| Requirement Info | |
| 1 | State unique rating differences for HH/LTC Riders. See State Reference Chart for details |
| 2 | Special Notice of Information Practice form required with all applications. I573-NWB-151 R10-17 |
| 3 | Spouse app that is BOTH SI (over MGI offer) AND OVER $50,000 requires dependent acknowledgement and authorization form. |
| 4 | CO, FL, MA, MN, NH, NC, NY, TX, VT, WA - state unique naming convention for LTC rider.See State Reference Chart for details (no pre-x MA NY TX) |
| 6 | FL-App listed is Elec Version, FL requires special apps for each type of enrollment. See State Reference Chart for other form numbers. |
| 33 | The following states contain question #9 on the application specific to Long Term Care coverage: CA, CO, FL, LA, MN, NC, NY(q11), OH, VT, WA |
| 39 | HH/LTC rider only available as case level benefit, no employee level option - can not be added to in force coverage |
| 44 | CTR and Child UL age limit max is through the age of 22. 23 can apply for Standard UL via paper app. |