Zsa-3065 (01.14)

La Capitale Financial Security Long Term Care Insurance
Height and Weight Guide
The fol owing height and weight table applies to males and females. The weight of a proposed insured must have remained stable for a period of 12 months prior to the application. If the applicant falls outside the range listed below, they are not insurable with La Capitale Financial Security. English system
Metric system
Height
Weight
Height
Weight
(in feet)
(in pounds)
(in centimetres)
(in kilograms)
4’10’’
4’11’’
5’0’’
5’1’’
5’2’’
5’3’’
5’4’’
5’5’’
5’6’’
5’7’’
5’8’’
5’9’’
5’10’’
5’11’’
6’0’’
6’1’’
6’2’’
6’3’’
6’4’’
6’5’’
6’6’’
La Capitale Financial Security Insurance Company
7150 Derrycrest Dr, Mississauga ON L5W 0E5
Page 1 of 2
Guide to Medication
Any medication (prescription or over-the-counter drugs) taken by the proposed insured is important and must be indicated on
the application. If the medication is for high blood pressure (and only 1 is listed) indicate on the application how often a
doctor monitors. Lack of follow up by MD or too frequent visits indicating lack of control may require a La Capitale Financial
Security application. Below is a list of some drugs associated with health problems that wil be rejected by La Capitale
Financial Security underwriters – if applying to La Capitale Financial Security refer to the La Capitale Financial Security Field
Guide.
Eldepryl
Lasix >80 mg/day
Parlodel
Adriamycin
Percocet
Ergamisol
Laradopa
Permitil
Akineton
Ergoloid
Platinol
Leukeran
Pramipexole
Prednisone
Thioplex
Antibuse
Levadopa
>6 mg/day
Thorazine
Timespan
Loxitane
Procyclidine
Arimidex
Lioresal
Trelstar
Foscavir
Lysodren
Proleukin
Trihexane
Prostigmin
Trilafon
Baclofen
Matulane
Purinethol
Benztropine
Galantamine
Prolixin
Mellaril
Blenoxane
Razadyne
Bromocriptine
Mesoridazine
Rebetron
Busulfex/Busulfan
Gold Therapy
Mestinon
Methadone
Remicade
Methotrexate
Wellcovorin
Haloperidol
Wellferon
Carbidopa
Herceptin
Risperidone
Retrovir
Hydergine
Molindone
Cerefolin
Mitomycin/Mutamycin
Risperidil
Cerubidine
Clozaril
Rivastigmine
Cogentin
Natrecor
Cytosar-U
Interferon
Neupogen
Serentil
Seroquel
Dacarbazine
Kemadrin
Nilandron
Stelazine
Donepezil
Nitroglycerin
Symadine
Novantrone
Symmetrel
Dostinex
Oxycodone
OxyContin
La Capitale Financial Security Insurance Company
7150 Derrycrest Dr, Mississauga ON L5W 0E5
Page 2 of 2

Source: http://static.lacapitale.com/pdf/en/courtiers/Penncorp/LTC_Height_and_weight_guide_ZSA-3065_EN.pdf

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