| Requirement Info | |
| 2 | Special Notice of Information Practice form required with all applications. I573-NWB-151 R10-17 |
| 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) |
| 8 | MA:Requires ESP MA form at time of app when electronic apps are taken .Can not vary on case by case basis the rating factor, expense charges or fees; use standard |
| 13 | Premium Rate Factor cannot be changed. See State Reference Chart for Factor. |
| 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. |
| 28 | MA- ITE included in base policy. Not a separate rider. |
| 35 | MA - INDIVIDUAL PLAN ONLY - Requires dependent acknowledgement and authorization form - all Spouse and all Child apps ages 15 and over - does NOT apply to Child Term Rider |
| 36 | MA - HH/LTC coverage should be referred to as Accelerated Benefit for Chronic Care; has NO Pre-Existing Limitation; and requires LTC Accelerated Disclosure at time of app with SIGNATURES REQUIRED |
| 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. |