DISABILITY INSURANCE
Guidelines Update 2014
MetLife Disability Insurance is dedicated to providing the best possible underwriting
experience for brokers and clients. As part of this commitment, we are undergoing a
thorough update of our medical underwriting guidelines by evaluating how we underwrite
medical conditions and identifying where we can make better offers.
This document includes the medical conditions we have recently updated.

Those with no major changes are in black.

Those with improvements are in green and include a brief explanation of what’s
changed.
Turn the page for an interactive Table of Contents.
MetLife
Metropolitan Life Insurance Company
200 Park Avenue
New York, NY 10166
metlife.com
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Disability Insurance Medical Underwriting Update
2014
Press Control + Click on the subject you would like to learn about.
MOST RECENT UPDATES ........................................................................................................................................ 4
JUNE 2014 .............................................................................................................................................................. 4
OVARIAN CYSTS .............................................................................................................................................................5
URETHRITIS ...................................................................................................................................................................5
2014 MEDICAL IMPAIRMENTS UPDATE ................................................................................................................. 6
ANAL AND RECTAL STRICTURES .........................................................................................................................................7
ASTHMA .......................................................................................................................................................................7
ANORECTAL ABSCESS ......................................................................................................................................................7
ANXIETY .......................................................................................................................................................................7
ANXIETY (CONT.)............................................................................................................................................................8
BREAST CANCER.............................................................................................................................................................8
BLEBS, BULLAE, LUNG CYSTS ............................................................................................................................................8
CHRONIC OBSTRUCTIVE LUNG DISEASE (COPD) ..................................................................................................................9
COLON CANCER .............................................................................................................................................................9
COLON POLYPS ..............................................................................................................................................................9
DIVERTICULAR DISEASE ...................................................................................................................................................9
DEPRESSION ..................................................................................................................................................................9
2/14/14 .....................................................................................................................................................................9
ENDOMETRIAL CANCER ...................................................................................................................................................9
ENDOMETRIOMA............................................................................................................................................................9
ENDOMETRIOSIS ............................................................................................................................................................9
GRANULOMAS ...............................................................................................................................................................9
HEPATITIS A ..................................................................................................................................................................9
IMPAIRED FASTING GLUCOSE (IFG)/ IMPAIRED GLUCOSE TOLERANCE (IGT) ...........................................................................10
OBSESSIVE COMPULSIVE DISORDER (OCD) .......................................................................................................................10
OVARIAN CYSTS ...........................................................................................................................................................10
PELVIC INFLAMMATORY DISEASE .....................................................................................................................................10
PLEURISY ....................................................................................................................................................................10
PINEAL GLAND CYST .....................................................................................................................................................10
POST-TRAUMATIC STRESS DISORDER (PTSD) ....................................................................................................................11
POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME (POTS) .................................................................................................11
PNEUMOTHORAX .........................................................................................................................................................11
PROSTATE CANCER .......................................................................................................................................................11
RECTAL PROLAPSE ........................................................................................................................................................11
RECTOVAGINAL FISTULA ................................................................................................................................................11
SPERMATOCELE, VARICOCELE, HYDROCELE........................................................................................................................11
TESTICULAR CANCER .....................................................................................................................................................12
TOTAL KNEE REPLACEMENT (TKR) ..................................................................................................................................12
TUBERCULOSIS .............................................................................................................................................................12
URETHRITIS .................................................................................................................................................................12
URINARY INCONTINENCE ...............................................................................................................................................12
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UTERINE FIBROIDS ........................................................................................................................................................12
VAGINITIS ...................................................................................................................................................................12
FOR MORE INFORMATION .............................................................................................................................................13
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Most Recent Updates
June 2014
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Ovarian Cysts
Urethritis
As of 2/15/2016
Then
Now
Guidelines were available
for only very few scenarios
relating to a history of
ovarian cysts, possibly
resulting in unnecessary
declines or more highly
rated offers
Comprehensive guidelines are
now provided relating to a
history of ovarian cysts,
increasing the likelihood of
offers or of those that may be
more favorable
Applications from women
with certain symptoms due
to ovarian cysts were
generally declined.
Offers are now generally
possible for most women with
symptoms due to ovarian cysts.
Applications were declined
for 1 year after successful
treatment of urethritis
Applications may be considered
in a few months after successful
treatment of urethritis
Applications were declined
for those with a history of
any recurrence of urethritis
Offers as favorable as Standard
may be available for those with
a history of recurrence of
urethritis
Date of
Change
6/23/14
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2014 Medical
Impairments Update
As of 2/15/2016
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Then
Anal and Rectal
strictures
Asthma
Anorectal Abscess
Now
No major improvements in ratings.
Applicants with asthma categorized
as minimal or mild who are smokers
can obtain an unrated policy with a 4/4/14
10 year BP, 180 day EP
Applications were declined for 6
months after resolution of any
anorectal abscess
Applications may be considered at
any time after resolution of a single
perianal abscess not complicated by 4/4/14
a fistula
For those with a history of two
episodes of anorectal abscess, a
For those with a history of two
Standard offer may be available,
episodes of anorectal abscess, a
without any form of Rider, at various
4/4/14
180 day Modified Exclusion Rider
times after resolution of the second
was always imposed
episode (depending upon certain
features of the abscesses)
Applicants with mild anxiety were
declined until 2 years of good
control of symptoms
As of 2/15/2016
5/15/14
Applicants with asthma
categorized as minimal or mild
who are smokers were rated and
limited to a 2 or 5 year BP
No guidelines were available
relating to a history of anorectal
abscess due to an underlying
disorder which may have resulted
in unnecessary declines or
substandard offers
Anxiety
Date of
Change
Guidelines are now provided for
anorectal abscess due to a history of
an underlying disorder, increasing
4/4/14
the likelihood of offers and/or more
favorable offers
Applicants with mild anxiety may
now be considered after 1 year of
good control of symptoms
Applicants with mild anxiety
Those taking 1 medication for
taking 1 regular medication for
treatment and another medication
treatment and another medication on an occasional basis may be
on an occasional basis were
considered
declined
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Applicants with mild anxiety taking Those same applicants can now be
medication, in addition to an
offered a 10 year BP after 3 years of
exclusion rider, were rated and
good control.
4/4/14
limited to 5 year BP until 5 years of
good control had elapsed
Anxiety (cont.)
Applicants with mild anxiety off all
medications, in addition to an
exclusion rider, were limited to a 5
year BP until 5 years of good
control elapsed
Those same applicants can now be
considered for BP-10 with a rider in
the first year after stopping the
medication, just an exclusion rider in
years 1-5 since ceasing medication, 4/4/14
and after 5 years off the medication
with good control, possibly
considered standard
All limited benefit periods that
were applied were short
Many of the applied limited benefit
periods are now of longer duration
Many percentage ratings were
Many percentage ratings are now
high for all ratable stages of breast lower for most of the ratable stages
cancer
of breast cancer
Breast Cancer
30 and 60 day elimination periods 30 and 60 day elimination periods
were often not available
are now more often available
No guidelines were available
relating to breast cancer with
microscopic nodal involvement
5/1/14
Guidelines are now provided for
breast cancer with microscopic nodal
involvement, increasing the
likelihood of offers or of those that
may be more favorable
For policies with a 30 or 60 day EP,
Standard rates are available to all
a rating was applied to all persons
persons with a favorable history with 1/2/14
with a history of 1-2 small blebs,
1-2 small blebs, bullae, or cysts
bullae, or cysts
Blebs, Bullae, Lung
Cysts
As of 2/15/2016
Guidelines relating to certain
complications of blebs, bullae, or
cysts or of surgical treatment of
them were not available, possibly
resulting in unnecessary declines
or more highly rated offers
Guidelines are now provided for
several types of complications of
blebs, bullae, or cysts and of surgical
treatment of them, increasing the
1/2/14
likelihood of offers, including those
that may be Standard or Substandard
but lower-rated
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Chronic Obstructive
Lung Disease (COPD)
Applicants with COPD categorized
as minimal who no longer smoke
for 5 years were offered with a
moderate rating and a 5 year BP
Applicants with COPD categorized as
minimal who are nonsmokers for at
least 5 years and age 40 or older have
improved offers with a reduced rating 4/4/14
and for those 50 and older also an
improvement to a 10 year BP
Colon Cancer
Several risk categories only
Several risk categories have been
allowed for a 5 year BP and certain increased to 10 year BP and certain
categories always required a
categories now allow for no rider
lifetime exclusion rider
after 10 years cancer free
Colon Polyps
Certain risk categories only
allowed for a 5 year BP
Certain risk categories have been
increased to 10 year BP
Diverticular Disease
Certain risk categories only
allowed for a 5 year BP with a
rating and a rider
Certain risk categories now only
require a rider
Depression
No major improvements in ratings.
Endometrial Cancer
Several risk categories only
Several risk categories have been
allowed for a 5 year BP and certain increased to 10 year BP and certain
categories always required a
categories now allow for no rider
lifetime exclusion rider
after 10 years cancer free
Endometrioma
No major improvements in ratings.
5/9/14
Endometriosis
No major improvements in ratings.
5/1/14
Granulomas
Guidelines relating to granulomas
were very limited in scope,
possibly resulting in unnecessary
declines or more highly rated
offers
Thorough guidelines are now
provided for granulomas, increasing
the likelihood of offers, including
1/2/14
those that may be Standard or
Substandard but lower-rated
Hepatitis A
Prior guidelines required a 6
months waiting period post
recovery before consideration for
disability benefits
Based on the new guidelines,
applicants can now be considered as
soon as 3 months post full recovery 2/7/14
for disability benefits
As of 2/15/2016
3/7/14
3/17/14
3/17/14
2/14/14
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Impaired Fasting
Glucose (IFG)/
Impaired Glucose
Tolerance (IGT)
In many situations applicants with Many of these situations can now be
IFG or IGT were limited to a 5 year offered with a 10 year BP
4/4/14
BP
Applicants with mild ObsessiveApplicants with mild OCD who take 1
Compulsive Disorder (OCD) were regular medication and another
declined if presently on
medications and even those not
on medications OCD were
Obsessive Compulsive declined until 5 years of good
control elapsed
Disorder (OCD)
Ovarian Cysts
medication on an occasional basis
may now be considered. And
consideration whether on or off
medications can occur after 3 years
5/30/14
of good control of symptoms
Applicants with mild OCD with
over 10 years of good control
were offered 50% rating with 5
year BP and Rider
Those same applicants can now be
considered for an offer with only a
Rider
Guidelines were available for only
very few scenarios relating to a
history of ovarian cysts, possibly
resulting in unnecessary declines
or more highly rated offers
Comprehensive guidelines are now
provided relating to a history of
ovarian cysts, increasing the
likelihood of offers or of those that
may be more favorable
6/23/14
Applications from women with
Offers are now generally possible for
certain symptoms due to ovarian most women with symptoms due to
cysts were generally declined.
ovarian cysts.
Pelvic Inflammatory
Disease
No major improvements in ratings.
5/9/14
Pleurisy
No major improvements in ratings.
1/2/14
Pineal Gland Cyst
Before there were no guidelines Small, asymptomatic pineal gland
for pineal gland cysts which may cysts that are incidental findings on
have resulted in unnecessary
imaging studies may qualify for
declines and/or substandard offers standard consideration
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Applicants with mild PostApplicants with mild PTSD who take 1
Traumatic Stress Disorder (PTSD) regular medication and another
were declined if presently on
medication on an occasional basis
medications and even those not may now be considered. And
on medications were declined until consideration whether on or off
5 years of good control elapsed
medications can occur after 3 years
of good control of symptoms
Post-Traumatic Stress
Applicants with mild PTSD at the 5 More specific guidelines now exist
Disorder (PTSD)
Postural orthostatic
tachycardia syndrome
(POTS)
5/30/14
year mark were only considered
on a case-by-case basis, possibly
resulting in unnecessary declines
or more highly rated and limited
offers
for applicants with mild PTSD
possibly allowing for a rated and
limited BP offer along with a rider
between 3-5 years, and
consideration for Standard after 5
years of resolution of symptoms
Previously there were no
guidelines for POTS which may
have resulted in unnecessary or
permanent declines
The new guidelines allow for
consideration for a substandard
policy after complete resolution of
symptoms for at least 5 years. Best 1/30/14
cases may be considered for
standard after 10 years of complete
resolution of symptoms
Pneumothorax
A 5-year limited benefit period
At 6-12 months after surgery for
was applied if surgery for
pneumothorax, no limitation of
pneumothorax occurred within the
benefit period is applied
past year
Prostate Cancer
Several risk categories only
allowed for a 5 year BP
Several risk categories have been
increased to 10 year BP
Rectal Prolapse
No guidelines were available
relating to a history of rectal
prolapse due to an underlying
disorder which may have resulted
in unnecessary declines or
substandard offers
Guidelines are now provided for
rectal prolapse due to a history of an
underlying disorder, increasing the
4/4/14
likelihood of offers and/or more
favorable offers
Rectovaginal Fistula
We would make a standard offer 6 We now will consider these cases
months after successful surgical standard 3 months post-surgery.
correction of this disorder.
Spermatocele,
No major improvements in ratings.
Varicocele, Hydrocele
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Testicular Cancer
Several risk categories only
Several risk categories have been
allowed for a 5 year BP and certain increased to 10 year BP and certain
categories always required a
categories now allow for no rider
lifetime exclusion rider
after 10 years cancer free
Total Knee
Replacement (TKR)
Applicants with full recovery from
TKR within 2 years from the date
of surgery were only offered a 5
year BP
Tuberculosis
3/7/14
Those with full recovery within 2
years from the date of surgery, have
no restriction on BP with a 90 or 180 4/4/14
day EP
Guidelines relating to the results Thorough guidelines are now
of screening tests for TB or for a provided for TB, including issues
history of treatment complications relating to the results of screening
or unusual features of infection tests for TB or for a history of
were absent or very limited in
treatment complications or unusual
scope, possibly resulting in
features of infection, increasing the
unnecessary declines or more
likelihood of offers for those that may 1/30/14
highly rated offers
be more favorable
Applications were declined for one Applications may be considered after
year after recovery from
6 months after completion of
tuberculosis involving sites other treatment of tuberculosis involving
than the lungs
sites other than the lungs
Applications were declined for 1 Applications may be considered in a
year after successful treatment of few months after successful
urethritis
treatment of urethritis
Urethritis
Urinary Incontinence
Applications were declined for
those with a history of any
recurrence of urethritis
Offers as favorable as Standard may
be available for those with a history
of recurrence of urethritis
There were no guidelines for
urinary incontinence possibly
resulting in unnecessary declines
or more highly substandard offers
Guidelines are now provided for
urinary incontinence increasing the
likelihood of offers or of those that
may be more favorable
6/6/14
5/1/14
Uterine Fibroids
No major improvements in ratings.
1/2/14
Vaginitis
No major improvements in ratings.
2/14/14
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For More Information
Find the most recent updates and Underwriting Alerts, which provide further details about the
conditions and how our underwriting guidelines were improved.

Career representatives: visit the portal under Products > Disability Insurance >
Underwriting.

Brokers and independent representatives: visit metlifeinvestors.com under Resources >
Operations & Services > Underwriting
If you have any questions, please contact your DI wholesaler or the Sales Desk or call the DI
Resource Line at 800-929-1492.
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