Determine Eligibility Based On Health

IF THE PROPOSED INSURED ANSWERS “YES” TO ANY QUESTIONS IN PART ONE BELOW, THAT PERSON IS NOT ELIGIBLE FOR ANY COVERAGE UNDER THE TRADITIONAL LEVEL COVERAGES – GO TO GUARANTEED ISSUE PRODUCTS

These questions are based on the MOO Living Promise app.  Check your underwriting guides or review the specific product application and knock-out health questions. If you are not certain the first action should be to contact the carrier directly and conduct a risk assessment and check the other carriers also.

PART ONE

1. Is the Proposed Insured CURRENTLY:
(a) bedridden or confined to any hospital, nursing home, long-term care facility or skilled nursing facility; or receiving or been advised to receive care in a nursing home, hospice care, or home health care?

(b) requiring assistance with activities of daily living such as taking medications, bathing, dressing, eating, toileting, getting in and out of a chair or bed, or control of bowel or bladder problems?

(c) requiring any of the following (other than for fractures, bone or joint surgery, including replacement): wheelchair, electric scooter, or oxygen equipment to assist breathing (excluding use for sleep apnea)?

2. Has the Proposed Insured EVER been:
(a) diagnosed as having Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or been treated for AIDS or ARC by a physician or heath care provider?

(b) diagnosed with, been treated for or advised by a physician or health care provider to receive treatment for Alzheimer’s Disease, Dementia, Huntington’s Disease, Sickle Cell Anemia, Myelodysplastic Syndrome (MDS), Lou Gehrig’s Disease (ALS), Quadriplegia, Paraplegia, Down’s Syndrome, mental incapacity, congestive heart failure, Cirrhosis, Metastatic Cancer or recurrent Cancer of the same type?

(c) diagnosed with insulin shock, diabetic coma, or had an amputation due to diabetic complications or diagnosed with End Stage Renal Disease or requiring dialysis?

(d) advised to receive or have received an organ or bone marrow transplant?

(e) diagnosed by a physician or health care provider as having a terminal medical condition that is expected to result in death within the next 12months?

3. In the PAST 12 MONTHS, has the Proposed Insured been:
(a) advised by a physician to have a surgical operation, diagnostic testing other than for routine screening purposes or for those related to AIDS, treatment, hospitalization, or other procedure which has not been done or for which results are not known?

(b) diagnosed by a physician or health care provider as having heart disease or heart surgery of any kind?

4. In the PAST 2 YEARS, has the Proposed Insured been diagnosed with:, been treated for or advised by a physician or health care provider to receive treatment for any form of cancer (except basal or squamous cell
skin cancer)?

5. Has the Proposed Insured: EVER (a) received care or treatment for, or (b) been advised by a physician or health care provider to seek treatment for:
(a) Diabetes before age 50 or diabetes at any age with complications of Retinopathy (eye), Nephropathy (kidney), Neuropathy (nerve) or Peripheral Vascular Disease (PVD or PAD)?

(b) Hepatitis C?

(c) Chronic Lung Disease, including Chronic Obstructive Pulmonary Disease (COPD), Chronic Bronchitis, Emphysema, or Sarcoidosis?

IF, THE PROPOSED INSURED ANSWERS “YES” TO ANY QUESTION IN PART TWO BELOW, THAT PERSON IS ELIGIBLE ONLY FOR THE GRADED BENEFIT PRODUCT.

PART TWO

6. In the PAST 4 YEARS, has the Proposed Insured: (a) received care or treatment for, or (b) been advised by a physician or health care provider to seek treatment for:
(a) Cancer, Leukemia, Melanoma or any other internal cancer (except basal or squamous cell skin cancer)?

(b) Chronic Kidney Disease, Systemic Lupus or Scleroderma?

(c) Bipolar Depression, Schizophrenia, Parkinson’s Disease or Multiple Sclerosis?

7. In the PAST 2 YEARS, has the Proposed Insured: received care or treatment for, or been advised by a physician or health care provider to seek treatment for:

(a) Coronary Artery Disease, Heart Attack, Coronary Artery Bypass Surgery, Angioplasty, Cardiomyopathy, irregular heart rhythm, or Valvular Heart Disease with surgical repair or replacement?

(b) Stroke or Transient Ischemic Attack (TIA)?

8. In the PAST 2 YEARS, has the Proposed Insured:
(a) been convicted of, incarcerated for or currently awaiting trial for a felony?

(b) been treated for or advised to have treatment for alcohol or drug abuse or convicted more than once of reckless driving or driving under the influence of drugs or alcohol?

(c) used unlawful drugs in any form or abused or misused prescription drugs?

9. In the PAST 2 YEARS, has the Proposed Insured: been hospitalized by a physician or health care provider for any mental or nervous disorder?

10. In the PAST 12 MONTHS, has the Proposed Insured: consulted a physician for chronic cough, unexplained weight loss greater than 10 pounds, fatigue or unexplained gastrointestinal bleeding?

HEALTHY CLIENT PRODUCTS