
National General Accident & Health offers a discount for individuals that meet the necessary
qualifications. See the chart below for details.
States Discount
AK, AL, AR, AZ, CA, CO, DE, DC,
GA, IA, LA, KS, KY, MD, MI, MO,
MS, MT, NC, ND, NM, NE, NV,
OH, OR, SC, SD, TN, TX, UT, VA,
WI, WV, WY
A 7 % discount is available to applicants who for the past 12 months have resided with at least
one, but no more than three, other adults who are age 50 or older. If living with another adult who
is their legal spouse, domestic partner, or in a Civil Union Partnership we will waive the one-year
requirement.
IL, NJ, OK, A 7% discount is available to applicants who for the past 12 months have resided with at least one
but no more than three, other adults who are age 50 or older and also have an active National General
Accident & Health Medicare Supplement insurance policy. If living with another adult who is the legal
spouse, domestic partner, or in a Civil Union Partnership, we will waive the one-year requirement.
PA A 7% household discount is available if the applicant is at least 65 at the time of the requested
effective date and meets the following criteria: married and residing with their spouse; or, must have
resided for the past 12 months in the same household with an individual who has either been issued
or is applying for a National Health Insurance Company policy.
ID, MN No discount available
FL 3% discount is available to applicants if they reside with their spouse who owns or is issued a
Medicare Supplement policy written by National Health Insurance Company.
IN A 7% discount is available to applicants whose spouse have or are applying for National General
Accident & Health Medicare Supplement insurance.
A 7% discount must be applied for applicants who qualify for Open Enrollment and Guarantee Issue.
Submitting the Application
National General Accident & Health offers two methods for submitting and completing applications:
• Web Application
• Paper Application
Each application has its own guidelines to follow when submitting for coverage.
Web Application (i.e. Electronic Application or eApp)
The Web Application is a digital form to be filled out and submitted through the agent portal.
NGAH-MEDSUPP-UW-GUIDE 1/2021 17
In order to complete an application using the Web Application Process:
1. Pre-qualify the applicant based on the Medical Questions (not required if the applicant is applying
under Open Enrollment or Guaranteed Issue).
2. Review the application with the applicant; you MUST read the required statements in the Disclosure
Section. If the client has not been read these statements, the application cannot be submitted.
3. Log on to the agent portal at EnrollNatGen.com
4. Begin the application on the “Quick Quote” screen. Complete the application in full.
5. Once you have completed the application you will have the option to select the signature option:
a. eSignature
b. Voice Signature
6. Once the application has been completed, you will be notified of the decision via email.
For fully underwritten applications, an underwriter will be assigned to the case and may contact your
applicant to complete the medical risk assessment if necessary.
Once the application has been completed, you will be notified of the decision via email or you may
contact the Underwriting Department for a point-of-sale decision.
Paper Application
To submit an application using the Paper Application Process:
1. Pre-qualify the applicant based on the Health Information questions on the application. (Not
required if the applicant is applying under Open Enrollment or Guaranteed Issue).
2. Complete the entire application.
3. Complete the Health Information Authorization – (N-HHA-MS).
4. If the applicant is replacing coverage: complete the Replacement Notice (NRN- 2017).
5. If the applicant is applying during Guaranteed Issue: Complete the Definition of Eligible Person for
Guaranteed Issue form (GI-MS).
Additional state specific form requirements: KY Comparison Statement*, IL Policy Checklist*, FL Certification, OH Agent Medicare
Supplement Insurance Solicitation Disclosure, LA Your Rights Regarding the Release and Use of Genetic Information**
*required if replacing coverage
**must be provided at point of sale, but signature is not required
Once the application has been completed, you can mail the application and initial premium to:
National General Accident and Health
PO Box 95464
Cleveland, OH 44101
Initial premium via Electronic Funds Transfer should also be sent to the address listed above.
The completed application can also be emailed to National General Accident & Health Medicare
Supplement Department at [email protected]
Any application dated outside 30 days from the date the application is received at the National General
Accident & Health home office will be returned.
In order to accelerate the application process, verify that the application has been completed in full. Try
to be as detailed as possible when filling out an application. This will assist in expediting the process.
Producer Checklist for Paper Applications
F Application is completely filled out.
F All Medical Questions have been answered
(only required if application is underwritten).
F Disclosure, Acknowledgements, and Agreement
signed and dated.
F Agent statement completed, signed, and dated.
F HIPAA statement (N-HHA-MS) signed and dated.
F Replacement Notice (NRN- 2017) completed
and signed (if necessary).
F Definition of Eligible Person for Guaranteed
Issue (GI-MS) completed (if necessary).
F State Specific Forms (if applicable).
NGAH-MEDSUPP-UW-GUIDE 1/2021 18
Application Signatures
All applications require a valid signatures in order to be processed.
Web/Applications
• Web Applications require eSignatures or Voice
Signature. (Only a wet signature is accepted
in CA)
• POA signatures are not accepted on Web
Applications.
Paper Applications
• All Paper Applications require the applicant’s
physical signature.
• POA signatures can be accepted only for OE/
GI cases.
Premium Payment
National General Accident & Health offers two forms of payment for premium charges:
Each form of payment has its own guidelines.
• Bank Draft. • Direct Bill.
Credit card payments will not be accepted.
Bank Draft
Bank draft is available for all forms of applications and is the only option available when completing a
Web Application. The payments will be set up to automatically draft from the applicant’s bank account.
Payments can be set up to be made:
• Monthly.
• Quarterly.
• Semi-annually.
• Annually.
The Draft Date can be up to the day prior to the policy effective date. The recurring draft payment will
be taken on the same day each month. If this day does not exist in a month, payment will be drafted on
the next business day.
Direct Bill
Direct bill is available for Paper Applications. We will process all checks as EFT (Electronic Funds
Transfer) with the bank. Cash, post-dated checks, money orders, traveler’s checks, agent checks and
agency checks will not be accepted. Unless required by law or regulation, checks from a third-party
payer (such as a foundation or other non-profit) will not be accepted. In some circumstances, checks
from a family member or business associate can be accepted.
When completing an application using the Web Application process, the applicant must set up their
payments to be automatically drafted from their account. If they wish to have their subsequent
payments to be billed to them directly, they are able to do so by contacting National General Accident
& Health. Direct bill payments can be set up:
• Quarterly. • Semi-annually. • Annually.
Required Forms
Each application method has different requirements for forms that need to be submitted to the home
office:
Web Application: For most states, the forms are built into the Web Application and submitted
electronically.
Paper Application: Refer to Paper Application section in this document.
NGAH-MEDSUPP-UW-GUIDE 1/2021 19
Agent Responsibilities
This section does not cover all of the agent’s responsibilities. Refer to other sections of the
Underwriting Guidelines, the agent contract, and other materials provided.
The Health Insurance Portability and Accountability Act (HIPAA) established requirements and
restrictions pertaining to the use and disclosure of Protected Health Information. Please familiarize
yourself with both National General Accident & Health’s HIPAA Policy and Privacy Policy. Your
adherence to federal and state laws and regulations that provide privacy protections is mandatory.
The applicant will not be familiar with the underwriting process. Therefore, it is important for you to
read the application and forms to the applicant. You can also ask the applicant to read the application
and forms themselves and explain anything that he/she does not understand.
Things That Can Delay the Application Process
• Licensing and appointment issues.
• Missing information on the application.
• Submitting an expired application; application must be received within 30 days of signature date.
• Premium shortage.
• Poor quality copies.
Tips for Completing the Application
• Ask each question exactly as written.
• Complete the application legibly and in black or blue ink, if submitting a Paper Application.
• Have the applicant initial and date any correction or mistake.
• If completing a Web Application, prepare the applicant for the Web Application process.
• The primary residence address is the physical address where the applicant lives. A post office box
should not be used for the primary residence address. The applicant can also provide an optional
mailing address which can be a post office box.
Underwriting Concepts
We review applications in the order in which they are received. Once an application has been
received and logged into the Underwriting Department, an underwriter is assigned to the case and
the application is reviewed. The underwriter will do their best to process the application with the
information provided but additional information may be required in order complete the application
process.
Applicant must sign to certify the health questions will be answered to the best of the applicant’s
memory, and also to acknowledge that the applicant’s misrepresentation could result in a denial of
benefits and/or rescission of the policy. Information from claims activity, or other sources could lead to
a file review and inquiry to consider if misrepresentations were made at the time of the application.
Medical Underwriting
Medical underwriting is the process of reviewing the medical history of applicants and comparing that
information with established guidelines in order to assess the risk associated with providing insurance
to that applicant.
NGAH-MEDSUPP-UW-GUIDE 1/2021 20
National General Accident & Health’s underwriting guidelines take into consideration many different
factors, including but not limited to the following:
• Height and weight.
• Current and past medical conditions.
• Diagnosis and prognosis.
• Use of prescription drugs.
• Follow-up required.
• Chronic nature of the disease.
National General Accident & Health collects pharmaceutical information on underwritten Medicare
Supplement applications. In order to obtain the pharmaceutical information as requested, all
underwritten applications must be submitted with a signed HIPAA Privacy form (N-HHA-MS).
Prescription information disclosed on the application will be compared to the additional pharmaceutical
information obtained in the underwriting process.
The decision to issue coverage will be made by underwriting based on a review of the application and
any additional information received.
Underwriting Appeals
In the event of an adverse decision, the application could be eligible for reconsideration.
Reconsiderations are case specific and should be carefully considered. Agents disputing a decline or
rate up are welcome to submit information from the applicant’s physician that disputes the reason for
the adverse decision.
Information received from the doctor’s letter must be current (dated within 30 days of the date of the
decline letter) and must be specific to the health condition related to the adverse decision. National
General Accident & Health reserves the right to request up to three years of medical records to
resolve any disputes. Random excerpts from the applicant’s medical records will not be accepted. Any
expenses to retrieve a doctor’s letter or medical records must be covered by the applicant.
Reconsiderations
In the event of an adverse decision, reconsiderations can be offered case by case if the underwriter
feels the passage of time might lead to a favorable underwriting outcome. Generally at least one year
is needed before the applicant can reapply.
Reinstatements
When Medicare Supplement insurance lapses and it is within 31 days of the last paid to date,
coverage may be automatically reinstated by submitting all outstanding premiums without meeting any
underwriting requirements.
Reinstatements are subject to claims review and may require a phone interview and prescription
history check.
Reinstatements submitted 90 or more days from the date the policy lapsed will not be accepted; after
90 days from the lapse date, a new application must be submitted.
When Medicare Supplement insurance lapses and it is not within 31 days of the last paid to date, the
client will need to apply for a reinstatement of coverage where all underwriting requirements must be
met before the policy can be reinstated.
Internal Replacement (Conversions):
Insured individuals requesting to modify benefits under their existing Medicare Supplement insurance
policy 90 days after their initial approval or insured individuals requesting to modify their rate class from
Standard to Preferred, will be required to submit a new application through underwriting. Follow the
Paper Application instructions (a new application fee will also be charged).
NGAH-MEDSUPP-UW-GUIDE 1/2021 21
The internal replacement process is subject to underwriting which requires a prescription history
check, claims history review, and telephone interview (if required). There are no Guarantee Issue
options available for internal replacements. Once approved, the benefit change will take effect on the
first renewal date following the application date. If the conversion is declined, the existing coverage will
remain as is.
Underwriting Guidelines
The purpose of our Underwriting Department is to assess and evaluate the degree of risk associated
with offering insurance to an applicant and make an informed decision based on the information
received. Applications may be underwritten up until the time the policy goes into effect.
If the applicant has a change in health after the application was signed but before the policy goes into
effect, the applicant is required to disclose the change in health. This new information will be factored
into the underwriting decision to approve or decline the application.
The main sources of underwriting information are:
• Application
• Prescription Report
• Telephone Interview
Applies to All States EXCEPT CA, OR, VA
If any of the following conditions or situations have applied to the applicant
within the time frames indicated, the application will be declined.
Note: This list is not all inclusive
WITHIN THE PAST 10 YEARS
Acquired Immune Deficiency
Syndrome (AIDS)
Cardiomyopathy Emphysema, COPD or other
Chronic Pulmonary/Respiratory
Disorder (see Underwriting
Pulmonary Disorders section)*
Renal Failure
AIDS Related Complex (ARC) Chronic Hepatitis B Enlarged Heart Schizophrenia
ALS (Amyotrophic Lateral
Sclerosis)
Cirrhosis Myasthenia Gravis
Alzheimer’s Disease Congestive Heart Failure Organ Transplant
Bipolar or Personality Disorder Diabetes with Neuropathy or
Retinopathy or Uncontrolled
Diabetes (see Underwriting
Diabetes section)**
Parkinson’s Disease
WITHIN THE PAST 2 YEARS
Alcoholism or Drug Abuse Enzyme Disorders Leukemia Peripheral Vascular Disease
Amputation Caused by Disease Epilepsy Major Depression Scleroderma
Carotid Artery Disease Heart Attack Melanoma Stroke or Transient Ischemic
Attack (TIA)
Crohn’s Disease Heart Rhythm Disorders Mental or Nervous Disorder
requiring psychiatric hospital-
ization
Systemic Lupus
Coronary Artery Disease Heart Valve Surgery Muscular Dystrophy
Crippling or Disabling Arthritis Hodgkin’s Disease or other
Lymphoma
Multiple Sclerosis
Deep Vein Thrombosis Internal Cancer Osteoporosis with one or more
fractures or treated by injection/
infusion
NGAH-MEDSUPP-UW-GUIDE 1/2021 22
Applies to All States EXCEPT CA, OR, VA
If any of the following conditions or situations have applied to the applicant
within the time frames indicated, the application will be declined.
Note: This list is not all inclusive
CURRENTLY
Implantable Cardiac Device Surgery, Medical Tests, Treatment or Therapy That Has Not Been
Performed
Oxygen Therapy Surgery May Be Required Within Next 12 Months for Cataracts
Rheumatoid Arthritis
Applies to States of CA, OR, VA
If any of the following conditions or situations have applied to the applicant
within the time frames indicated, the application will be declined.
Note: This list is not all inclusive
WITHIN THE PAST 10 YEARS
Acquired Immune Deficiency
Syndrome (AIDS)
Cardiomyopathy Human Immunodeficiency Virus
(HIV) Infection
Parkinson’s Disease
AIDS Related Complex (ARC) Cognitive or Brain disorder Multiple Sclerosis Renal Failure
ALS (Amyotrophic Lateral
Sclerosis)
Dementia Muscular Dystrophy Scleroderma
Alzheimer’s Disease Diabetes with Neuropathy or
Retinopathy or Uncontrolled
Diabetes (see Underwriting
Diabetes section)**
Myasthenia Gravis Systemic Lupus
Amputation Caused by Disease Emphysema, COPD or other
Chronic Pulmonary/Respiratory
Disorder (see Underwriting
Pulmonary Disorders section)*
Organ Transplant
WITHIN THE PAST 2 YEARS
Alcoholism or Drug Abuse Congestive Heart Failure Heart Attack Melanoma
Bipolar or Personality Disorder Coronary Artery Disease Heart Rhythm Disorders Mental or Nervous Disorder
requiring psychiatric hospital-
ization
Carotid Artery Disease Crippling or Disabling Arthritis Heart Valve Surgery Osteoporosis with one or more
fractures or treated by injection/
infusion
Chronic Kidney Disease Includ-
ing End Stage Renal Disease
Deep Vein Thrombosis Hodgkin’s Disease or other
Lymphoma
Peripheral Vascular Disease
Crohn’s Disease Enlarged Heart Internal Cancer Rheumatoid Arthritis
Chronic Hepatitis B Enzyme Disorders Leukemia Schizophrenia
Cirrhosis Epilepsy Major Depression Stroke or Transient Ischemic
Attack (TIA)
CURRENTLY
Implantable Cardiac Device Surgery, Medical Tests, Treatment or Therapy That Has Not Been
Performed
Oxygen Therapy Surgery May Be Required Within Next 12 Months for Cataracts
NGAH-MEDSUPP-UW-GUIDE 1/2021 23
Underwriting Diabetes*
An applicant who has diabetes without current complications of neuropathy, retinopathy, nephropathy
or skin ulcers and without any current or past history of coronary artery disease, carotid artery disease
or peripheral artery disease could be insurable.
Some applications will ask about A1C, also called hemoglobin A1C, glycosylated hemoglobin or HbA1c,
which is a common blood test used to diagnose both type 1 and type 2 diabetes. A1C is also used
on an ongoing basis to gauge how well the patient is managing the diabetes condition. It reflects the
average blood sugar level for the past two to three months. If the applicant remembers A1C levels
before the most recent one, ask the applicant to provide the levels and approximate dates in Section F
under Additional Comments.
The use of insulin as a treatment, and the number of units of insulin being taken at the time of the
application, is not a determining factor for insurability all by itself. If the applicant is significantly
overweight and/or has certain conditions, such as heart disorder or lung disease, the risk is generally
uninsurable. The underwriter will consider all of the information in the application as well as information
from other sources.
Underwriting Pulmonary/Respiratory Disorders**
An applicant who has emphysema, COPD, or any other chronic pulmonary (respiratory; lung) disorder
other than mild asthma is uninsurable. An applicant who has asthma, and required treatment in an
emergency room or hospital within the past 2 years will be considered uninsurable. If the applicant’s
pulmonary disorder has requires treatment with supplemental oxygen, or the applicant has been
advised that oxygen will be required, the risk is uninsurable.
Build Table
Applications will be declined for applicants whose weight is below the Preferred minimum or above the Standard maximum.
Height Preferred weight Standard weight Height Preferred weight Standard weight
4 ft 2 ins 66-125 126-143 5 ft 10 ins 129-244 245-279
4 ft 3 ins 69-130 131-148 5 ft 11 ins 133-251 252-287
4 ft 4 ins 72-135 136-154 6 ft 137-259 260-295
4 ft 5 ins 74-140 141-160 6 ft 1 in 141-266 267-304
4 ft 6 ins 77-146 147-166 6 ft 2 ins 145-273 274-312
4 ft 7 ins 80-151 152-173 6 ft 3 ins 149-281 282-321
4 ft 8 ins 83-157 158-179 6 ft 4 ins 152-288 289-329
4 ft 9 ins 86-162 163-185 6 ft 5 ins 157-296 297-338
4 ft 10 ins 89-168 169-192 6 ft 6 ins 161-303 304-347
4 ft 11 ins 92-174 175-199 6 ft 7 ins 165-311 312-356
5 ft 95-180 181-205 6 ft 8 ins 169-319 320-365
5 ft 1 in 98-186 187-212 6 ft 9 ins 173-327 328-374
5 ft 2 ins 102-192 193-219 6 ft 10 ins 177-335 336-383
5 ft 3 ins 105-198 199-226 6 ft 11 ins 182-343 344-392
5 ft 4 ins 108-204 205-234 7 ft 186-352 353-402
5 ft 5 ins 112-211 212-241 7 ft 1 in 191-360 361-412
5 ft 6 ins 115-217 218-248 7 ft 2 ins 195-369 370-421
5 ft 7 ins 119-224 225-256 7 ft 3 ins 200-377 378-431
5 ft 8 ins 122-231 232-264 7 ft 4 ins 204-386 387-441
5 ft 9 ins 126-238 239-271
NGAH-MEDSUPP-UW-GUIDE 1/2021 24
Drug List Information
Drug list information is provided to assist agents in the application process. This is a list of the most
commonly prescribed medications for declinable conditions. Applicants may be unaware of a condition
listed on the application, but prescribed medication may indicate the condition exists and therefore
make the applicant not eligible for coverage with the company.
Uninsurable Medications:
Below is a partial list of uninsurable medications. Please contact underwriting if you are unsure about a
medication that does not appear in the list below.
If the medication is on the list below but is being prescribed for a condition not listed below or is being
prescribed in an “off-label” situation, the condition may or may not be insurable. However, if the “off-
label” condition being treated is on the list of uninsurable health conditions, the risk is not insurable. If
the situation is not clear, it is best to contact underwriting in advance of filling out an application.
Generic Brands Used for
abacavir Ziagen HIV
abarelix Plenaxis cancer
abciximab ReoPro heart disorder
acamprosate Campral alcohol abuse
adalimumab Humira rheumatoid arthritis
AL-721 AL-721 AIDS, HIV
albuterol/ipratropium DuoNeb, Combivent Respimat COPD
alemtuzumab Campath, Lemtrada multiple sclerosis, leukemia
alteplase Activase heart disorder, stroke
altretamine Hexalen cancer
amantadine Endantadine, Symmetrel, Symadine Parkinson's
ambrisentan Letairis pulmonary hypertension
amiodarone Cordarone, Pacerone, Nexterone heart disorder
anakinra Kineret rheumatoid arthritis
anastrozole Arimidex cancer
apomorphine Apokyn, Uprima Parkinson's
aripripazole Abilify, Aristada schizophrenia
asparaginase Elspar leukemia
atazanavir Reyataz HIV
auranofin Ridaura rheumatoid arthritis
aurothioglucose Solganal rheumatoid arthritis
aurothiomalate Myochrysine, Aurolate severe arthritis
azathioprine Imuran, Azasan rheumatoid arthritis, kidney transplant
BCG TheraCyx, Tice BCG bladder cancer
becaplermin Regranex diabetic neuropathy
benztropine Cogentin Parkinson's
bevacizumab Avastin cancer
bicalutamide Casodex prostate cancer
biperiden hydrochloride Akineton Parkinson's
NGAH-MEDSUPP-UW-GUIDE 1/2021 25
Generic Brands Used for
bleomycin Blenoxane cancer
bromocriptine Cycloset, Parlodel Parkinson's
busulfan Myleran, Busulfex cancer
capecitabine Xeloda cancer
carbidopa Lodosyn Parkinson's
carbidopa/levodopa Sinemet, Rytary, Duopa, Atamet, Carbilev,
Parcopa
Parkinson's
carboplatin Paraplatin cancer
chlorambucil Leukeran cancer, kidney disease, rheumatoid
arthritis Activase heart disorder, stroke
chlorotrianisene Tace cancer
chlorpromazine Thorazine schizophrenia, psychosis
cilostazol Pletal peripheral vascular disease
cinacalcet Sensipar hyperparathyroidism due to cancer or kidney
disease
cisplatin Platinol cancer
cladribine Leustatin leukemia
clopidogrel Plavix cardiovascular
clozapine Clozaril, FazaClo, Versacloz schizophrenia
cyclophosphamide Cytoxan, Neosar cancer, rheumatoid arthritis, lupus
cycloserine Seromycin tuberculosis
cyclosporine Neoral, Sandimmune, Gengraf organ transplant, cancer, severe arthritis
dalteparin Fragmin cardiovascular, cancer
dantrolene Dantrium, Ryanodex, Revonto multiple sclerosis
darunavir Prezista AIDS, HIV
delavirdine Rescriptor AIDS, HIV
didanosine Videx, ddl AIDS, HIV
dipyridamole Persantine cardiovascular
dipyridamole/aspirin Aggrenox stroke, TIA
disulfiram Antabuse alcohol abuse
donepezil Aricept dementia
doxorubicin Adriamycin, Caelyx, Rubex cancer
dronabinol Marinol, THC cancer
efavirenz Sustiva AIDS, HIV
emtricitabine Atripla AIDS, HIV
emtricitabine Emtriva, Coviracil AIDS, HIV
emtricitabine/tenofovir Truvada HIV
enfuvirtide Fuzeon AIDS, HIV
enoxaparin Lovenox peripheral vascular disease
entacapone Comtan Parkinson's
entacapone/levodopa/carbidopa Stalevo Parkinson's
epoetin alfa Epogen, Procrit, Eprex chronic kidney disease
eptifibatide Integrilin heart disorder
ergoloid mesylates Hydergine dementia
NGAH-MEDSUPP-UW-GUIDE 1/2021 26
Generic Brands Used for
estramustine Emcyt cancer
etanercept Enbrel severe arthritis
ethinyl estradiol Estinyl cancer
ethopropazine Parsidol Parkinson's
etoposide VePesid, Toposar, Etopophos cancer
exemestane Aromasin cancer
filgrastim Neupogen, Granix, Zarxio cancer
flecainide Tambocor heart disorder
fluorourcil Adrucil cancer
fluphenazine Modecate, Prolixin, Moditen, Permitil psychosis
flutamide Euflex, Eulexin cancer
fondaparinux Arixtra vascular disease
fosamprenavir Lexiva HIV
foscarnet sodium Foscavir AIDS, HIV
fulvestrant Faslodex cancer
galantamine Razadyne, Reminyl dementia
glatiramer Copaxone, Glatopa multiple sclerosis
gold sodium thiomalate Myochrysine, Aurolate severe arthritis
goserelin Zoladex cancer
haloperidol Haldol, Peridol psychosis
heparin Calcilean, Calciparine, Hepalean, Liquaemin cardiovascular
hydroxyurea Hydrea, Droxia cancer
imatinib Gleevec cancer
indinavir Crixivan, IDV AIDS, HIV
infliximab Remicade rheumatoid arthritis
insulin > 50 units per day many brands diabetes mellitus
interferon many brands AIDS, HIV, cancer, multiple sclerosis,
hepatitis Antabuse alcohol abuse
interferon alfa-2a Roferon-A AIDS, HIV, cancer
interferon beta 1a Avonex, Rebif multiple sclerosis
interferon beta 1b Betaseron, Extavia multiple sclerosis
ipratropium Atrovent COPD
isoniazid Hyzyd, INH, Laniazid, Nydrazid, Rimifon,
Tubizid
tuberculosis
lamivudine Combivir, 3TC, Epivir AIDS
lamivudine/zidovudine/abacavir Trizivir HIV
letrozole Femara cancer
leucovorin Wellcovorin cancer
leuprolide Lupron, Eligard cancer
levamisole hydrochloride Ergamisol cancer
levodopa Larodopa, Dopar, L-Dopa Parkinson's
lomustine Gleostine, CCNU cancer
lopinavir Kaletra HIV
loxapine Loxitane schizophrenia
NGAH-MEDSUPP-UW-GUIDE 1/2021 27
Generic Brands Used for
maraviroc Selzentry HIV
medroxyprogesterone acetate Depo-Provera, Provera, Amen, Curretab,
Cycrin
cancer
megestrol Megace cancer
melphalan Alkeran cancer
memantine Namenda dementia
methadone Methadose, Dolophine severe pain
methotrexate Trexall, Rheumatrex, Rasuvo, Otrexup severe arthritis, cancer
mitomycin Mutamycin cancer
mitoxantrone Novantrone multiple sclerosis, cancer
morphine Contin, Avinza, Depodur, Duramorph,
Infumorph, Astramorph, Kadian, Oramorph,
Rapi-Ject, Roxanol
severe pain
mycophenolate CellCept, Myfortic myasthenia gravis, organ transplant
naltrexone ReVia, Vivitrol, Depade opioid or alcohol detox
natalizumab Tysabri multiple sclerosis
nebulizer device respiratory / pulmonary disorders
nelfinavir Viracept AIDS, HIV
neostigmine Prostigmin, Bloxiverz Myasthenia Gravis
nesiritide Natrecor congestive heart disorder failure
nevirapine Viramune AIDS, HIV
nilutamide Nilandron cancer
nitroglycerine glyceryl trinitrate, Nitrol, Nitro Bid, Tridil,
NTG
heart disorder
nitroglycerine transdermal NitroDur, Minitran, Deponit, Nitrocine heart disorder
olanzapine Zyprexa schizophrenia
ondansetron Zofran cancer
oxygen Respiratory / pulmonary disorder
paliperidone Invega schizophrenia
penicillamine Cuprimine, Depen rheumatoid arthritis, disease of liver or
kidneys
pergolide mesylate Permax Parkinson's
perphenazine Trilafon schizophrenia
pimozide Orap schizophrenia
pramipexole Mirapex Parkinson's
procainamide Procanbid, Pronestyl heart disorder
prochlorperazine Compazine psychosis
procyclidine Kemadrin Parkinson's
pyridostigmine Mestinon, Regonol Myasthenia Gravis
quetiapine Seroquel schizophrenia
quinidine Quinaglute, Quinidex heart disorder
rasagiline Azilect Parkinson's
riluzole Rilutek ALS - amyotrophic lateral sclerosis
risperidone Risperdal schizophrenia, psychosis
ritonavir Norvir AIDS, HIV
NGAH-MEDSUPP-UW-GUIDE 1/2021 28
Generic Brands Used for
rituximab Rituxan non-Hodgkin lymphoma
rivaroxaban Xarelto cardiovascular
rivastigmine Exelon dementia
ropinirole Requip Parkinson's
rotigotine Neupro Parkinson's
saquinavir Invirase, Fortovase AIDS, HIV
selegiline Carbex, Eldepryl, Zelapar Parkinson's
sotalol Betapace, Sorine, Sotylize heart disorder
stavudine Zerit, d4T AIDS, HIV
streptozocin Zanosar cancer
tacrine Cognex dementia
tacrolimus Prograf, Hecoria, Astagraf, Envarsus myasthenia gravis, organ transplant
tamoxifen Soltamox cancer
tenofovir Viread AIDS, HIV
testolactone Teslac cancer
thioridazine Mellaril psychosis, dementia
thiotepa Tespa, Thioplex cancer
thiothixene Navane psychosis
ticlopidine Ticlid cardiovascular
tiotropium Spiriva COPD
tipranavir Aptivus AIDS, HIV
tirofiban Aggrastat heart disorder, kidney
tolcapone Tasmar Parkinson's
toremifene Fareston cancer
trastuzumab Herceptin cancer
treprosinil Tyvaso, Remodulin, Orenitram pulmonary hypertension
trifluoperazine Stelazine schizophrenia, psychosis
trihexyphenidyl Artane, Trihex Parkinson's
triptorelin Trelstar cancer
valganiciclovir Valcyte cytomegalovirus disease, HIV
vincristine Oncovin, Vincasar cancer
warfarin Coumadin, Jantoven cardiovascular
zalcitabine Hivid, ddC AIDS, HIV
zidovudine AZT, ZDV, Retrovir AIDS, HIV, hepatitis
ziprasidone Geodon schizophrenia, psychosis
zoledronic acid Reclast, Zometa hypercalcemia caused by cancer
Any questions concerning medications should be directed to the Underwriting Department.
