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APPLICATION
Nicotine to Non-nicotine Rate Change

Insureds who have not used tobacco or nicotine AND not used a nicotine aid (such as a patch, gum, etc.) for 12 months, may qualify for the Non-nicotine rate class, and are subject to an underwriting review. The insured should complete all questions on a new Part I Life Application and send it to the Home Office. In the "Remarks" section of the application, explain that the purpose of the application is to request a change to nonsmoker rates. Your underwriter will review the application and determine if additional information is needed or certain medical requirements must be met. If the insured has acquired a health impairment related to smoking, nonsmoker rates cannot be approved.

To download state specific Part I Life Application, go to Life Forms & Applications