16 Questions
When shopping for health insurance, consider the following questions:
Within the last 6 years, has any proposed insured:- Had surgery in a hospital or outpatient facility?
- Had medical treatment in a hospital or outpatient facility?
- Had any urgent care or emergency room visits?
- Received treatment, testing, consulted with or received a diagnosis from a doctor or other healthcare provider? Do NOT include annual physical exams.
- Had any testing with abnormal findings or tests for which you have not received results?
- Been recommended or scheduled for diagnostic testing, consultations, treatment, follow-up or surgery that has not been completed?
- Received or recommended to have any treatment for alcoholism, alcohol or drug abuse or addiction, including but not limited to, counseling or attendance at support groups?
- Used illegal drugs, or prescription medications other than as prescribed, or been advised by a doctor or other healthcare provider to discontinue or decrease alcohol consumption or drug use?
- Been cited for operating a motor vehicle under the influence of alcohol or drugs?
- Participated in any motorized vehicle racing (includes drivers, pit crew, owners or mechanics) or any of the following activities; skydiving, ultra light flying, scuba diving, hang gliding, rock or mountain climbing or rodeo participation?
- Has any proposed insured taken or been advised
to take any prescription medication in the last 12 months?
Are all medication(s) taken listed below?- Birth control pills for contraception only, or
- Medication for adult hypothyroidism, or
- Hormone replacement pills, or
- Cough syrup or
antibiotics for one episode of a cold, flu, ear infection, sinus
infection, sore throat, or bronchitis.
Select the applicant(s) form the list below for which this applies:
- Has any proposed adult used tobacco products in any form or nicotine substitutes in the last 12 months?
- Has any proposed insured had a diagnosis, treatment or follow-up for cancer in the last 10 years?
- Is any proposed insured currently pregnant, an expectant parent or in the process of adoption or surrogate pregnancy?
- Have any of the proposed insured been declined, postponed, reformed, charged an extra premium or had a portion of coverage excluded for life, disability or medical insurance?
- Have you fully disclosed all medical conditions for you (and your family) with the last 6 years?



