| 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) |
| 17 | AL, AR, CO, GA, HI, IL, IN, KS, LA, MA, MD, MI, MN, MO, MS, NC, NJ, OH, OK, PA, TN, VA & WA- ABR disclosure at time of app REQUIRES SIGNATURE. |
| 27 | NC - minimum policy benefit amount is $10,000 |
| 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 |
| 41 | NC - HH/LTC rider monthly benefit is greater of 4% of death benefit or $750 |
| 44 | CTR and Child UL age limit max is through the age of 22. 23 can apply for Standard UL via paper app. |
| 48 | CO, MN, NC, WA- outline of coverage and LTC Rate Disclosure form LTC RATE DISC delivered at time of app if HH/LTC rider enrolled |