Upload
carubel
View
219
Download
0
Embed Size (px)
Citation preview
7/30/2019 Agent Guide Booklet
1/16
Agent Guide
Issued by Forethought Lie Insurance Company
ForethoughtFreedomSM
M6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
2/16
M6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
3/16
The Forethought FreedomSM Advantages .......................................... 2
Forethought FreedomSM Market ............................................................ 3
Forethought FreedomSM Product .......................................................... 4
Agent Responsibilities ................................................................................ 5
Getting Started.............................................................................................. 6
Completing the Application Part 1 ................................................ 8
Forethought Contact Inormation ....................................................... 13
Table o Contents
Completing the Application Part 2Medical Questionnaire & Underwriting Guide ......................... 10
6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
4/16
With Forethought Lie Insurance Company (Forethought) you can be
condent your clients security comes rst. For over a quarter century weve
been providing nal expense products. Forethought Lie Insurance Company is
a stable and secure nancial institution and is consistently rated A- Excellent
by AM Best. As our valued partner, we want to provide you the necessary tools
to positively impact the lives o the amilies and communities you serve. Theollowing guide was created to make the Forethought FreedomSM application
and underwriting interview process as easy as possible or you and your client:
Why Forethought FreedomSM?
Simplied application submission process
Comprehensie Underwriting Medical Conditions Guide
Medication Listing
Online, llable applications aailable in most states
Free supplemental benets
Accelerated Death Benet
Grandchildrens Benet
Accidental Death Benet
Forethought Uniersity Training & CE Opportunities
Access to both live and recorded webinars
Online continuing education through www.successce.com
Access to Online Reporting 24/7
Point-of-sale underwriting with most decisions in about 15 minutes
Product aailable in 48 states and the District of Columbia*
Low Premiums
Commissionable policy fee and commission adance for qualied agents
Access to the largest end-of-life assistance network of oer 5,000
Forethought Funeral Planning NetworkSM partners and retirementplanning tools viawww.orethought.com/planningtools
Forethought FreedomSM
Advantage
*All underwriting classes and supplemental benefts not available in all states.
2
6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
5/16
Forethought FreedomSM
Market
Forethought FreedomSM appeals to individuals who do not want to burden their loved ones as they age. They
are hardworking individuals rom all walks o lie looking to maintain a sense o dignity and independence. Low
premiums, easy to understand policy language and a simple underwriting process combine to make this a prime
product or the ollowing:
The Silent Generation
Approximately 32 million people
Born from 19301945
Aerage median income of $25,000
Modest and conseratie
Seeking protection for their family
The Baby Boomer Generation
Approximately 77 million people
Born from 19451960
Aerage median income $42,000
Representing $1 trillion in annual spending power
Preparing for their retirement years
6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
6/16
Forethought FreedomSM is a whole lie insurance product designed to help your client cover the costs associated
with end-o-lie expenses. These include uneral expenses, medical bills, and other obligations that may occur
when the client passes away. In addition to being a simplied product, Forethought Freedom provides your amilies
with a unique value oering. Following are highlights o the benets oered with this product.
1 Not available in all states.2 Coverage may vary state by state. Not all
supplemental benefts are available in all states.3 Available to issue ages 50 through 70 only.
Coverage terminates on the policy anniversaryollowing attained age 75. Not available or all riskclassifcations.
4
Less any policy loans, premiums due, and atransaction ee. The policy terminates ollowingpayment o the Accelerated Death Beneft and cannotbe reinstated.Not available or all risk classifcations. May not beavailable during the frst 12 or 24 policy months.
5 All coverage under this beneft terminates on theearlier o the payment o one Grandchildrens Beneftor termination o the base policy or any reason.Grandchildren over the age o 18 at policy issuewill not be covered. Coverage or any par ticulargrandchild will end on his or her 22nd birthday.
6 Certain restrictions apply.
Forethought FreedomSM
Product4
Funeral home nder
End-of-life planner
Retirement planning tools
Forethought FuneralPlanning NetworkSM
Forethought Planning Tools iawww.orethought.com/
planning tools
Access to Forethought Funeral
Planning NetworkSM
Oer 5,000 local and national funeral
and cemetery proessionals available
and committed to helping amilies
during their time o need
Additional Benets
Upon death of the insured,
beneciaries receive the ull
policy amount within 48 hours 6
Quick policy turnaround
Option of policy deliery to agent
or client
Point-of-sale underwriting process with
most decisions in about 15 minutes
Leel Death Benet
Graded Death Benet
Return o Premium Death Benet
Male/emale
Smoker/non cigarette smoker
(non cigarette smoker is defned as
not having used cigarettes in the last
12 months)
Example:
60 year old, nonsmoker, male
$10,000 face amount
Monthly APA premium Life pay: Full death benet
$45.00 annual premium x 10 = $450.00
Annual policy ee + 39.00
Annual premium $489.00
Monthly APA mode actor x 0.0865
Monthly APA premium $42.30
Monthly EFT ................................. 0.0865
Quarterly........................................ 0.2600
Semiannual ...................................0.5150
Annual ............................................1.0000
Lie Pay
Level ........................................................5080
Graded ....................................................5080
Return o Premium ............................5080
Issue Ages:
Underwriting Classes1:
Premium Calculation Example:
Premium Modal Factors:
LeelFull ace amount and SupplementalAccidental Death Benet available
GradedFull ace amount (percentage based) andSupplemental Accidental Death BenetavailableNon Accidental Death = Full ace amountonly (percentage based)
Year 1 = 30% of face amountYear 2 = 70% of face amountYear 3+ = Full face amount
Accidental Death = Full ace amount plusSupplemental Accidental Death Benet
amountReturn o Premium: Percentage based.Supplemental Accidental Death Benet notavailable
Non Accidental Death = Return oPremium (percentage based)Non accidental death
Year 1 = 110% of premiums paidYear 2 = 110% of premiums paidYear 3+ = Full face amount
Accidental Death = Full ace amount onlyNo Supplemental Accidental Death Benet
Death Benet:
$39.00 (commissionable)
Annual Policy Fee:
Min. Max.Leel $2,500 $25,000
Graded $2,500 $15,000
Return of $2,500 $10,000
Premium
Face Amounts:
Supplemental Benets1, 2:
Accidental Death Benet
This benet pays an amount equal to
the Face Amount, in addition to the
Basic Death Benet, i death is due to a
covered accident. This benet is availableimmediately 3
Accelerated Death Benet
Proides 97% of the base policy face
amount payout i a licensed physician
determines you have a lie expectancy
o six months or less 4
Grandchildrens Benet
Provides coverage or eligible
grandchildren ages six months up to
18 years old. The benet amount is
$5,000 or the base policy face amount,
whichever is lower, and will be paid
only one time. This benet does nothave a conversion privilege 5
FORETHOUGHT FREEDOMSM
PRODUCT HIGHLIGHTS
FORETHOUGHT FREEDOMSM
SERvICE HIGHLIGHTS
6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
7/16
Agent Responsibilities
Contracts andlicenses
Solicitation
Agentaccess and
communication
Authority o
agents
Market conduct
Policysubmission
Adertising
Rebating
Replacement
An agent must be licensed and contracted with Forethought and receie a
Forethought writing number, prior to soliciting business. Additionally, an agent
must be licensed and contracted with Forethought in all nonresident states beore
taking an application or insurance in these states.
Agents shall inorm their prospective client, prior to commencing a lie insurance sales
presentation, that he or she is acting as a lie insurance agent and inorm the prospective
purchaser o the ull name o the insurance company which the agent is representing
to the buyer.
Agents must not disclose any condential inormation to any unauthorized person or
entity. Without limiting the generality o the oregoing, condential inormation o
Forethought includes inormation regarding computer program processes, products
and rate setting, names and addresses and any other personal nancial or health
inormation o any o Forethoughts policyholders.
Agents are authorized to solicit applications or insurance on such plans as oered
by Forethought, to collect the initial premium, and to perorm such other duties as
Forethought may require.
Agents are not authorized to make, alter, or discharge policies or any other contracts
or Forethought, or to waive oreitures, grant permits, make extra rates or special risk,
or bind Forethought in any way.
Agents must remain in compliance with all applicable anti-money laundering laws
and regulations.
Agents should ax an application with a voided check to Forethought at
1-877-432-1646 or email to [email protected] .
Agents shall not use or authorize any advertisement, circular, company logo, news
release or other communication using Forethoughts name or our product names
(whether written, verbal, audio or visual) without prior written approval by us.
Agents shall not, under any circumstances, pay or allow, or oer to pay or allow any
rebate o premiums in any manner, directly or indirectly, and shall not violate any o
the laws relating to the subject o insurance o any state in which the agent may be
acting on behal o Forethought.
Agents will not, directly or indirectly, engage in any marketing activities with the
intent or eect o replacing in-orce Forethought Lie Insurance business. Should
such replacement activity take place, commissions will be adjusted according to
company rules.
6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
8/16
Agent requirementsAn agent MUST be assigned a writing numberbeore taking an application.
Application and initial payment requirements Use
the New Business Packet (NBP) approved or the statein which the application is signed. NBPs are availableat www.orethought.com. An original application orlegible axed application along with a copy o the initialcheck, voided check or savings deposit ticket and staterequired orms, including replacement orms, willbe accepted.
Application submission An original application or alegible axed application along with a copy o the initialcheck will be accepted. It is the agents responsibilityto mail the orm o payment immediately ollowing theunderwriting process. Any changes or corrections on theapplication must be initialed by the applicant. No errorscovered with correction fuid will be accepted.
Initial payment No agent or agency checks, CODs,money orders or cashiers checks will be acceptedor premium payment. Checks will be accepted asinitial payment on monthly Electronic Funds Transer(EFT). Howeer, the check will be oided and placedin the policy le and the owners initial paymentwill be electronically drated. Check payment is theonly option or annual, semi-annual, and quarterlybilling modes. FLIC will attempt to secure premium
a second time when the rst attempt is returned orinsucient unds. FLIC will not be responsibleor oerdrats.
Insurable interest Policyowners and beneciaries musthave an insurable interest in the lie o the insured. Thismeans they have a relationship by blood, marriage, orwould suer nancial loss i the insured dies.
Insured consent ALL applications must have theconsent and signature o the applicant. I the applicantsigns with an X or the signature is not legible, we
require the applicants signature to be witnessed bysomeone other than the agent.
Replacement We will permit external replacementsas long as the replacement is in the best interest o theclient and the appropriate state replacement orms aresubmitted with the application.
Policy Applications must be dated the day theapplication is completed. Only applications that aresigned within the preceding 30 days o receipt at the
processing location are processed. Coverage is noteective until the initial premium has been depositedand the policy has been issued. It may take up to 30days to process special EFT dates. The procedure or anapplicant to request a special drat date will be allowed
up to 30 days rom the day the application is signed.I you take advantage o this option, you must list therequest on the application.
Commissions Commissions are paid seven daysater the rst drat. The rst drat is determined bythe date requested on the application. Policy ee iscommissionable.
Backdating The procedure or an applicant to saeage will be allowed up to six months. I you takeadvantage o this option, you must include all additionalback premiums required.
Policy re-dating is not allowed.
Reinstatement Policy reinstatements are allowed upto 3 years rom the Paid To Date with ull payment opremium to bring policy current.
Underwriting The underwriting is based on theanswers to the health questions on the application,MIB data, IntelliScript pharmacy data and a telephoneinterview. I conficting inormation is received romMIB, the client may be asked to contact MIB or a copy
o their disclosure report and to orward the reportto Forethought. In cases where the client eels theinormation upon which our underwriting decisionwas made was incorrect, we are willing to reviewthe Proposed Insureds medical records.I you would like a case to be reiewed, pleasecontact the Underwriting Department [email protected] or 1-888-606-6372and well be happy to assist you in determining theappropriate source rom which we would requiremedical records.
These underwriting tools are used to help ensure prompt,accurate and consistent underwriting decisions. OurNew Business/Underwriting associates are aailableto answer any questions regarding eligibility and weencourage all agents to utilize them whenever theremay be an area o uncertainty. You may reach themby calling 1-888-606-6372.
Hours: Monday Friday, 8:00am 5:00pmeastern
Getting Started6
6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
9/16
All Proposed Insureds will be required to completea phone interiew with Apptical, Inc. (Apptical),Forethoughts chosen nal expense interiewer.The telephone interview is used to conrm and reviewhealth inormation. Apptical will also perorm an MIB
and IntelliScript prescription medication data basesearch. It is imperative that all Proposed Insuredscomplete, sign and date the application and a HIPAAauthorization prior to contacting Apptical or thephone interview.
1. Beore scheduling the phone interview, the sellingagent must complete the application and allrequired documents. I the applicant does notspeak English, Apptical will provide an interpreter.
2. Our preference is to hae the agent complete the
phone interview with the client at the point o sale.You may do so by calling Forethought/AppticalInterviewing at 1-800-737-6972 directly rom theapplicants home during the ollowing hours:Monday Friday, 8:30am Midnight easternSaturday & Sunday, 10:00am 8:00pmeasternPlease call using a land line. It provides more claritythan a cell phone.
3. I you choose not to initiate the phone interview atthe time o sale or your sale is being written outsidenormal business hours, the telephone interview willbe ordered by the Home Oce when the applicationis received. For this reason, it is essential that you
indicate the applicants phone number and best timeto call.I the applicant does not have a numberwhere we can contact them, they will need tocontact us at 1-800-737-6972 within ve workingdays o completing the application.
4. Also, telephone interviews can be scheduled orapplicants that cannot be reached during normalbusiness hours by calling 1-800-737-6972.
Telephone interviews are recorded and saved oruture reerence.This is critical in the event thatthere is ever any dispute over the manner in whichthe medical questions were originally answered onthe application.
All completed, signed and dated applications and
authorizations must be sent to the Home Ofce,regardless o the underwriting decision.
Forethought must receive the application within14 days o completion o the telephone interviewregardless o the underwriting decision.Due to compliance and legal implications o nothaving the required documentation or our les,agents who ail to submit the application andHIPAA authorization orm in a timely mannerwill be subject to corrective actions, up to andincluding termination.
Health Insurance Portability and Accountability ActThe Health Insurance Portability and Accountability Act of 1996 (HIPAA) combats waste, fraud and abuse in theinsurance industry. HIPAA guidelines have specic disclosure requirements that prohibit unauthorized persons romviewing or receiving condential medical inormation. As a result, strict HIPAA regulations prohibit us rom divulgingor discussing, with the agent, any medical inormation obtained during underwriting. HIPAA Authorization to ReleaseCondential Medical Inormation orm number A7080-01-HIPAA must be completed as part o the applicationprocess. This must be submitted or all applications.
Medical Inormation Bureau, Inc.
The Medical Inormation Bureau (MIB), Inc. is a membership association o lie insurance companies. The primarymission o the MIB is to provide an alert to its member insurance companies against omissions and raud. This helpsMIB member companies to protect their interests and leads to cost savings that can be passed on to the insuranceconsumer.
The authorization sections on the application authorize Forethought to access the MIB and to obtain any necessarymedical records on the Proposed Insured during the underwriting process. All necessary signatures must be on theapplication at the time o submission or the application will be returned. Please note that the MIB is used as an alert.Actual underwriting decisions are not based on MIB inquiry results alone.
Getting Started
6143-05 2012 Forethought
0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
10/16
Completing the Application Part 1
*2-Part Application Process Now Aailable
The objective behind the 2-part application is to simpliy the application process or both the agent and the
consumer by improving the application fow and eliminating repetition o the medical questions by having them
handled solely by our underwriter, Apptical, during the interview process (where allowed). Following are2 options available to complete this process:
1. 2-Part Process Agent completes and submits Part 1, and all required documents in NBP, with wet
signatures; Apptical completes and submits Part 2 with voice signatures
2. Traditional Process Florida Only. Agent completes and submits the entire application with wet
signatures; Apptical does only the phone interview or underwriting purposes
Simplied Application Submission Process Oeriew
The agent will complete Part 1 of the application, and all required documents, with the proposed insured
and then will contact Apptical to complete the phone interview
Apptical will complete the phone interiew which includes asking all medical questions and
completion o Part 2 o the application (where allowed)
If your client does not agree to oice signature of Part 2, then you must complete Part 2 with client and submit
Medical Information Bureau (MIB) and prescription database checks will be completed and point-of-sale
underwriting decisions will be rendered where possible
Upon completion of the interiew, the agent will submit the parts they hae compiled (minimum Part 1),
o the application, and all required documents, to Forethought and Apptical will submit Part 2 o theapplication to Forethought except in the situations identied above where the agent must complete Part 2
Forethought operations will match up the application parts as receied and complete the entry
o the applications
Part 1 Questions: To be completed by Agent.IMPORTANT NOTICE: Order and appearance o questions may ary on state-specic applications.
Please print legibly
1. PROPOSED INSURED:
Include Proposed Insureds First Name, Middle Initial, Last Name, Sex, Date o Birth, Age, State o Birth, SocialSecurity Number, Citizenship, Mailing Address, Residential Address (i dierent rom Mailing Address), City,
State, Zip Code, Occupation, Phone Number (home), Phone Number (work), and E-mail Address. Answer yes
or no to have you smoked cigarettes in the last 12 months?
*Not available in all states.
8
6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
11/16
Completing the Application Part 1
2. OWNER (Complete only if the Owner and Proposed Insured are dierent). Owner must hae aninsurable interest:Include Owners First Name, Middle Initial, Last Name, Sex, Relationship to Proposed Insured, Social SecurityNumber, Citizenship, Mailing Address, Residential Address (i dierent rom Mailing Address), City, State, Zip Code,Phone Number (home), Phone Number (work), and E-mail Address
3. BENEFICIARY INFORMATION (Beneciary proceeds will be split equally i no percentages are provided):Primary First Name, Middle Initial, Last Name, Age, Relationship to Proposed Insured, Social SecurityNumber, Percentage
Contingent First Name, Middle Initial, Last Name, Age, Relationship to Proposed Insured, Social SecurityNumber, and Percentage
4. INSURANCE PLAN INFORMATION:Plan o Insurance Check Level Death Benet, Graded Death Benet or Return o Premium
Billing Mode Check Annual, Semi Annual, Quarterly or Monthly EFT
Face Amount List amount o insurance applying or
Initial Premium Select a payment plan and list the amount o the initial premium. Agent or agency checks,CODs, money orders and cashiers checks will not be accepted for premium payment
5. BANK DRAFT AUTHORIZATION I payment is drawn rom a checking account, attach a voided check. Idrawn rom a savings account, provide the account number, routing number, bank name and phone numberor verication. We will drat a second time or each NSF transaction
6. REPLACEMENT INFORMATION Both questions must be answered. I question 2 is answered yes, provide thename, ace amount, and policy number o current coverage and submit the state specic replacement orm
7. ELIGIBLE GRANDCHILDREN (to be covered by Grandchildrens Benet) Include Grandchildrens FullName and Date of Birth. Only natural or legally adopted grandchildren of the proposed owner are eligibleor coverage
8. FRAUD WARNING/NOTICE Review with applicant as needed based on state o issue. State required noticesare outlined
9. AUTHORIZATION TO OBTAIN AND DISCLOSE INFORMATION Review with applicant as needed. Thisauthorizes Forethought Lie Insurance Company to obtain protected health inormation
10. AGREEMENT Proposed Insured, Owner, and Licensed Agent signatures, dates, city and state are all required
11. AGENT DECLARATION AND SIGNATURES To be completed by the licensed agent meeting with theproposed applicant
6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
12/16
Medical Questionnaire andUnderwriting Guide Part 2
Part 2 Completing the Medical QuestionnaireTo be completed by Apptical. I your client does not agree to oice signature
o Part 2, then you must also complete Part 2 with client and submit
PROPOSED INSURED: Include Proposed Insureds First Name, Middle Initial, Last Name, Date o Birth, Mailing
Address, City, State, and Social Security
HEALTH QUESTIONS Have the Proposed Insured answer yes or no to the ollowing:
1. Height in eet & inches. Weight in pounds
Any yes answer to questions 2 through 5 will result in a Decline
2. Do you require assistance in perorming the Actiities o Daily Liing (ADLs) o eating, bathing, toileting,
transerring or dressing or are you conned to a wheelchair?Does the Proposed Insured need assistance
rom any individual, skilled or unskilled, amily or proessional?
3. Are you currently:
a . Hospitalized or conned to a bed, nursing home, psychiatric acility, receiving home health care or
hospice care or are you currently incarcerated?
b. Receiving kidney dialysis, chemotherapy or radiation, or using oxygen equipment to assist in breathing
(other than or sleep apnea)?
4. Hae you:a. Been medically diagnosed as having a lie expectancy o 12 months or less?
b. Had a heart, lung, liver or kidney transplant or has one been recommended to you?
c. Within the last 12 months, been advised to have any medical procedure, diagnostic test or surgery
that has not yet been done or which the results have not been received?
d. Been diagnosed or treated by a medical proessional or Acquired Immune Deciency Syndrome
(AIDS), AIDS Related complex (ARC), or tested positive or Human Immunodeciency Virus (HIV)?
This may vary slightly by state.
5. Hae you been medically diagnosed, treated or, adised to hae treatment or, taken medication,
or been prescribed medication or:
a. Alzheimers disease, dementia, chronic memory loss?b. Lou Gehrigs disease (ALS), kidney or liver ailure, or end stage kidney disease?
c. Congestive heart ailure or cardiomyopathy within the last 24 months?
0
6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
13/16
Any yes answer to questions 6 through 8 will result in a Return o Premium
6. In the last 12 months hae you been medically diagnosed, treated or, adised to hae treatment or,
taken medication or been prescribed medication or:a. Coronary artery disease, heart attack, angina, heart surgery (including bypass, angioplasty and stent
placement) or heart valve replacement?
b. Stroke or transient ischemic attack (TIA), carotid artery surgery or aneurysm? Transient Ischemic
Attack may also be defned as mini strokes. An example o a procedure to improve circulation to the
heart or brain would include, but not be limited to: angioplasty, coronary artery bypass grating (CABG),
or a carotid endartectomy.
7. In the last 24 months hae you been medically diagnosed, treated or, adised to hae treatment or,
taken medication or been prescribed medication or:Been medically diagnosed includes the act or process o
determining the nature o a disease by examination and the opinion derived rom such an examination by a medical
doctor or hospital. Been treated includes taking prescription drugs or the ollowing medical conditions, with theexception o prescription drugs to control diabetes. Treated or includes ollow up treatments or amputated limbs,
toes and digits related to amputations necessary to treat diabetic conditions.
a. Any internal cancer, brain tumor, leukemia, melanoma, Hodgkins disease or other lymphoma,
cirrhosis o the liver or alcohol or drug dependency?
b. Diabetes with complications including, eye or kidney disorders, diabetic coma, insulin shock or
amputation due to disease?
8. Do you hae diabetes in combination with a stroke, TIA, or heart disease (including heart attack and
heart surgery):have you had multiple strokes, TIAs or heart attacks, or do you have heart disease with
a history o a stroke or TIA?
Medical Questionnaire andUnderwriting Guide Part 2
6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
14/16
Any yes answer to questions 9 through 12, will result in an ofer o Graded Coerage
9. In the last 24 months hae you been medically diagnosed, treated or, adised to hae treatment or,
taken medication or been prescribed medication or:
a. Coronary artery disease, heart attack, angina, heart surgery (including bypass, angioplasty and
stent placement) or heart valve replacement?
b. Stroke or transient ischemic attack (TIA), carotid artery surgery, aneurysm or any irregular
heartbeat, such as atrial brillation (including a pacemaker or debrillator)?
c. Depression, bipolar disorder, schizophrenia or other psychosis?
d. Parkinsons disease, multiple sclerosis or chronic hepatitis?
e. Emphysema, chronic obstructie pulmonary disease (COPD), asthma or chronic bronchitis?
Chronic Obstructive Pulmonary Disease, also known as COPD, is any orm o severe respiratory disease. The use o
oxygen will result in a decline. The ollowing are additional conditions that are considered COPD:
Pneumoconiosis(BlackLung,FarmersLung)
Asbestosis
Silicosis
Bronchietasis
PulmonarySarcoidosis
ActiveTuberculosis
Histoplasmosis
Nocardiosis
10. Do you hae diabetes that has required insulin treatment within the last 5 years?
11. In the last 12 months, hae you had a seizure or conulsion?
12. Hae you been hospitalized 2 or more times in the last 12 months or any reason?
AUTHORIZATION TO OBTAIN AND DISCLOSE INFORMATION AGREEMENT Review with applicant as needed
AGREEMENT Proposed Insured Signature, Printed Name, Examiner/Interiewer, and Date needed. Depending
on process chosen to complete application, Examiner/Interviewer will be Agent or Apptical
Medical Questionnaire andUnderwriting Guide Part 2
2
6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
15/16
ONLINE SERvICES:
Access product inormation, service details,
commission and policy reports, and other
valuable inormation by logging on to
www.orethought.com.
UNDERWRITING:
To complete phone interviews o the health
questions, contact Apptical at 1-800-737-6972.
All other questions or status email
AGENT SUPPORT SERvICES:
Call 1-888-606-6372 or assistance with product
sales, commissions, and agent contracting.
Submitting a new business application:
Fax to 1-877-432-1646
Email to [email protected]
FORETHOUGHT MAILING ADDRESSES:
Forethought Freedom
Attn: New Business
P.O. Box 148
Batesille, IN 47006
Oernight Deliery
Forethought Freedom
One Forethought Center
Batesille, IN 47006
SUPPLY ORDERS:
Order your supplies online at
www.orethought.com.
Email your order [email protected]
or processing.
Contact 1-888-606-6372 or assistance with placing
the order.
CLIENT SERVICE CENTER:
Clients may access specic policy details through
our customer service via phone or email.
Phone: 1-888-606-6372
Email: [email protected]
Forethought Contact Inormation
6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS
7/30/2019 Agent Guide Booklet
16/16
Forethought Lie Insurance Company
Administrative Ofce
One Forethought Center
Batesille, IN 47006
Phone: 1-888-606-6372
Email: [email protected]
www.orethought.com
Forethought FreedomSM is unded through the purchase o whole lie insurance rom Forethought Lie Insurance Company,
Indianapolis, Indiana. Depending upon payment plan selected, death benet may vary up to the rst three policy years. A
representative who may also be an agent o Forethought Lie Insurance Company can answer any questions you may have.