|
* required
|
|
|
|
* required
|
|
* required
|
|
|
|
|
tax qualified non-tax qualified
|
|
regular
partnership
|
|
|
male female
|
|
male female
|
|
|
|
|
|
preferred
standard
impaired
tobacco
|
|
preferred
standard
impaired
tobacco
|
Insured Elimination Period |
0
30
60
90
180
365
|
Spouse Elimination Period |
0
30
60
90
180
365
|
|
|
|
|
|
|
1
2
3
4
5
6
life
|
|
1
2
3
4
5
6
life
|
|
none
simple
compound
cola
|
|
none
simple
compound
cola
|
|
yes
no
|
|
yes
no
|
|
yes
no
|
|
yes
no
|
|
yes
no
|
|
yes
no
|
|
yes
no
|
|
Medical History / Details / Dates / Medication / Treatment / Other Information
|
|