Noneligible Persons The following persons are not eligible for Individual Medical insurance coverage: Recently laid off or temporarily unemployed persons Persons between jobs Those contemplating imminent or extended travel Non-U.S. citizens (except as described below). To be considered for coverage, applicants who are not U.S. citizens must: Have been in the U.S. for at least one year Have a permanent visa or green card status Have an established physician in this country from whom medical records can be obtained Be able to speak and read the English language, or have completed the application with the use of an interpreter. Occupation Most persons will qualify for medical insurance without regard to occupation. Among the occupations that are NOT eligible are the following: Air trafc controller Armed Forces personnel Asbestos/toxic chemical workers Divers (professional skin or scuba) Explosive workers Fishermen/Crew Government employees Off-shore oil workers Oil and natural gas workers, including off-shore operations Professional motor vehicle racers Rodeo participants Structural steel workers Underground miners Professional athletes Football Wrestling Baseball Basketball Note: Pro-bowlers and golfers are acceptable. Fortis Healths Underwriting Department reserves the right to decline other occupations not listed above. The following occupations will be considered on an individual basis: Horse trainers Long-haul truckers Pilots Ski instructors Loggers-rated 25% if they do not have workers compensation and their duties include actual logging. Ofce personnel are acceptable as standard. If eligible for coverage, we reserve the right to offer on a sub-standard basis for these occupations. The limitations listed in this section are necessary to assure satisfactory persistency. Some state variations exist. Refer to the State Specic Underwriting Guidelines. Medical Conditions Refer to the topic HEALTH HISTORY GUIDELINES for a list of medical conditions that must be considered. 1 2 Health History Guidelines Permanent Declines by Health Condition The following conditions are considered permanent declines. Applications on individuals with any of these conditions should NOT be submitted. A Addisons disease
Adult respiratory distress syndrome (ARDS) with severe
respiratory impairment, greater than one month steroid use
AIDS
Alcohol abuser (diagnosed; associated with other drug abuse,
medical disease, three or more DWIs or more than one detox
hospitalization)
Alzheimers disease
Amphetamine usage (current history of usage)
Amyotropic lateral sclerosis (ALS)
Aneurysms
Angina (unstable, variant, prinzmetal, vasospastic)
Ankylosing spondylitis
Anorexia nervosa (up to 5 years decline; individual
consideration thereafter)
Aortic arch arteritis
Aortic insufciency
Aortic stenosis
Aortitis
Aplastic anemia
Aregenerative anemia
Arterial embolism (clot)
Arterial occlusion
Arteriosclerosis obliterans (ASO)
Arteriovenous malformation
Arteritis
Ataxia telangiectasia
Atherosclerosis obliterans
Atherosclerosis thrombotic disease
Atrial brillation chronic
Atrial septal defect (if surgically corrected with complications)
Autism B Bantis syndrome (spleen disorder)
Bronchiectasis
Bladder extropy (congenital malformation of the bladder wall)
Asymptomatic permanent rider
Symptomatic decline C Cardiac decompensation
Cardiomyopathy
Cerebral palsy
Charcots syndrome
Charcot-Marie tooth disease (if present)
Christmas disease
Chronic obstructive pulmonary disease (COPD) (less than 45
years old, smoker, underweight with associated respiratory
disorders or older than 45 and severe form)
Cirrhosis of the liver
Coarctation of the aorta
Cocaine abuser
Congenital lymphedema
Congestive heart failure (CHF)
Cor pulmonale
Coronary artery disease (CAD)
Coronary heart disease (CHD)
Crohns disease
Curvature of the spine (with pulmonary, cardiac
or spinal cord involvement)
Cushing syndrome (caused by bilateral adrenal hyperplasia
or administration of steroids to treat another disorder)
Cystic brosis
Cystic medical necrosis D Dejerine type sclerosis
Dementia
Depressant addiction (current history of addiction
with current usage)
Dermatitis herpetiformis (with evidence of signicant
immunological compromise)
Diabetes mellitus
Downs syndrome E Ebsteins malformation
Eisenmengers complex
Electroconvulsive therapy (ECT administered for a
manic episode resulting in a life-threatening situation)
Eosinophilic granuloma
Eosinophilic granuloma of bone
Esophageal varices (varicose veins in the esophagus)
Ehlers-Danlos syndrome 3 F Fabry disease
Factor VIII or IX deciency (clotting disorder)
Fatty liver
Fragilitas ossium G Gargoylism
Gastric bypass/stapling
Gilles de la tourettes syndrome
Glycogen storage disease H Hand-Schuller-Christian disease
Heart-lung transplants
Heavy chain disease
Hemiplegia
Hemochromotosis
Hemophilia A or B
Histocytosis X
Hodgkins disease
Hydrocephalus (older than age 20, surgically corrected
with complications or shunt procedure)
Hydronephrosis (bilateral or under age 20)
Hypersplenism
Huntingtons chorea
Hypoplastic anemia I Idiopathic thrombocytopenia purpura (ITP)
Ischemic heart disease
Ischemic / ulcerative colitis K Kahlers disease
Kartageners syndrome (heart is twisted and
in the right chest area)
Kidney injury (major injury with history of dialysis)
Kidney transplant L Letterer-Siwe disease
Leukemia
Liver abscess (with residuals)
Liver transplant
Lobsteins disease
Lou Gehrigs disease
Lymphoblastoma
Lymphoma M Malaria (more than one occurrence, severe complications,
frequent disabling attacks)
Malignant melanoma (stage II or III, Clark level III, IV or V)
Marchiafava-Micheli syndrome
Marfans syndrome
Marijuana usage (current or past history in conjunction
with other drugs, relapse)
Medullary sponge kidney (unilateral with history
of infections, or bilateral)
Mental retardation (severe, emotionally unstable
seizures or psychiatric impairments)
Milroys disease
Mitral insufciency
Mitral stenosis
Mixed connective tissue disease
Mongolism
Mucopolysaccaridosis
Multiple myeloma
Multiple sclerosis
Muscular dystrophy
Myocardial infarction (MI)
Myocardial ischemia N Narcotic use/addiction
Nephrocalcinosis
Nephrosclerosis
Neurobromatosis (malignant, single or multiple)
Niemann-pick disease O Osteitis brosa cystica (multiple cysts or history)
Osteitis brosa cystica disseminate
Osteitis brosa cystica generalisata
Osteogenesis imperfecta P Pacemakers
Pancreatitis (chronic with enzymes and medications)
Pancytopenia
Paralysis
Paranoid disorder
Paraplegia
Parkinsons disease
Paroxysmal noctural hemoglobinuria
Periarteritis nodosa
Permanent Declines by Disorder, continued
Peripheral occlusive arterial disease (POAD)
Pituitary dwarsm
Plasmacytoma
Pneumocystitis carinii pneumonia (PCP)
Polio myelitis (acute with loss of bladder or bowel control,
requiring wheelchair) 4 Polyarteritis
Polycystic kidney
Polycythemia vera
Porphyria (diagnosed less than 5 years prior to application)
Premature ventricular contractions (if symptomatic and treated
with encaid/encainide or tambocor)
Primary pulmonary hypertension
Primary sclerosing cholangitis
Pseudocysts (if multiple cysts are present)
Pseudohemophilia
Pseudotumor cerebri (if surgically corrected
with shunt present or residual complications)
Psittacosis (with extensive respiratory involvement)
Psoriatic arthritis (with spine involvement, gold injections)
Psychedelics usage (current or past history: LSD, PCP)
Pulmonary heart disease (chronic or acute)
Pulmonic insufciency
Pulmonic stenosis
Pulseless disease Q Quadraplegia R Renal agenesis (unilateral kidney absence) (if under age 20;
over age 20 and symptomatic or abnormal renal functions)
Rhabdomyosarcoma S Sarcoma
Scleroderma (systemic, diagnosed or suspected)
Sick sinus syndrome
Sickle cell anemia
Sleep apnea (surgery suggested or advanced condition
with cardiac or pulmonary complications)
Spina bida (older than age 20; surgically corrected
with recurrent symptoms or surgeries needed)
Splenomegaly (congestive)
Spurways disease
Stimulant usage (current or past history)
Stroke
Sturge-Weber syndrome
Sudden infant death syndrome (SIDS) (must be
off monitor two years before consideration)
Suicide attempt
Syndrome X
Systemic lupus erythematosis T Takaysus disease
Tetrology of fallot
Thalassemia major
Thrombocytopenia (if cause is known)
Total anomalous pulmonary venous connection
Tourettes syndrome
Transient ischemic attack (TIA)
Transposition of the great vessels
Transsexualism
Tricuspid atresia
Tricuspid insufciency (if surgically repaired,
annuloplasty or other valve repair)
Tricuspid stenosis
Trisomy 21 syndrome
Truncus arteriousus
Turners syndrome (less than age 25 or evidence
of cardiovascular disease) V Valve replacement
Vascular hemophilia
Ventricular arrhythmias
Ventricular septal defect (if surgically corrected
with complications)
Von Hipple-Lindau syndrome (malignant or evidence
of renal carcinoma)
Von Willebrands disease W Waldenstroms macroglobulinemia
Wegeners granulomatosis
Wilsons disease Z Zollinger-Ellison syndrome (multiple tumors) Build Tables - Applicant must weigh no more than Max For Rating to qualify for coverage Age 16 and Older If the applicants height and weight fall within the PREFERRED Ranges, he/she may qualify for preferred rates. NOTE: Reconsideration of overweight
ratings will be given after the insured has maintained an average weight for one year. MALES FEMALES Height Preferred Max for Max For Height Preferred Max for Max For Ranges Standard Rating Ranges Standard Rating 5 0 98-152 178 206 4 10 90-138 160 185 5 1 101-155 182 211 4 11 92-140 164 190 5 2 103-159 186 215 5 0 94-143 168 194 5 3 105-162 190 220 5 1 96-146 172 199 5 4 107-166 193 223 5 2 98-150 176 203 5 5 110-171 196 227 5 3 101-153 180 208 5 6 112-175 201 232 5 4 104-158 185 214 5 7 115-181 206 238 5 5 107-163 189 218 5 8 118-186 210 242 5 6 109-168 193 223 5 9 121-191 215 248 5 7 112-173 198 229 5 10 124-197 219 253 5 8 115-178 203 235 5 11 126-203 224 259 5 9 117-185 207 239 6 0 129-208 228 263 5 10 119-192 211 244 6 1 132-215 233 269 5 11 122-197 215 248 6 2 135-220 240 277 6 0 123-202 219 253 6 3 139-226 245 283 6 4 143-232 251 290 6 5 146-240 258 298 5