State |
Group or Ind. |
HH/LTC |
BRR |
EOB |
BXR |
LW |
ABR |
ADB |
WP |
Employee Application |
Outline of Coverage |
ABR Requirements |
Requirements |
AK |
G |
A | A | NA | NA | A | A | A | A | L-205 AK | None | None |
2
, 3
, 44
|
AL |
G |
A | A | A | A | A | A | A | A | L-205 | None | ABR DISCLOSURE |
2
, 3
, 17
, 44
|
AR |
G |
A | A | A | A | A | A | A | A | L-205 AR | None | ABR DISCLOSURE |
2
, 3
, 17
, 44
|
AZ |
G |
A | A | A | A | A | A | A | A | L-205 AZ | OC-HH/LTC-205 AZ | None |
2
, 3
, 44
|
CA |
G |
A | A | N/A | N/A | A | A | A | A | L-205 (G) CA R0324 | OC-HH/LTC.205V3 (G) CA | None |
2
, 12
, 14
, 26
, 33
|
CO |
G |
A | A | N/A | N/A | A | A | A | A | L-205 (G) R5-09 | OC-HH/LTC.205V3 (G) | ABR DISCLOSURE |
1
, 2
, 3
, 4
, 17
, 19
, 33
, 44
, 48
|
CT |
G |
A | A | N/A | N/A | A | A | A | A | L-205 CT R1-15 | None | ABR DISCLOSURE CT |
2
, 3
, 15
, 19
, 44
|
DC |
G |
A | A | A | A | A | A | A | A | L-205 DC | None | None |
2
, 3
, 44
|
DE |
G |
A | A | A | A | A | A | A | A | L-205 | None | None |
2
, 3
, 44
|
FL |
G |
A | A | N/A | N/A | N/A | A | A | A | L-205 (G) FL E ES | OC-HH/LTC.205 FL | None |
1
, 2
, 3
, 4
, 6
, 33
, 39
, 44
|
GA |
G |
A | A | A | A | A | A | A | A | L-205 IL | OC-HH/LTC.205 IL | ABR DISCLOSURE |
2
, 3
, 17
, 44
|
HI |
G |
N/A | N/A | N/A | N/A | A | A | A | A | L-205 IL | None | ABR DISCLOSURE |
2
, 3
, 17
, 44
|
IA |
G |
A | A | A | A | A | A | A | A | L-205 | IA-SHIIP | None |
2
, 3
, 32
, 44
|
ID |
G |
A | A | A | A | A | A | A | A | L-205 | None | None |
2
, 3
, 44
|
IL |
G |
A | A | A | A | A | A | A | A | L-205 IL | OC-HH/LTC.205 IL | ABR DISCLOSURE |
2
, 3
, 17
, 44
|
IN |
G |
A | A | A | A | A | A | A | A | L-205 IN | OC-HH.LTC.205 IN | ABR DISCLOSURE IN |
2
, 3
, 7
, 17
, 44
|
KS |
G |
A | A | A | A | A | A | A | A | L-205 KS | OC-HH/LTC.205 KS R2-07 | ABR DISCLOSURE KS |
2
, 3
, 5
, 17
, 44
|
KY |
G |
A | A | A | A | A | A | A | A | L-205 KY | OC-HH/LTC.205 | None |
2
, 3
, 44
|
LA |
I |
A | A | A | A | A | A | A | A | L-205 LA | OC-HH/LTC.205/I LA | ABR DISCLOSURE LA |
2
, 3
, 17
, 33
, 44
|
MA |
I |
A | A | NA | A | A | A | A | A | L-205 MA R311 | None | AB APP DISCLOSURE MA |
2
, 4
, 8
, 13
, 17
, 28
, 35
, 36
, 39
, 44
|
MD |
G |
A | A | A | A | A | A | A | A | L-205 (G) MD R4-13 | OC-HH/LTC.205 IL | ABR DISCLOSURE |
2
, 3
, 7
, 17
, 42
, 44
|
ME |
G |
A | A | A | A | A | A | A | A | L-205 ME | None | None |
2
, 3
, 5
, 10
, 44
|
MI |
G |
A | A | A | A | A | A | A | A | L-205 IL | OC-HH/LTC.205 IL | ABR DISCLOSURE |
2
, 3
, 17
, 44
|
MN |
G |
A | A | N/A | N/A | N/A | A | A | A | L-205 MN R5-09 | OC-HH/LTC.205V2 (G) MN | ABR DISCLOSURE MN |
1
, 2
, 3
, 4
, 17
, 19
, 33
, 44
, 48
, 49
|
MO |
G |
A | A | A | A | N/A | A | A | A | L-205 IL | OC-HH/LTC.205 IL | ABR DISCLOSURE |
2
, 3
, 17
, 44
|
MS |
G |
A | A | A | A | A | A | A | A | L-205 | None | ABR DISCLOSURE |
2
, 3
, 17
, 44
|
MT |
G |
A | A | A | A | N/A | A | A | A | L-205 | OC-HH/LTC.205 MT | None |
2
, 3
, 16
, 24
, 44
|
NC |
G |
A | A | N/A | N/A | A | A | A | A | L-205 (G) NC R6-08 | OC-HH/LTC.205V2 (G) NC | ABR DISCLOSURE |
1
, 2
, 3
, 4
, 17
, 27
, 33
, 41
, 44
, 48
|
ND |
G |
A | A | A | A | A | A | A | A | L-205 ND | None | None |
2
, 3
, 44
|
NE |
G |
A | A | A | A | A | A | A | A | L-205 | None | None |
2
, 3
, 44
|
NH |
G |
A | A | A | A | N/A | A | A | A | L-205 NH | None | None |
2
, 3
, 4
, 20
, 44
|
NJ |
G |
A | A | A | A | A | A | A | A | L-205 IL | OC-HH/LTC.205 IL | ABR DISCLOSURE |
2
, 3
, 17
, 44
|
NM |
G |
A | A | A | A | A | A | A | A | L-205 NM R718 | None | None |
2
, 3
, 22
, 29
|
NV |
G |
A | A | A | A | A | A | A | A | L-205 | None | None |
2
, 3
, 44
|
NY |
I |
A | N/A | N/A | N/A | N/A | A | A | A | L-205 (I) NY R11-12 | OC-HH/LTC.205V2 (I) NY | ABR APP DISC NY |
1
, 2
, 4
, 11
, 13
, 15
, 18
, 20
, 33
, 38
, 43
, 44
, 46
, 47
|
OH |
G |
A | A | A | A | A | A | A | A | L-205 OH | OC-HH/LTC.205 OH | ABR DISCLOSURE |
2
, 3
, 17
, 33
, 44
|
OK |
G |
A | A | A | A | A | A | A | A | L-205 OK | None | ABR DISCLOSURE OK |
2
, 3
, 17
, 34
, 44
|
OR |
I |
N/A | N/A | N/A | N/A | A | N/A | N/A | A | L-205 (I) OR | None | None |
2
, 3
, 13
, 21
, 40
, 44
, 45
|
PA |
G |
A | A | A | A | A | A | A | A | L-205 IL | OC-HH/LTC.205 IL | ABR DISCLOSURE |
2
, 17
, 44
|
RI |
G |
A | A | A | A | A | A | A | A | L-205 RI | None | None |
2
, 3
, 44
|
SC |
G |
A | A | A | A | A | A | A | A | L-205 | None | None |
2
, 3
, 44
|
SD |
I |
A | A | A | A | A | A | A | A | L-205 SD | OC-HH/LTC.205/I SD | None |
2
, 3
, 25
, 37
, 44
|
TN |
G |
A | A | A | A | N/A | A | A | A | L-205 TN (R511) | OC-HH/LTC.205 IL | ABR DISCLOSURE |
2
, 3
, 17
, 44
|
TX |
G |
A | A | N/A | N/A | A | A | A | A | L-205 TX R0615 (Eff 2/1/17) | None | ABR DISCLOSURE TX |
2
, 3
, 4
, 15
, 19
, 26
, 31
|
UT |
I |
N/A | N/A | N/A | N/A | A | A | A | A | L-205 (I) UT R0521 | None | ABR DISCLOSURE PERM (I) |
2
, 3
, 9
, 15
|
VA |
G |
A | A | A | A | A | A | A | A | L-205 VA | OC-HH/LTC.205 IL | ABR DISCLOSURE VA |
2
, 3
, 17
, 44
|
VT |
I |
A | A | N/A | N/A | N/A | A | A | A | L-205 (I) VT R7-10 | OC-HH/LTC.205V3 (I) VT | None |
2
, 3
, 44
|
WA |
I |
A | A | N/A | N/A | N/A | A | A | A | L-205 (I) WA R5-09 | OC-HH.LTC.205V3(I) WA | ABR DISCLOSURE/I WA R6-10 |
2
, 3
, 4
, 17
, 19
, 33
, 48
, 50
|
WI |
G |
A | A | A | A | A | A | A | A | L-205 WI | None | None |
2
, 3
, 44
|
WV |
G |
A | A | A | A | A | A | A | A | L-205 WV | OC-HH/LTC.205 WV | None |
2
, 3
, 30
, 44
|
WY |
G |
A | A | A | A | A | A | A | A | L-205 | None | None |
2
, 3
, 44
|
Unapproved States |
PR |
|
| | | | | | | | | | | |
|