16 Questions

When shopping for health insurance, consider the following questions:

Within the last 6 years, has any proposed insured:

  1. Had surgery in a hospital or outpatient facility?
  2. Had medical treatment in a hospital or outpatient facility?
  3. Had any urgent care or emergency room visits?
  4. Received treatment, testing, consulted with or received a diagnosis from a doctor or other healthcare provider? Do NOT include annual physical exams.
  5. Had any testing with abnormal findings or tests for which you have not received results?
  6. Been recommended or scheduled for diagnostic testing, consultations, treatment, follow-up or surgery that has not been completed?
  7. 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?
  8. 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?
  9. Been cited for operating a motor vehicle under the influence of alcohol or drugs?
  10. 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?
  11. 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?
    1. Birth control pills for contraception only, or
    2. Medication for adult hypothyroidism, or
    3. Hormone replacement pills, or
    4. 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:

  12. Has any proposed adult used tobacco products in any form or nicotine substitutes in the last 12 months?
  13. Has any proposed insured had a diagnosis, treatment or follow-up for cancer in the last 10 years?
  14. Is any proposed insured currently pregnant, an expectant parent or in the process of adoption or surrogate pregnancy?
  15. 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?
  16. Have you fully disclosed all medical conditions for you (and your family) with the last 6 years?
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