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    Agent Guide

    Issued by Forethought Lie Insurance Company

    ForethoughtFreedomSM

    M6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS

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    M6143-05 2012 Forethought0512FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS

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    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

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    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

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    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

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    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

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    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.

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    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

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    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

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    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.

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    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

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    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

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    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

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    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

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    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

    [email protected]

    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

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    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.