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Insspecialties.com

1275 Milwaukee Ave. Glenview, IL 60025www.gtlic.com (800) 323-6907 LUmP SUm CaNCeR, HeaRt attaCk & StRoke Rates (Non-Smoker).
Rates (Smoker). Underwriting Guide.
Premium Calculation Sheet.
chs PROTEcTION PLUs
Lump Sum Cancer, Heart Attack and Stroke Coverage with Recurrence Benefits Rates do not include a $20 Annual Policy Fee CANCER WITH HEART ATTACK & STROKE RIDER STAND-ALONE HEART ATTACK & STROKE POLICY We will return premiums (less any claims paid) if you pass Note: ROP not available for ages 80+.
* Rates applied based on original issue age of policy Lump Sum Rate Sheet For: AL, AK, AR, DE, HI, IL, LA, MI, MS, MO, MT, NE, NM, OK, OR, TN, WI chs PROTEcTION PLUs
Lump Sum Cancer, Heart Attack and Stroke Coverage with Recurrence Benefits Rates do not include a $20 Annual Policy Fee CANCER WITH HEART ATTACK & STROKE RIDER STAND-ALONE HEART ATTACK & STROKE POLICY We will return premiums (less any claims paid) if you pass Note: ROP not available for ages 80+.
* Rates applied based on original issue age of policy Lump Sum Rate Sheet For: AL, AK, AR, DE, HI, IL, LA, MI, MS, MO, MT, NE, NM, OK, OR, TN, WI Guarantee Trust Life Lump Sum Cancer/Heart Attack and Stroke 1. Each person must be a U.S. citizen or hold a “green card” (permanent resident of US).
2. The agent must be health licensed and use the state approved application in the state where the 3. If both spouses’ apply for coverage, each person must answer the questions and sign the application.
4. If power of attorney is used, please submit a signed copy of the form with the application.
5. An RX check (Prescription drug check) will be done when the Heart & Stroke rider or Heart Attack & Stroke policy is applied for. In some cases, depending on the information received, a phone interview may also be conducted to clarify information. If so, the interview will be ordered by Home Office. 6. Tobacco use means cigarettes, cigar, pipe, snuff, chewing tobacco, nicotine delivery systems such as electric cigarettes, nicotine gum or patch, or marijuana used in the 12 months prior to the application date. Use the tobacco rates if any person applying for Individual, Single Parent, Couple or the Family plan uses tobacco. For example, if the spouse applying for the Family plan is using tobacco, tobacco rates will apply. In some instances, it may be advantageous to submit one applicant under non tobacco rates and another application on the spouse if tobacco rates apply. However, the policy fee must be 7. If the applicant is taking any of the medications listed on the Medication List, the applicant will not 8. If an application is over 31 days old when received by the Company, we will require a new currently 9. The effective date cannot be more than 90 days from the application date or earlier than the application 10. Dual applicants must be legally married or their resident state must recognize civil unions. If the state recognizes common law marriage, they must complete the common law form and submit it with the application. If the state does not recognize common law marriage, each person must submit their own application and each must pay the annual policy fee. 11. Family and Couple premium rates will be calculated by the older spouse’s age regardless of how it is 12. The maximum benefit amount for the Cancer plan is $75,000. The Heart Attack/Stroke plan/rider also A) If you submit an application for the Cancer plan with Heart Attack/Stroke rider the amount for each benefit must be the same. For example, if the Cancer benefit is $75,000, the Heart Attack/Stroke B) If the amounts are different, if approved, separate policies will be issued. For example, if the Cancer benefit is $75,000 but the Heart Attack/Stroke benefit is $50,000, each benefit will be a standalone plan. Please note that each policy will have an annual policy fee. 13. Please remember to add the $20 annual policy fee to the total premium--then calculate the modal premium i.e.; monthly (.09), quarterly (.265), or semi-annual (.52). In this case—monthly was selected, example would be: $291.00 + $20.00 = $311.00 x .09 = $27.99 14. Single Parent plan denotes one parent (regardless of marital status) applying with eligible dependent An application for the CHS Protection Plan should not be taken in the following situations: → Leukemia, Hodgkin’s Disease, lymphoma, malignant melanoma, sarcoma, or any internal cancer, a pre-malignant condition or a condition with malignant potential within 5 years of the application date.
• A pre-leukemic condition is also known as known as Myelodysplastic Syndromes (MDS). This is a blood related condition, where not enough blood cells are produced by the bone marrow.
• Pre-malignant condition or condition with malignant potential examples includes Barrett’s esophagus, adenomatous polyps, adenomas, dysplasia, Monoclonal Gammopathy of Undetermined Significance (MGUS) or cervical intraepithelial neoplasia. → Medication prescribed for the treatment of these conditions within 5 years of the application date.
→ PSA reading of 4.0 or greater without further investigation.
→ Chronic Obstructive Lung Disease includes Chronic Bronchitis and Emphysema. It does not include asthma. If the applicant takes 2 or more of the medications for COPD, the person is not eligible for any The applicant is not eligible for the Heart Attack and Stroke Plan or Rider in the following situations: → Heart attack, heart bypass, angioplasty, angina, congestive heart failure, coronary artery disease, atrial fibrillation, chronic kidney disease, diabetes requiring insulin use, stroke, or Transient Ischemic Attack (TIA) within 5 years of the application date.
→ If the applicant is on kidney dialysis or had a kidney transplant, the person does not qualify for this → If the applicant took or is now taking medication for any of these conditions within 5 years of the application date, the person will not be eligible for the rider or plan.
If the applicant is taking any of the following medications for the condition listed, the applicant is not eligible for the plan or a benefit rider. If the applicant takes 2 or more medications for COPD, the applicant does not qualify for any plan. This is not an all inclusive list and maybe subject to change from time to time. Medication
Medical Condition
Medication
Medical Condition
If the applicant is taking any of the following medications for the condition listed, the applicant is not eligible for the plan or a benefit rider. If the applicant takes 2 or more medications for COPD, the applicant does not qualify for any plan. This is not an all inclusive list and maybe subject to change from time to time. Medication
Medical Condition
Medication
Medical Condition
Step 1. Determine The Annual PremiumDivide __________________ by 5,000 = _______________ Number of Units Multiply _______________ by __________________ = _______________ Annual Premium Step 2. Determine The Intensive Care Rider Premium (Optional) Multiply the _________________ by ________________ = _______________ Intensive Care Rider Premium Step 3: Determine The Return of Premium (Optional)Add the __________________=(A) Premium, Multiply by 1.25 (ROP Factor) = _______________(B) Premium Step 4. Enter Annual Premium (See STEP 1) Step 5. (Optional) Intensive Care Rider (See STEP 2) Step 6. (Optional) Therapy & Wellness Rider Step 7. (Optional) Return of Premium (See STEP 3) Step 8. Add $20 Annual Policy Fee (If Applicable)* Step 9. Total Annual Premium (Add STEP 4 Through STEP 8) Step 10. Enter Modal Factor (MonThly PAC= .09) (QuArTErly= .265) (SEMI-AnnuAl= .52) SAMPLE PREMIUM CALCULATION
This is based on a 40-year old individual who has selected a $15,000 Cancer benefit with the Heart Attack and Stroke Rider, Intensive Care Rider and Return of Premium Rider.
1. Determine the correct rate per $5,000, based on the proposed insured’s age — in this example it is $95.06 2. Take the Lump Sum Benefit and divide it by $5,000 to figure out the number of units of coverage. For example, $15,000/$5,000 = 3 units 3. Multiply the units by the correct rate. For example, 3 x $95.06 = $285.18 4. To figure the premium for the Intensive Care Rider, multiply Rider Rate by number of units. In this case: $11.27 x 4 = $45.08 5. To figure the Return of Premium Rider Premium, multiply the Policy Premium and Rider Premium(s) by the Return of Premium Factor - in this case, $285.18 + $45.08 = $330.26 x 1.25 = $412.83 To calculate the ROP Premium ($412.83 - $330.26 = $82.57).
6. Add the Annual Premium, any Rider Premium(s), $20 Annual Policy Fee, and the ROP Premium to get the Total Annual Premium. For example, $285.18 + $45.08 + $82.57 + $20 = $432.83 7. If paying by monthly PAC take the Total Annual Premium and multiply by the Modal Factor - in this case, $432.83 x .09 = $38.95 Modal Factors: MonThly PAC= .09, QuArTErly= .265, SEMI-AnnuAl= .52

Source: http://www.insspecialties.com/pdfs/GTL_Cancer_Rates_10-11-13.pdf

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