Current abuse, or within two years of treatment: Decline

Treatment within two to five years: minimum Classic 2

Treatment over five years prior: Classic 1

From injury no impact to ADLs: Classic 1

From Disease: Decline

Possible Classic 1 if surgically corrected over three years prior

Otherwise minimum Classic 2

Over age 60, non-tobacco: minimum Classic 2 if investigated with cardiac catheterization and treated/stable, described as either mild or moderate

Unstable angina, described as severe, not fully investigated with cardiac catheterization, tobacco user, or under age 60 yrs: Decline. Combined with Stroke/tia or diabetes: Decline

Under age 60, non-tobacco: minimum Classic2

Under age 60, tobacco: Decline

Over age 60, non-tobacco: minimum Classic 1

Over age 60, tobacco: Classic 2

Ongoing angina after procedure: Decline. Combined with Stroke/tia or diabetes: Decline

Mild or moderate, without use of corticosteroids, Gold, sulphasalazine, chloroquine or methotrexate and able to perform all ADLs: Classic 1

Severe, use of any drugs listed above and able to perform most or all ADLS: Classic 2.

Otherwise: Decline

Atrial fibrillation (see below)

Paroxysmal supraventricular tachycardia: Classic 1

Paroxysmal ventricular tachycardia: Decline

Premature atrial complexes Classic 1

Premature ventricular complexes Decline

Sick Sinus Syndrome Decline

Sinus bradycardia (BPM ≥45) Classic 1

Ventricular fibrillation Decline

Wandering pacemaker Classic 1

Any arrythmia combined with ischemic heart disease or other organic heart disease: Decline

Treated daily with single medication, inhaler use only as needed, non-tobacco or tobacco user: Classic 1

Non-tobacco user, treated daily with single medication, inhaler use only as needed: Classic 1

Tobacco user: Classic 2

Non-tobacco user with continuous use of steroids and rescue inhalers: Classic 2

Recent history of hospitalization or tobacco user: Decline

Corrected with successful Ablation: Classic 1

Ongoing treatment or current symptoms: Classic 2

Accompanied by coronary or cerebral vascular disease: Decline

Minimum one year after diagnosis: Mild or moderate, well controlled with fewer than three medications, little impact on daily living: Classic 2

Otherwise: Decline

Under age 60, non-tobacco: minimum Classic 2

Under age 60, tobacco: Decline

Over age 60, non-tobacco: minimum Classic 1

Over age 60, tobacco: Classic 2

Ongoing angina after procedure: Decline. Combined with Stroke/tia or diabetes: Decline

Potential rate class depends on tumor stage, grade, location, type of and time since treatment

Stage 1 or 2, over two years since successful treatment: Classic 1

The following cancers should be quoted Classic 1 if: 1) Single occurrence, 2) Over 5 years since successful treatment, 3) regular follow up testing has been completed.

Breast stage 0&1

Prostate stage 1&2

Testicular stage 1

Thyroid Stage 1 & 2

Melanoma Stage 1A&1B

Cervical Stage 0&1A

All other types, staging, multiple cancers, recurrence, spreading to lymph nodes or other areas of the body: Decline

Decline

Would consider application for UL policy subject to current cardiac medical records. Minimum two years after diagnosis, stable symptoms. Age 40 to 59 yrs: minimum Table F. Age 60 yrs and over: minimum Table D.

Decline

Would consider application for UL subject to medical records. Table D to Decline

Intermittent, mild or moderate (single or intermittent attack with clinical remission greater than 1 month), without corticosteroid or immunosuppressive therapy: Classic 1

Otherwise minimum Classic 2

Decline

Would consider application for UL policy subject to current cardiac medical records. Minimum two years after diagnosis, stable symptoms. Age 40 to 59 yrs: minimum Table F. Age 60 yrs and over: minimum Table D

Mild or moderate, no current shortness of breath, non-smoker and only occasional time off work: Classic 2

Severe, on oxygen or smoker: Decline

Over one year since last attack, no ongoing treatment with corticosteroids or immunosuppressive drugs and no current symptoms: Classic 1

Otherwise: Classic 2

Current symptoms or within one year of last attack: Decline

Must be at least one year since single stroke, no or minimal residual symptoms, non-tobacco user

Under age 40 yrs at time of diagnosis: Decline

Age at diagnosis 40 to 69 yrs: Classic 2

Age at diagnosis 70 yrs or greater: Classic 1

If multiple strokes or single stroke with severe residuals: Decline. Combined with heart disease or diabetes: Decline

Treated with one or two medications and no impact on daily living: Classic 1

Treated with 3 medications: Classic 2

More than 3 medications, recent hospitalization, interferes with daily living: Decline

Minimum Classic 2

More than 3 medications, recent hospitalization, interferes with daily living: Decline

Decline

Would consider application on UL policy subject to medical records. More than two years since single episode, stable symptoms, on low dose antidepressant preventive medication only, fully functioning: minimum Table D

After childbirth and recovery: Classic 1. If diabetes isn't resolved post-partum, refer to Diabetes section below

Under age 30 yrs: Decline

Current age 30 through 59, good control, non-tobacco: Classic 2

Current age 30 through 59, good control, tobacco: Decline

Current age 60 and older, good control, non-tobacco: Classic 1

Current age 60 and older, good control, tobacco: Classic 2

History uncontrolled blood sugars or complications such as insulin shock, diabetic coma or significant neuropathy: Decline. Combined with heart disease, kidney disease, stroke,tia, or peripheral vascular disease: Decline. If also near upper limits of build chart Classic 2 to Decline.

Under age 20: Decline

Current age 20 through 39, good control, non-tobacco: Classic 2

Current age 20 through 39, good control, tobacco: Decline

Current age 40 and older, good control, non-tobacco: Classic 1

Current age 40 and older, good control, tobacco: Classic 2

History uncontrolled blood sugars or complications such as insulin shock, diabetic coma or significant neuropathy: Decline. Combined with heart disease, kidney disease, stroke,tia, or peripheral vascular disease: Decline. If also near upper limits of build chart Classic 2 to Decline.

Minimum five years after successful treatment, no relapse: Classic 1

History of attempted reform with relapse, minimum five years after successful treatment: Classic 2

Within five years of treatment or current substance abuse: Decline

>3 years since single DUI with no other citations. Classic 1

3 DUIs ever, Decline

Less than 3 speeding/similar tickets within the last 3 years: Classic 1

Otherwise email uwrisk@gmpmlife.com for risk assement with driving history.

Mild or moderate, no current shortness of breath, non-smoker and only occasional time off work: Classic 2

Severe and/or on oxygen or smoker: Decline

Absence or petit mal seizures: Classic 1

Grand mal seizures, less than 12 episodes per year: Classic 1

Grand mal seizures, greater than 12 episodes per year: Classic 2

History of status epilepticus, personality or cognitive changes, progression of underlying disease: Decline

> 3 years since parole/probation ended for a single nonviolent conviction: Classic 1

Otherwise, or if multiple separate criminal convictions: Decline

Fully resolved with no residual effects and not currently on anti-viral drugs: Classic 1

Currently on anti-viral drug treatment: Classic 2

Decline

Would consider application on UL policy subject to medical records. Minimum Table D to Decline. If cleared of virus with Harvoni treatment would consider Standard after one year

Well controlled (with or without medication): Classic 1

Uncontrolled: Classic 2 to Decline

Decline

Would consider application for UL policy subject to medical records. Rating dependent upon cause of disease and extent of kidney damage

Classic 1 if successful surgery over 6 months before application

Decline

Would consider application for UL policy subject to medical records. Rating dependent upon cause of disease and extent of liver damage

Classic 1

Mild: Classic 1

Moderate: Classic 2

Severe: Decline

Within one year of diagnosis: Decline

Greater than one year since diagnosis, mild (no or minimal symptoms and disability): Classic 1

Moderate (moderate symptoms and disability preventing full time work): Classic 2

Severe (requiring assisted ambulation to being restricted to wheelchair): Decline

Classic 1

Mild or moderate with little impact on daily activities: Classic 1

Regular use of aids for ambulation: Decline

Decline

Classic 1

Accompanied by ischemic heart disease or other organic heart disease: Decline

Single acute episode, over one year since recovery, not alcohol related: Classic 1

Chronic condition, not related to alcohol, without complications (such as malabsorption, diabetes, or impaired glucose tolerance), less than three years since last symptoms: Classic 2

Greater than three years since last symptoms: Classic 1

Related to alcohol, or complications mentioned above: Decline

Well controlled with consistent CPAP use: Classic 1

If treated with oxygen: Decline

Under age 60, non-tobacco: minimum Classic 2

Under age 60, tobacco user: Decline

Over age 60, non-tobacco: minimum Classic 1

Over age 60, tobacco minimum: Classic 2

If ongoing angina after procedure: Decline. Combined with Stroke/tia or diabetes: Decline

Must be at least one year since single stroke, no or minimal residual symptoms, non-tobacco user

Under age 40 yrs at time of diagnosis: Decline

Age at diagnosis 40 to 69 yrs: Classic 2

Age at diagnosis 70 yrs or greater: Classic 1

If multiple strokes or single stroke with severe residuals: Decline. Combined with heart disease or diabetes: Decline

All cases must be at least one year since single TIA and non-tobacco use.

Ages less than 40: Classic 2

Ages 40 and older: Classic 1

If multiple TIA's or current tobacco use: Decline. Combined with heart disease or diabetes: Decline

Classic 1 if treatment complete and recovered.

Otherwise: Decline

Classic 1 if successful surgery over 6 months before application.