CRITICAL ILLNESS

Section 1: All Insurance Applied For: To The Best Of Your Knowledge And Belief

 

  • Has any Proposed Insured been diagnosed with or treated for Acquired Immune Deficiency Syndrome (AIDS), or Aids Related Complex (ARC) or any AIDS related condition? 

 

 

Section 2: Cancer Insurance Applied For: To The Best Of Your Knowledge And Belief

 

  • Within the past 10 years, has any Proposed Insured been diagnosed with, treated or consulted with a medical professional for internal cancer, malignant tumors, lymphoma, leukemia or melanoma?

  • Within the past 3 years, has any Proposed Insured been advised by a medical professional to undergo treatment, testing or had tests performed where the results are pending or not been received for cancer (other than HIV test)?

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Section 3: Heart Attack and Stroke Insurance Applied For: To The Best Of Your Knowledge And Belief

 

  • Within the past 10 years, has any Proposed Insured been diagnosed with, treated, been ordered to have treatment, prescribed medication, hospitalized or evaluated by a medical professional for any disease or condition of the heart or blood vessels, excluding high blood pressure or cholesterol which is considered controlled by a medical professional?

  • Within the past 3 years, has any Proposed Insured been ordered by a medical professional to undergo treatment, testing or had tests performed where the results are pending, not been received for a heart or blood vessel condition(s)?

  • Has any Proposed Insured been diagnosed by a medical professional with diabetes? (Type 1, Type II diagnosed under age of 30, A1C greater than 7.0 within the last 12 months, or with tobacco use) (Except for Gestational Diabetes)?

 

 

Section 4: Critical Illness Insurance Applied For: To The Best Of Your Knowledge And Belief

 

  • Within the past 10 years, has any Proposed Insured been hospitalized, diagnosed with, treated or prescribed medication by a medical professional for any of the following conditions or diseases? 

 

  • Kidney Function

  • Alzheimer's/Dementia/Cognitive Impairment

  • Chronic Liver (to include Cirrhosis, Hepatitis B & C)

  • Eye or Ear Disorder

  • Neurological Condition (such as Multiple Sclerosis, Parkinson's, Seizures, Muscular Dystrophy)

  • Organ Transplant

  • Pulmonary Fibrosis

  • Severe Chronic Lung

  • Within the past 3 years, has any Proposed Insured been ordered by a medical professional to undergo treatment, testing, or had tests performed where the results are still pending or not been received for a medical condition (other than HIV test)?