If you are applying for coverage during open enrollment or during a
Guaranteed issue period you do not need to answer questions (A. thru L.).
(A.) Are you currently hospitalized or confined to a nursing facility; or, are you bedridden or confined to a wheelchair?
(B.) Do you have emphysema, Chronic Obstructive Pulmonary
Disease (COPD) or other Chronic Pulmonary disorders?
(C.) Do you have Parkinson's Disease or Multiple or Lateral
(D.) Have you been diagnosed with Alzheimer's Disease, senile
dementia, organic brain disorder, or any other senility disorder?
(E.) Have you been diagnosed with or treated for Acquired
Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC)?
(F.) Do you have kidney disease requiring dialysis or
diabetes requiring more than 50 units of insulin daily?
(G.) Within the past two years have you been treated for
or been advised by a physician to have treatment for internal cancer,
alcoholism, or drug abuse; cirrhosis; mental or nervous disorder requiring
psychiatric care; or have you had any amputation caused by disease?
(H.) Within the past two years have you been treated for
or been advised by a physician to have treatment for heart, coronary or
carotid artery disease (not including high blood pressure); peripheral
vascular disease; congestive heart failure or enlarged heart; stroke;
transient ischemic attacks (TIA); or heart rhythm disorders?
(I.) Within the past two years have you been treated for
osteoporosis, degenerative bone disease, or crippling arthritis?
(J.) Have you been advised that surgery may be required
within the next twelve months for cataracts?
(K.) Have you been advised to have surgery or medical tests
that have not been performed?
(L.) Have you been hospital confined three or more times
in the last two years?