Forethought Freedom

Issued by Forethought Life Insurance Company

SM

Underwriting Medical Conditions Guide

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M8487-02

FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS

2013 Forethought 0113

Forethought Freedom

SM

Underwriting Medical Conditions Guide

This Underwriting Medical Conditions Guide has been developed to assist you in pre-qualifying your clients for the Forethought FreedomSM product. Prior to beginning the application process, we suggest that you ask your client if he or she has had any medical problems in the last several years, such as heart disease, heart surgery, diabetes, stroke, cancer, lung disease, etc. After collecting the details regarding your clients medical history, refer to the guide to determine the probable plan of insurance for which he or she 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 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 Company (Forethought) reserves the right to request any additional information deemed necessary to make an underwriting decision.

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Medical Conditions
Activities of Daily Living (ADL) AIDS Alcohol dependency Alzheimers disease Amputation Amyotrophic lateral sclerosis (ALS) Aneurysm

Considerations
Currently requiring assistance with any ADL Ever been diagnosed or treated for Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Ever been diagnosed, treated or advised to have treatment for, taken or been prescribed medication for Due to disease in the last 24 months Ever been diagnosed, treated or advised to have treatment for, taken or been prescribed medication for Surgery performed within the last 12 months. Diagnosed, treated, advised to have treatment for, taken or been prescribed medication for in the last 12 months Diagnosed, treated or taken medication for 13 to 24 months ago. No treatment or medication in the last 12 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication in the last 12 months Diagnosed, treated or advised to have treatment, taken medication for 13 to 24 month ago. No attacks, treatment or medication taken in the last 12 months Surgery performed within the last 12 months. Treated, advised to have treatment for, taken or been prescribed medication for in the last 12 months With a history of stroke With a history of transient ischemic attack (TIA) With a history of diabetes Surgery performed 13 to 24 months ago. Treated or taken medication for 13 to 24 months ago. No treatment or medication taken in the last 12 months Diagnosed, treated, advised to have treatment for, taken or been prescribed medication for in the last 24 months Diagnosed, treated, advised to have treatment for, taken or been prescribed medication for in the last 24 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Diagnosed, treated, advised to have treatment for, taken or been prescribed medication for in the last 24 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Surgery performed within the last 12 months. Treated, advised to have treatment for, taken or been prescribed medication for in the last 12 months With a history of stroke With a history of transient ischemic attack (TIA) With a history of diabetes Surgery performed 13 to 24 months ago. Treated or taken medication for 13 to 24 months ago. No treatment or medication taken in the last 12 months Other than basal cell of the skin, diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months With a history of a stroke or TIA With a history of diabetes Surgery performed in the last 12 months Surgery performed 13 to 24 months ago Currently receiving or been advised to receive

Probable Underwriting Result

Decline Decline ROP Decline ROP Decline ROP

Aneurysm Angina Angina

Graded ROP Graded

Angioplasty Angioplasty Angioplasty Angioplasty Angioplasy Atrial fibrillation Atrial flutter Bipolar disorder Bradycardia Brain tumor Bypass surgery Bypass surgery Bypass surgery Bypass surgery Bypass surgery Cancer Cardiomyopathy Cardiomyopathy Cardiomyopathy Carotid artery surgery Carotid artery surgery Chemotherapy

ROP ROP ROP ROP Graded Graded Graded Graded Graded ROP ROP ROP ROP ROP Graded ROP Decline ROP ROP ROP Graded Decline

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Medical Conditions
Chronic bronchitis Chronic hepatitis Chronic memory loss Chronic obstructive pulmonary disease (COPD) Cirrhosis of the liver Confined to a bed Congestive heart failure Congestive heart failure Congestive heart failure Convulsion Coronary artery disease Coronary artery disease Coronary artery disease Coronary artery disease Coronary artery disease Defibrillator Dementia Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetic coma Drug dependency Emphysema End stage kidney disease Endarterectomy

Considerations
Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Ever been diagnosed, treated or advised to have treatment for, taken or been prescribed medication for Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Currently confined to a bed Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months With a history of a stroke or transient ischemic attack (TIA) With a history of diabetes Convulsion within the last 12 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication in the last 12 months With a history of stroke With a history of transient ischemic attack (TIA) With a history of diabetes Diagnosed, treated or advised to have treatment, taken medication for 13 to 24 months ago. No treatment or medication taken in the last 12 months Currently implanted Ever been diagnosed, treated or advised to have treatment for, taken or been prescribed medication for With retinopathy/eye disorder in the last 24 months With kidney disorder in the last 24 months With insulin shock in the last 24 months With a history of a stroke With a history of a transient ischemic attack (TIA) With a history of heart attack With a history of heart disease With a history of bypass surgery With a history of angioplasty or stent placement Taken insulin within the last 5 years With a history of a heart valve replacement With a history of congestive heart failure With a history of cardiomyopathy In the last 24 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Ever been diagnosed, treated or advised to have treatment for, taken or been prescribed medication for Surgery performed within the last 12 months. Been treated for, advised to have treatment for, taken or been prescribed medication for, in the last 12 months Surgery performed 13-24 months ago. Been treated for, advised to have treatment for, taken or been prescribed medication for, 13-24 months ago. No treatment or medication taken in the last 12 months

Probable Underwriting Result

Graded Graded Decline Graded ROP Decline Decline ROP ROP Graded ROP ROP ROP ROP Graded Graded Decline ROP ROP ROP ROP ROP ROP ROP ROP ROP Graded ROP ROP ROP ROP ROP Graded Decline ROP

Endarterectomy

Graded

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Medical Conditions
Epilepsy Heart attack Heart attack Heart attack Heart attack Heart attack Heart surgery Heart surgery Heart transplant Heart valve replacement Heart valve replacement Heart valve replacement Heart valve replacement Hepatitis HIV positive Hodgkins disease Home Health Care Hospice Care Hospitalized Hospitalized Incarceration/Prison Irregular heartbeat Kidney dialysis Kidney failure Kidney transplant Leukemia Liver failure Liver transplant Lou Gehrigs disease (ALS) Lung transplant Lymphoma Melanoma Multiple Myeloma Multiple sclerosis Nursing Home

Considerations
Seizure within the last 12 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication in the last 12 months Multiple heart attacks With a history of stroke With a history of transient ischemic attack (TIA) Diagnosed, treated or advised to have treatment, taken medication for 13 to 24 month ago. No treatment or medication taken in the last 12 months Surgery performed within the last 12 months. Treated, advised to have treatment for, taken or been prescribed medication for in the last 12 months Surgery performed 13 to 24 months ago. Treated or taken medication for 13 to 24 months ago. No treatment or medication taken in the last 12 months Had or been recommended to have Surgery performed within the last 12 months. Treated, advised to have treatment for, taken or been prescribed medication for in the last 12 months Surgery performed 13 to 24 months ago. Treated or taken medication for 13 to 24 months ago. No treatment or medication taken in the last 12 months With a history of diabetes With a history of a stroke or transient ischemic attack (TIA) Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Ever been diagnosed or treated for Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Currently receiving any type of home health care Currently receiving hospice care Currently in a hospital Two or more hospitalizations for any reason, within the last 12 months Currently in prison Diagnosed, treated, advised to have treatment for, taken or been prescribed medication for in the last 24 months Currently receiving or been advised to receive Ever been diagnosed, treated or advised to have treatment for, taken or been prescribed medication for Had or been recommended to have Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Ever been diagnosed, treated or advised to have treatment for, taken or been prescribed medication for Had or been recommended to have Ever been diagnosed, treated or advised to have treatment for, taken or been prescribed medication for Had or been recommended to have Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Currently confined to a nursing home

Probable Underwriting Result

Graded ROP ROP ROP ROP Graded ROP Graded Decline ROP Graded ROP ROP Graded Decline ROP Decline Decline Decline Graded Decline Graded Decline Decline Decline ROP Decline Decline Decline Decline ROP ROP ROP Graded Decline

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Medical Conditions
Oxygen Pacemaker Parkinsons disease Psychiatric facility Psychosis Radiation Schizophrenia Seizure Stent placement Stent placement Stent placement Stent placement Stent placement Stroke Stroke Stroke Stroke Stroke Stroke Stroke Stroke Stroke Stroke Stroke Supra ventricular tachycardia Tachycardia Transient ischemic attack (TIA) Transient ischemic attack (TIA) Transient ischemic attack (TIA) Transient ischemic attack (TIA) Transient ischemic attack (TIA) Transient ischemic attack (TIA) Transient ischemic attack (TIA) Transient ischemic attack (TIA) Transient ischemic attack (TIA) Transient ischemic attack (TIA) Transient ischemic attack (TIA) Wheel Chair

Considerations
Currently using or been advised to use ( other than for sleep apnea) Currently implanted or been advised to have implanted Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Currently confined to a psychiatric facility Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Currently receiving or been advised to receive Diagnosed, treated, advised to have treatment, taken or been prescribed medication for in the last 24 months Seizure within the last 12 months Surgery performed within the last 12 months. Treated, advised to have treatment for, taken or been prescribed medication for in the last 12 months With a history of stroke With a history of transient ischemic attack (TIA) With a history of diabetes Surgery performed 13 to 24 months ago. Treated or taken medication for 13 to 24 months ago. No treatment or medication taken in the last 12 months Stroke occurred within the last 12 months. Treated, advised to have treatment for, taken or been prescribed medication for in the last 12 months Multiple strokes With a history of heart disease With a history of angioplasty or stent placement With a history of heart attack Stroke occurred 13 to 24 months ago. Treated or taken medication for 13 to 24 months ago. No treatment or medication taken in last 12 months With a history of a transient ischemic attack (TIA) With a history of a heart valve replacement With a history of cardiomyopathy With a history of congestive heart failure With a history of bypass surgery Diagnosed, treated, advised to have treatment for, taken or been prescribed medication for in the last 24 months Diagnosed, treated, advised to have treatment for, taken or been prescribed medication for in the last 24 months TIA occurred within the last 12 months. Treated, advised to have treatment for, taken or been prescribed medication for in the last 12 months Multiple transient ischemic attacks (TIA) With a history of heart disease With a history of angioplasty or stent placement With a history of bypass surgery With a history of heart attack TIA occurred 13 to 24 months ago. Treated or taken medication for 13 to 24 months ago. No treatment or medication taken in last 12 months With a history of a stroke With a history of a heart valve replacement With a history of cardiomyopathy With a history of congestive heart failure Currently confined to or using

Probable Underwriting Result

Decline Graded Graded Decline Graded Decline Graded Graded ROP ROP ROP ROP Graded ROP ROP ROP ROP ROP Graded ROP ROP ROP ROP ROP Graded Graded ROP ROP ROP ROP ROP ROP Graded ROP ROP ROP ROP Decline

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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 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

M8487-02

FOR AGENT USE ONLY NOT FOR USE WITH CONSUMERS

2013 Forethought 0113