Forethought Freedom

Issued by Forethought Life Insurance Company

SM

Medication Guide

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Forethought Freedom
Medication Guide

SM

This Medication Guide has been developed to assist you in pre-qualifying your clients for the Forethought FreedomSM product. Although this guide is comprehensive, it is not all inclusive. Medications are constantly changing and combinations of various medications may lead to an underwriting decision different than indicated for a single medication. Prior to beginning the application process, we suggest that you ask your clients for a list of the medications that they are currently taking, have taken in the past several years or have been prescribed to take by their doctor. You can then refer to the Medication Guide to determine the probable plan of coverage for which your client may qualify. Please remember that this is only a guide and the final underwriting decision will be based on all data collected, including MIB, Inc., Prescription Drug database search, and a teleinterview. Please contact our Underwriting Department at underwriting@forethought.com or 1-888-606-6372 with any questions. Forethought Life Insurance (Forethought) reserves the right to request any additional information deemed necessary to make an underwriting decision.

M8488-02

FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS

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Medication Abilify Abraxane Abstral Accolate

Usage Nervous Disorder Cancer Cancer COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma Alzheimers disease Cancer Cancer Heart Disease Heart disorder/Angina Heart disorder/Angina Hypertension Cancer Arrythmia Arrythmia COPD, Emphysema, Chronic Bronchitis Asthma Cancer Cancer COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma Heart disorder/Angina Heart disorder/Angina Hypertension Cancer COPD, Emphysema, Chronic Bronchitis AIDS

Taken within time frame 2 years 2 years 2 years 2 years No time limit 2 years No time limit No time limit 2 years 2 years 1 year 2 years 1 year 2 years No time limit 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 1 year 2 years No time limit 2 years 2 years No time limit

Probable underwriting class Graded ROP ROP Graded Level Graded Level Decline ROP ROP ROP Graded ROP Graded Level ROP Graded Graded Graded Level ROP ROP Graded Level Graded Level Graded Level Graded Level ROP Graded Level ROP Graded Decline
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Accuneb

Acetyl L-Carnitine Actimmune Actiq Activase Adalat

Adcetris Adenocard Adenosine Adrenalin

Adriamycin Adrucil Advair

Advair Diskus

Aerobid

Aerolate

Afeditab CR

Afinitor Aformoterol Agenerase

M8488-02

FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS

Medication Aggrastat Aggrenox Airet

Usage Heart disease Heart disease COPD, Emphysema, Chronic Bronchitis Asthma Parkinsons disease COPD, Emphysema, Chronic Bronchitis Asthma Congestive heart failure Hypertension Congestive heart failure Hypertension COPD, Emphysema Chronic Bronchitis Asthma Cancer Cancer Cancer Cancer COPD, Emphysema, Chronic Bronchitis Asthma Parkinsons disease AIDS Heart disease Cancer Congestive heart failure Hypertension Heart disease COPD, Emphysema, Chronic Bronchitis Asthma Arrythmia Multiple Sclerosis Heart Disorder-Angina Cancer Heart disease

Taken within time frame 1 year 2 years 1 year 2 years 2 years No time limit 2 years 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years 2 years 2 years 2 years 2 years No time limit 2 years No time limit 1 year 2 years 2 years 2 years No time limit 1 year 2 years 2 years No time limit 2 years 2 years 1 year 2 years 2 years 1 year 2 years

Probable underwriting class ROP Graded ROP Graded Graded Level Graded Graded Level Decline Level Decline Level Graded Level ROP ROP ROP ROP Graded Level Graded Decline ROP Graded ROP Decline Level ROP Graded Graded Level Graded Graded ROP Graded ROP ROP Graded
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Akineton Albuterol

Aldactazide Aldactone Alupent

Alferon Alimta Alkeran Aloxi Alvesco

Amantadine Ambisome Amicar Amifostine Amiloride HCL Aminocarproic Acid Aminophylline

Amiodarone Ampyra Amyl Nitrate Anastrozole Angiomax

M8488-02

FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS

Medication Antabuse Anzemet Apidira Apokyn Aptivus Aralast

Usage Alcohol/Drug Dependency Cancer Diabetes Parkinsons disease AIDS COPD, Emphysema, Chronic Bronchitis Asthma Kidney Disorder COPD, Emphysema, Chronic Bronchitis Alzheimers disease Cancer Cancer Cancer Cancer Cancer Nervous Disorder COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma Parkinsons disease Organ Transplant AIDS COPD, Emphysema, Chronic Bronchitis Cancer Multiple Sclerosis Cancer Organ Transplant Organ Transplant Parkinsons disease COPD, Emphysema, Chronic Bronchitis Asthma Multiple Sclerosis

Taken within time frame 2 years 2 years 5 years 2 years No time limit 2 years No time limit No time limit 2 years No time limit 2 years 2 years 2 years 2 years 2 years 2 Years 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit No time limit 2 years 2 years 2 years 2 years No time limit No time limit 2 years 2 years No Time limit 2 years

Probable underwriting class ROP ROP Graded Graded Decline Graded Level Decline Graded Decline ROP ROP ROP ROP ROP Graded Graded Level Graded Level Graded Level Graded Decline Decline Graded ROP Graded ROP Decline Decline Graded Graded Level Graded

Aranesp Arcapta Aricept Arimidex Aromasin Arranon Arsenic Trioxide Arzerra Asenapine Asmanex

Asthmahaler

Asthmanefrin

Atamet Atgam Atripla Atrovent Avastin Avonex Axitimib Azasan Azathioprine Azilect Azmacort

Baclofen

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Medication Beclovent

Usage COPD, Emphysema, Chronic Bronchitis Asthma Parkinsons disease Arrythmia Multiple Sclerosis Cancer Cancer Cancer Heart Disorder COPD, Emphysema, Chronic Bronchitis Asthma Cancer Cancer COPD, Emphysema, Chronic Bronchitis Asthma Arrythmia Arrythmia Heart disease Parkinsons disease COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma

Taken within time frame 2 years No time limit 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years No time limit 2 years 2 years 1 year 2 years 2 years 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit

Probable underwriting class Graded Level Graded Graded Graded ROP ROP ROP Decline Graded Level ROP ROP Graded Level Graded Graded ROP Graded Graded Graded Level Graded Level Graded Level Graded Level Graded Level Graded Level Graded Level
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Benztropine Mesylate Betapace Betaseron Bexxar Bicalutamide Bicnu Bidil Bi-filin

Blenoxane Bleomycin Sulfate Brethine

Bretyllium Tosylate Brevibloc Brlinta Bromocriptine Mesylate Broncap

Bronchial inhaler

Bronchial mist

Broncodur

Broncomar

Brondelate

Brondil

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FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS

Medication Bronkosol

Usage COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis COPD, Emphysema, Chronic Bronchitis Asthma Congestive heart failure Hypertension Congestive heart failure Hypertension Alcohol/Drug Dependency Alcohol/Drug Dependency Cancer Organ Transplant Organ Transplant Kidney Disorder Cancer Cancer Alcohol/Drug Dependency Cancer Cancer Parkinsons disease Cancer Heart Disorder Heart disorder/Angina Heart disorder/Angin Hypertension Kidney Disorder Heart disorder/Angina Heart disorder/Angina Hypertension Congestive heart failure Hypertension Cancer Cancer Organ Transplant Cancer Cancer Cancer Nervous Disorder

Taken within time frame 2 years No time limit 2 years 2 years No time limit 2 years No time limit 2 years No time limit 2 years 2 years 2 years No time limit No time limit No time limit 2 years 2 years 2 years 2 years 2 years 2 years 2 years 1 year 2 years 1 year 2 years No time limit No time limit 1 year 2 years No time limit 2 years No time limit 2 years 2 years No time limit 2 years 2 years 2 years 2 years

Probable underwriting class Graded Level Graded Graded Level Decline Level Decline Level ROP ROP ROP Decline Decline Decline ROP ROP ROP ROP ROP Graded ROP ROP Graded ROP Graded Level Decline ROP Graded Level Decline Level ROP ROP Decline ROP ROP ROP Graded

Brovana Budesonide

Bumetanide Bumex Buprenex Buprenorphine Busulfex Calcijex Calcitriol Calcium Acetate Calcium Folinate Campath Campral Camptosar Caprelsa Carbidopa Carboplatin Cardioplegic Cardizem

Carnitor Cartia XT

Carvedilol Casodex Ceenu Cellcept Cerubidine Cesamet Chlorambucil Chlorpromazine

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Medication Choledyl

Usage COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma Cancer Cancer Cancer Heart disease Nervous Disorder Nervous Disorder Parkinsons disease Alzheimers disease COPD, Emphysema, Chronic Bronchitis AIDS Nervous Disorder AIDS Nervous Disorder Parkinsons disease Multiple Sclerosis Hepatitis Arrythmia Congestive heart failure Hypertension Arrythmia Cancer Cerebrovascular disease AIDS COPD, Emphysema, Chronic Bronchitis Asthma Cancer Organ Transplant Kidney Disorder Cancer Organ Transplant Cancer AIDS Cancer

Taken within time frame 2 years No time limit 2 years No time limit 2 years 2 years 2 years 1 year 2 years 2 years 2 years 2 years No time limit 2 years No time limit 2 years No time limit 2 years 2 years 2 years 2 years 2 years 2 years No time limit 2 years 2 years 1 year 2 years No time limit 2 years No time limit 2 years No time limit No time limit 2 years No time limit 2 years No time limit 2 years

Probable underwriting class Graded Level Graded Level ROP ROP ROP ROP Graded Graded Graded Graded Decline Graded Decline Graded Decline Graded Graded Graded Graded Graded Decline Level Graded ROP ROP Graded Decline Graded Level ROP Decline Decline ROP Decline ROP Decline ROP

Cielesonide

Cisplatin Cladribine Clolar Clopidogrel Clozapine Clozaril Cogentin Cognex Combivent Combivir Compazine Complera Compro Comtan Copaxone Copegus Cordarone Coreg Corvert Cosmegen Coumadin Crixivan Cromolyn Sodium

Cyclophosphamide Cyclosporine Cystagon Cytarbine Cytogam Cytosar-U Cytovene Cytoxan

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Medication Dacarbazine Dacogen Dactinomycin Daliresp Daunorubicin Daunoxome Demadex Depade Depocyt Depo-provera Dextrazoxane Didanosine Difil

Usage Cancer Cancer Cancer COPD, Emphysema, Chronic Bronchitis Cancer Cancer Congestive heart failure Hypertension Alcohol/Drug Dependency Cancer Cancer Cancer AIDS COPD, Emphysema, Chronic Bronchitis Asthma Heart Disorder Heart Disorder Heart disorder/Angina Heart disorder/Angina Hypertension Heart Disorder-Angina COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma Heart disorder/Angina Heart disorder/Angina Hypertension Heart disorder/Angina Heart disorder/Angina Hypertension Heart disease Heart disease Arrythmia Alcohol/Drug Dependency Heart Disorder Heart Disorder

Taken within time frame 2 years 2 years 2 years 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years 2 years No time limit 2 years No time limit 2 years 2 years 1 year 2 years No time limit 1 year 2 years 2 years No time limit 2 years No time limit 1 year 2 years No time limit 1 year 2 years No time limit 1 year 2 years 1 year 2 years 2 years 2 years 2 years 2 years

Probable underwriting class ROP ROP ROP Graded ROP ROP Decline Level ROP ROP ROP ROP Decline Graded Level Decline Decline ROP Graded Level ROP Graded Graded Level Graded Level ROP Graded Level ROP Graded Level ROP Graded ROP Graded Graded ROP Decline Decline
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Digitek Digoxin Dilacor

Dilatrate SR Dilex

Dilor

Diltiazem

Diltzac

Dipradam Dipyridamole Disopyramide Phosphate Disulfiram Dobutamine Dobutrex

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FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS

Medication Docefrez Docetaxil Dolophine Donepezil Dopamine Doxil Doxorubicin HCL Dronabinol Dtic-Dome Dulera

Usage Cancer Cancer Alcohol/Drug Dependency Alzheimers disease Heart Disorder Cancer Cancer Cancer Cancer COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Cancer COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma Heart Disorder COPD, Emphysema, Chronic Bronchitis Asthma Congestive heart failure Hypertension AIDS

Taken within time frame 2 years 2 years 2 years No time limit 2 years 2 years 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years 2 years No time limit 2 years No time limit No time limit

Probable underwriting class ROP ROP ROP Decline Decline ROP ROP ROP ROP Graded Level Graded ROP Graded Level Graded Level Graded Level Graded Level Graded Level Graded Level Graded Level Decline Graded Level Decline Level Decline

Duoneb Duragesic Dyfillin

Dyflex

Dylix

Dyphilin

Dyphylline

Dyphyl

Dyphysin

Dyrenium Ed-Bron

Edecrin Edurant

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Medication Effient Egrifta Eldepryl Eligard Eliphos Elitek Elixophyllin

Usage Heart disease AIDS Parkinsons disease Cancer Kidney Disorder Cancer COPD, Emphysema, Chronic Bronchitis Asthma Cancer Cancer Cancer Cancer Cancer Heart disease AIDS Heart disease COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma Cancer AIDS Congestive heart failure Hypertension Kidney Disorder AIDS Nervous Disorder Cancer Alzheimers disease Cancer Nervous Disorder Arrythmia Arrythmia Cancer Cancer

Taken within time frame 1 year 2 years No time limit 2 years 2 years No time limit 2 years 2 years No time limit 2 years 2 years 2 years 2 years 2 years 1 year 2 years No time limit 1 year 2 years 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit No time limit No time limit 2 years 2 years No time limit 2 years 2 years 2 years 2 years 2 years 2 years

Probable underwriting class ROP Graded Decline Graded ROP Decline ROP Graded Level ROP ROP ROP ROP ROP ROP Graded Decline ROP Graded Graded Level Graded Level Graded Level ROP Level Decline Level Decline Decline Graded ROP Decline ROP Graded Graded Graded ROP ROP
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Ellence Eloxatin Elspar Emcyt Emend Eminase Emtriva Enoxaparin sodium Ephedrine HCL

Ephedrine Sulfate

Epinephrine

Epirubicin HCL Epivir Eplerenone Epogen Epzicom Equetro Erbitux Ergoloyd Mesylates Erwinaze Eskalith Esmolol HCL Ethmozine Ethyol Etopophos
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Medication Etoposide Eulexin Exelon Exemestane Extavia Fanapt Fareston Faslodex Fazaclo Femara Fentanyl Fentora Firmagon Flecainide Acetate Flovent

Usage Cancer Cancer Alzheimers disease Cancer Multiple Sclerosis Nervous Disorder Cancer Cancer Nervous Disorder Cancer Cancer Cancer Cancer Arrythmia COPD, Emphysema, Chronic Bronchitis Asthma Cancer Cancer Cancer COPD, Emphysema, Chronic Bronchitis Asthma Cancer Nervous Disorder Cancer Cancer COPD, Emphysema, Chronic Bronchitis Asthma AIDS AIDS AIDS Heart disease Cancer Congestive heart failure Hypertension Cancer AIDS Multiple Sclerosis Alzheimers disease AIDS Cancer

Taken within time frame 2 years 2 years No time limit 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years 2 years 2 years No time limit No time limit No time limit No time limit 1 year 2 years 2 years 2 years No time limit 2 years No time limit 2 years No time limit No time limit 2 years

Probable underwriting class ROP ROP Decline ROP Graded Graded ROP ROP Graded ROP ROP ROP ROP Graded Graded Level ROP ROP ROP Graded Level ROP Graded ROP ROP Graded Level Decline Decline Decline ROP Graded ROP Decline Level ROP Decline Graded Decline Decline ROP
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Floxuridine Fludara Fludarabine Phosphate Flunisolide

Fluorouacil Fluphenazine Flutamide Folotyn Foradil

Fortovase Foscarnet sodium Foscavir Fragmin Fudr Furosemide Fusilev Fuzeon Gablofen Galantamine Ganciclovir Gemcitabine
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Medication Gemzar Gengraf Geodon Gilenya Glassia Gleevec Gliadel wafer Granisetron HCL Granisol Halaven Haldol Haloperidol Hectorol Heparin Herceptin Hexalen Hivid Humalog Humulin Hycamtin Hydergine Hydrea Hydroxyurea Ibutilide Fumarate Idamycin PFS Idarubicin HCL Ifex Ifosfamide Iloperidone Imdur Imuran Inamrinone Incivek Infergen Inlyta Inspra Insulin Intal

Usage Cancer Organ Transplant Nervous Disorder Multiple Sclerosis COPD, Emphysema, Chronic Bronchitis Cancer Cancer Cancer Cancer Cancer Nervous Disorder Nervous Disorder Organ Transplant Cerebrovascular disease Cancer Cancer AIDS Diabetes Diabetes Cancer Alzheimers disease Cancer Cancer Arrythmia Cancer Cancer Cancer Cancer Nervous Disorder Heart Disorder-Angina Organ Transplant Heart Disorder Hepatitis Hepatitis Cancer Congestive heart failure Hypertension Diabetes COPD, Emphysema, Chronic Bronchitis Asthma

Taken within time frame 2 years No time limit 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years No time limit 1 year 2 years 2 years 2 years No time limit 5 years 5 years 2 years No time limit 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 Years 1 year 2 years No time limit 2 years 2 years 2 years 2 years 2 years No time limit 5 years 2 years No time limit

Probable underwriting class ROP Decline Graded Graded Graded ROP ROP ROP ROP ROP Graded Graded Decline ROP Graded ROP ROP Decline Graded Graded ROP Decline ROP ROP Graded ROP ROP ROP ROP Graded ROP Graded Decline Decline Graded Graded ROP Decline Level Graded Graded Level
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Medication Integrilin Intelence Intron-A Invega Invirase Ipratropium Bromide Iressa Isentress Ismo Isochron Isoditrate Isoetharine

Usage Heart disease AIDS Cancer Nervous Disorder AIDS COPD, Emphysema, Chronic Bronchitis Cancer AIDS Heart Disorder-Angina Heart Disorder-Angina Heart Disorder-Angina COPD, Emphysema, Chronic Bronchitis Asthma Heart Disorder-Angina Heart Disorder-Angina Cancer COPD, Emphysema, Chronic Bronchitis Cancer Cancer Cerebrovascular disease COPD, Emphysema, Chronic Bronchitis Asthma Cancer AIDS Respiratory Disorder Parkinsons disease Cancer COPD, Emphysema, Chronic Bronchitis Asthma Cancer Heart Disorder Diabetes

Taken within time frame 1 year 2 years No time limit 2 years 2 years No time limit 2 years 2 years No time limit 1 year 2 years 1 year 2 years 1 year 2 years 2 years No time limit 1 year 2 years 1 year 2 years 2 years 2 years 2 years 2 years 1 year 2 years 2 years No time limit 2 years No time limit 2 years 2 years 2 years 2 years No time limit 2 years 2 years 5 years

Probable underwriting class ROP Graded Decline ROP Graded Decline Graded ROP Decline ROP Graded ROP Graded ROP Graded Graded Level ROP Graded ROP Graded ROP Graded ROP ROP ROP Graded Graded Level ROP Decline Graded Graded ROP Graded Level ROP Decline Graded
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Isordil Isosorbide Istodax Ivacaftor Ixempra Jakafi Jantoven Jay-Phyl

Jevtana Kaletra Kalydeco Kemadrin Kepivance Kie

Kytril Lanoxin Lantus

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Medication Laradopa Lasix Latuda Lazanda Letrozole Leucovorin Calcium Leukeran Leukine Leuprolide Acetate Leustatin Levadopa Levamisole HCL Levemir Levocarnitine Levalbuterol

Usage Parkinsons disease Congestive Heart Failure Nervous Disorder Cancer Cancer Cancer Cancer Cancer Cancer Cancer Parkinsons disease Cancer Diabetes Kidney Disorder COPD, Emphysema, Chronic Bronchitis Asthma AIDS Multiple Sclerosis Nervous Disorder Nervous Disorder Nervous Disorder Parkinsons disease Heart disease Nervous Disorder Nervous Disorder COPD, Emphysema, Chronic Bronchitis Asthma Cancer Nervous Disorder Cancer Cancer Cancer Heart disorder/Angina Heart disorder/Angina Hypertension COPD, Emphysema, Chronic Bronchitis Asthma AIDS Cancer

Taken within time frame 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 5 years No time limit 2 years No time limit No time limit 2 years 2 years 2 years 2 years 2 years 1 year 2 years 2 years 2 years 2 years No time limit 2 years 2 Years 2 years 2 years 2 years 1 year 2 years No time limit 2 years No time limit No time limit 2 years

Probable underwriting class Graded Decline Graded ROP ROP ROP ROP ROP ROP ROP Graded ROP Graded Decline Graded Level Decline Graded Graded Graded Graded Graded ROP Graded Graded Graded Graded Level ROP Graded ROP ROP ROP ROP Graded Level Graded Level Decline ROP

Lexiva Lioresal Lithium Carbonate Lithium Citrate Lithobid Lodosyn Lovenox Loxapine Loxitane Lufyllin

Lupron Lurasidone Lysodren Marinol Matulane Matzim

Maxair

Megace Megace

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Medication Megestrol Acetate Mellaril Melphalan Hydrochloride Mepron Mercaptopurine Mesna Mesnex Mesoridazine Metastron Methadone Methadose Metaproterenol

Usage Cancer Nervous Disorder Cancer AIDS Cancer Cancer Cancer Nervous Disorder Cancer Alcohol/Drug Dependency Alcohol/Drug Dependency COPD, Emphysema, Chronic Bronchitis Asthma Arrythmia Arrythmia COPD, Emphysema, Chronic Bronchitis Asthma Congestive heart failure Hypertension Heart Disorder Heart Disorder-Angina Parkinsons disease Cancer Cancer Cancer Nervous Disorder Nervous Disorder Heart Disorder-Angina COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma Arrythmia Cancer Cancer AIDS Organ Transplant

Taken within time frame 2 years 2 years 2 years No time limit 2 years 2 years 2 years 2 Years 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years No time limit 2 years No time limit 2 years 1 year 2 years 2 years 2 years 2 years 2 years 2 years 2 Years 1 year 2 years 2 years No time limit 2 years No time limit 2 years 2 years 2 years No time limit No time limit

Probable underwriting class ROP Graded ROP Decline ROP ROP ROP Graded ROP ROP ROP Graded Level Graded Graded Graded Level Decline Level Decline ROP Graded Graded ROP ROP ROP Graded Graded ROP Graded Graded Level Graded Level Graded ROP ROP Decline Decline

Mexiletine Mexitil Micronefrin

Midamor Milrinone Lactate Minitran Mirapex Mithracin Mitomycin Mitoxantrone HCL Moban Molindone Monoket Mometasone

Montelukast

Multaq Mustargen Mutamycin Mycobutin Mycophenolate Mofetil

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Medication Myfortic Myleran Mylocel Mylotarg Naloxone Naltrexone Namenda Narcan Natrecor Navane Navelbine Nebupent Neoral Neosar Neulasta Neumega Neupogen Neupro Neutrexin Nexavar Nexterone Nifediac

Usage Organ Transplant Cancer Cancer Cancer Alcohol/Drug Dependency Alcohol/Drug Dependency Alzheimers disease Alcohol/Drug Dependency Heart Disorder Nervous Disorder Cancer AIDS Organ Transplant Cancer Cancer Cancer Cancer Parkinsons disease AIDS Cancer Arrythmia Heart disorder/Angina Heart disorder/Angina Hypertension Heart disorder/Angina Heart disorder/Angina Hypertension Heart disorder/Angina Heart disorder/Angina Hypertension Cancer Cardiovascular disease Cardiovascular disease Cancer Heart Disorder-Angina Heart Disorder-Angina

Taken within time frame No time limit 2 years 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years 2 years No time limit No time limit 2 years 2 years 2 years 2 years 2 years No time limit 2 years 2 years 1 year 2 years No time limit 1 year 2 years No time limit 1 year 2 years No time limit 2 years 1 year 2 years 1 year 2 years 2 years 1 year 2 years 1 year 2 years

Probable underwriting class Decline ROP ROP ROP ROP ROP Decline ROP Decline Graded ROP Decline Decline ROP ROP ROP ROP Graded Decline ROP Graded ROP Graded Level ROP Graded Level ROP Graded Level ROP ROP Graded ROP Graded ROP ROP Graded ROP Graded

Nifedical

Nifedipine

Nilandron Nimodipine Nimotop Nipent Nitrek Nitro-bid

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Medication Nitro-dur Nitrogard Nitroglycerin Nitrol Nitromist Nitroquick Nitrostat Nitrotab Norepinephrine Bitartrate Norpace Norvir Novadex Novantrone Novolin Novolog Nulojix Oforta Olanzapine Omalizumab

Usage Heart Disorder-Angina Heart Disorder-Angina Heart Disorder-Angina Heart Disorder-Angina Heart Disorder-Angina Heart Disorder-Angina Heart Disorder-Angina Heart Disorder-Angina Heart Disorder Arrythmia AIDS Cancer Cancer Diabetes Diabetes Organ Transplant Cancer Nervous Disorder COPD, Emphysema, Chronic Bronchitis Asthma Kidney Disorder Cancer Cancer Cancer Cancer Cancer Alcohol/Drug Dependency Organ Transplant Cancer Arrythmia Cancer Nervous Disorder COPD, Emphysema, Chronic Bronchitis Asthma

Taken within time frame 1 year 2 years 1 year 2 years 1 year 2 years 1 year 2 years 1 year 2 years 1 year 2 years 1 year 2 years 1 year 2 years 2 years 2 years No time limit 2 years 2 years 5 years 5 years No time limit 2 years 2 years 2 years No time limit No time limit 2 years 2 years 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years 2 Years 2 years No time limit

Probable underwriting class ROP Graded ROP Graded ROP Graded ROP Graded ROP Graded ROP Graded ROP Graded ROP Graded Decline Graded Decline ROP ROP Graded Graded Decline ROP Graded Graded Level Decline ROP ROP ROP ROP ROP ROP Decline ROP Graded ROP Graded Graded Level
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Omontys Oncaspar Ondansetron Onsolis Ontak Onxol Orlaam Orthoclone Oxaliplatin Pacerone Paclitaxel Paliperidone Panfil

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Medication Panretin Papaverine Paraplatin Parlodel Pegasys Peginesatide Peg-Intron Pentam 300 Pentamidine Isethionate Pentostatin Perforomist

Usage AIDS Arrythmia Cancer Parkinsons disease Hepatitis Kidney Disorder Hepatitis AIDS AIDS Cancer COPD, Emphysema, Chronic Bronchitis Asthma Parkinsons disease Cancer Parkinsons disease Nervous Disorder Nervous Disorder Heart disease Kidney Disorder Kidney Disorder Cancer Cancer Heart disease Heart Disorder Cancer Arrythmia Parkinsons disease COPD, Emphysema, Chronic Bronchitis Heart Disorder Organ Transplant COPD, Emphysema, Chronic Bronchitis Asthma Arrythmia Arrythmia Heart disorder/Angina Heart disorder/Angina Hypertension

Taken within time frame No time limit 2 years 2 years 2 years 2 years No time limit 2 years No time limit No time limit 2 years 2 years No time limit 2 years 2 years 2 years 2 Years 2 years 1 year 2 years No time limit No time limit 2 years 2 years 1 year 2 years 1 year 2 years 2 years 2 years 2 years 2 years 2 years No time limit 2 years No time limit 2 years 2 years 1 year 2 years No time limit

Probable underwriting class Decline Graded ROP Graded Graded Decline Graded Decline Decline ROP Graded Level Graded ROP Graded Graded Graded ROP Graded Decline Decline ROP ROP ROP Graded ROP Graded ROP Graded Graded Graded Decline Decline Graded Level Graded Graded ROP Graded Level

Pergolide Mesylate Perjeta Permax Permitil Perphenazine Persantine Phoslo Phoslyra Photofrin Platinol Plavix Plegisol Plenaxis Pradaxa Pramipexole Pressair Primacor Prismasol Proair

Procainamide Procanbid Procardia

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Medication Prochlorperazine Procrit Prograf Prolastin Proleukin Prolixin Pronestyl Propafenone HCL Provenge Proventil

Usage Nervous Disorder Kidney Disorder Organ Transplant COPD, Emphysema, Chronic Bronchitis Cancer Nervous Disorder Arrythmia Arrythmia Cancer COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Cancer Cancer Nervous Disorder COPD, Emphysema, Chronic Bronchitis Asthma Arrythmia Arrythmia Arrythmia COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma Heart Disorder-Angina Organ Transplant Alzheimers disease Hepatitis Hepatitis Multiple Sclerosis Alzheimers disease

Taken within time frame 2 years No time limit No time limit 2 years 2 years 2 years 2 years 2 years 2 years 2 years No time limit 2 years No time limit 2 years No time limit 2 years 2 years 2 years 2 Years 2 years No time limit 2 years 2 years 2 years 2 years No time limit 2 years No time limit 1 year 2 years No time limit No time limit 2 years 2 years 2 years No time limit

Probable underwriting class Graded Decline Decline Graded ROP Graded Graded Graded ROP Graded Level Graded Level Graded Level Graded ROP ROP Graded Graded Level Graded Graded Graded Graded Level Graded Level ROP Graded Decline Decline Graded Graded Graded Decline
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Pulmicort

Pulmophylline

Pulmozyne Purinethol Quadramet Quetiapine Quibron

Quinidex Quinidine Gluconate Quinidine Sulfate Qvar

Racepinephrine

Ranexa Rapamune Razadyne Rebetol Rebetron Rebif Reminyl

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Medication Renagel Renese Renvela Reopro Requip Rescriptor Retavase Retrovir Revex Revia Revlimid Revonto Reyataz Ribapak Ribasphere Ribatab Ribavirin Rilutek Risperdal Risperidone Rituxan Rivastigmine Tartrate Rocaltrol Roferon-A Ropinirole Rubex Rythmol Saluron Sancuso Sandimmune Saphris Sclerosol Intrapleural

Usage Organ Transplant Heart Disorder Organ Transplant Heart disease Parkinsons disease AIDS Heart disease AIDS Alcohol/Drug Dependency Alcohol/Drug Dependency Cancer Multiple Sclerosis AIDS Hepatitis Hepatitis Hepatitis Hepatitis Lou Gehrigs Disease (ALS) Nervous Disorder Nervous Disorder Cancer Alzheimers disease Organ Transplant Cancer Parkinsons disease Cancer Arrythmia Heart Disorder Cancer Organ Transplant Nervous Disorder COPD, Emphysema, Chronic Bronchitis Asthma Parkinsons disease AIDS COPD, Emphysema, Chronic Bronchitis Asthma Organ Transplant Nervous Disorder

Taken within time frame No time limit 2 years No time limit 1 year 2 years 2 years No time limit 1 year 2 years No time limit 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years No time limit No time limit 2 years 2 years 2 years 2 years 2 years 2 years No time limit 2 years 2 years No time limit 2 years No time limit 2 years No time limit No time limit 2 years

Probable underwriting class Decline Decline Decline ROP Graded Graded Decline ROP Graded Decline ROP ROP ROP Graded Decline Graded Graded Graded Graded Decline Graded Graded ROP Decline Decline ROP Graded ROP Graded Decline ROP Decline Graded Graded Level Graded Decline Graded Level Decline Graded

Selegiline Selzentry Senophylline

Sensipar Serentil

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Medication Serevent

Usage COPD, Emphysema, Chronic Bronchitis Asthma Nervous Disorder Organ Transplant Parkinsons disease COPD, Emphysema, Chronic Bronchitis Asthma Cancer Arrythmia Arrythmia COPD, Emphysema, Chronic Bronchitis Congestive Heart Failure Hypertension Cancer Parkinsons disease AIDS Nervous Disorder Cancer Heart disease Cancer Alcohol/Drug Dependency Alcohol/Drug Dependency AIDS Cancer Cancer COPD, Emphysema, Chronic Bronchitis Asthma Nervous Disorder Parkinsons disease Cancer Organ Transplant Arrythmia Cancer Cancer Cancer Cancer Parkinsons disease Cancer

Taken within time frame 2 years No time limit 2 years No time limit 2 years 2 years No time limit 2 years 2 years 2 years 2 years 2 years No time limit 2 years 2 years No time limit 2 years 2 years 1 year 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years No time limit 2 years 2 years 2 years No time limit 2 years 2 years 2 years 2 years 2 years 2 years 2 years

Probable underwriting class Graded Level Graded Decline Graded Graded Level ROP Graded Graded Graded Decline Level ROP Graded Decline Graded ROP ROP Graded ROP ROP ROP Decline ROP ROP Graded Level Graded Graded ROP Decline Graded ROP ROP ROP ROP Graded ROP

Seroquel Simulect Sinemet Singulair

Soltamox Sorine Sotalol HCL Spiriva Spironolactone Sprycel Stalevo Stavudine Stelazine Stilphostrol Streptase Sublimaze Suboxone Subutex Sustiva Sutent Sylatron Symbicort

Symbyax Symmetrel Tabloid Tacrolimus Tambocor Tamoxifen Tarceva Targretin Tasigna Tasmar Taxol

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Medication Taxotere Taztia XT

Usage Cancer Heart disorder/Angina Heart disorder/Angina Hypertension Cancer COPD, Emphysema, Chronic Bronchitis Asthma Cancer COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma Cancer Cancer Nervous Disorder Cancer Nervous Disorder Nervous Disorder Organ Transplant Heart disorder/Angina Heart disorder/Angina Hypertension

Taken within time frame 2 years 1 year 2 years No time limit 2 years 2 years No time limit 2 years 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years No time limit 2 years 2 years 2 years 2 years 2 years 2 years No time limit 1 year 2 years No time limit

Probable underwriting class ROP ROP Graded Level ROP Graded Level ROP Graded Level Graded Level Graded Level Graded Level Graded Level Graded Level Graded Level Graded Level ROP ROP Graded ROP Graded Graded Decline ROP Graded Level

Temodar Terbutaline Sulfate

Teslac Theocap

Theolate

Theocron

Theodur

Theolair

Theolate

Theomar

Theophylline

Theracys Thioplex Thioradazine Thiotepa Thiothixene Thorazine Thymoglobulin Tiazac

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Medication Tice BCG Ticlid Ticlopidine HCL Tikosyn Tilade

Usage Cancer Cerebrovascular disease Cerebrovascular disease Arrythmia COPD, Emphysema, Chronic Bronchitis Asthma Heart Disorder-Angina Multiple Sclerosis Heart disease Arrythmia Cancer Cancer Cancer Congestive heart failure Hypertension Cancer Heart disease Cancer Cancer Cancer Heart Disorder Nervous Disorder Parkinsons disease Nervous Disorder Cancer AIDS AIDS Cancer Multiple Sclerosis Hepatitis Cancer AIDS Cancer Cancer Cancer Cancer Cancer

Taken within time frame 2 years 1 year 2 years 1 year 2 years 2 years 2 years No time limit 1 year 2 years 2 years 1 year 2 years 2 years 2 years 2 years 2 years 2 years No time limit 2 years 1 year 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 Years 2 years No time limit No time limit 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years 2 years 2 years

Probable underwriting class ROP ROP Graded ROP Graded Graded Graded Level ROP Graded Graded ROP Graded Graded ROP ROP ROP Decline Level ROP ROP Graded ROP ROP ROP Decline Graded Graded Graded ROP Decline Decline ROP Graded Graded ROP Decline ROP ROP ROP ROP ROP

Titradose Tizanidine Tnkase Tonocard Toposar Topotecan HCL Torisel Torsemide Totect Trasylol Treanda Trelstar Tretinoin Triamterene Trifluoperazine Trihexyphenidyl Trilafon Trisenox Trizivir Truvada Tykerb Tysabri Tyzeka Uvadex Valcyte Valstar Vandetanib Vantas Vectibix Velcade

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Medication Velosulin Ventolin

Usage Diabetes COPD, Emphysema, Chronic Bronchitis Asthma Cancer Cancer Nervous Disorder Cancer Hepatitis Cancer AIDS Cancer Cancer Cancer Cancer AIDS AIDS AIDS AIDS Alcohol/Drug Dependency COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma Cancer Cancer Cerebrovascular disease Cancer Cancer COPD, Emphysema, Chronic Bronchitis Asthma COPD, Emphysema, Chronic Bronchitis Asthma Cancer COPD, Emphysema, Chronic Bronchitis Asthma Multiple Sclerosis

Taken within time frame 5 years 2 years No time limit 2 years 2 years 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years 2 years No time limit No time limit No time limit No time limit 2 years 2 years No time limit 2 years No time limit 2 years 2 years 1 year 2 years 2 years 2 years 2 years No time limit 2 years No time limit 2 years 2 years No time limit 2 years

Probable underwriting class Graded Graded Level ROP ROP Graded ROP Graded ROP Decline ROP ROP ROP ROP Decline Decline Decline Decline ROP Graded Level Graded Level ROP ROP ROP Graded ROP ROP Graded Level Graded Level ROP Graded Level Graded
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Vepesid Vesanoid Vesprin Viadur Victrelis Vidaza Videx Vinblastine Sulfate Vincasar Vincristine Sulfate Vinorelbine Tartrate Viracept Viramune Viread Vistide Vivitrol Volmax

Vospire

Votrient Vumon Warfarin Xalkori Xeloda Xolair

Xopenex

Yervoy Zafirlukast

Zanaflex
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Medication Zanosar Zelapar Zelboraf Zemaira Zemplar Zenapax Zerit Zevalin Ziagen Zidovudine Zinecard Zofran Zoladex Zolinza Zortress Zuplenz Zydis Zyflo

Usage Cancer Parkinsons disease Cancer COPD, Emphysema, Chronic Bronchitis Kidney Disorder Organ Transplant AIDS Cancer AIDS AIDS Cancer Cancer Cancer Cancer Organ Transplant Cancer Nervous Disorder COPD, Emphysema, Chronic Bronchitis Asthma Nervous Disorder Cancer

Taken within time frame 2 years 2 years 2 years 2 years No time limit No time limit No time limit 2 years No time limit No time limit 2 years 2 years 2 years 2 years No time limit 2 years 2 years 2 years No time limit 2 years 2 years

Probable underwriting class ROP Graded ROP Graded Decline Decline Decline ROP Decline Decline ROP ROP ROP ROP Decline ROP Graded Graded Level Graded ROP

Zyprexa Zytiga

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Forethought FreedomSM is funded through the purchase of whole life insurance from Forethought Life Insurance Company, Indianapolis, Indiana. Depending upon insurance plan offered, death benefit may vary during the first two policy years. A representative who may also be an agent of Forethought Life Insurance Company can answer any questions you may have. Forethought Life Insurance Company (Forethought), provides innovative insurance and financial solutions for families managing retirement and end-of-life needs. Headquartered in Indianapolis, Indiana, Forethought provides life insurance and annuities. Forethought has been consistently recognized by A.M. Best for financial strength. As of June 30, 2012, Forethought has assets owned and under management in excess of $5.9 billion, approximately $1.7 billion in annual revenue, and more than $5.3 billion of life insurance and annuity reserves. With over 25 years of proven integrity, Forethought has served more than a million customers who rely on us to protect the financial future of their families.

Forethought Life Insurance Company

Administrative Office One Forethought Center Batesville, IN 47006 Phone: 1-888-606-6372 Email: final.expense@forethought.com

www.forethought.com

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