Sample Medical Application Questions - Short Term Health Insurance

If you can answer NO to any of the following medical related questions, you will be accepted for short term health insurance. Short term health insurance does not require underwriting approval from the insurance company.  Each insurance company has their own set of medical questionnaire guidelines.  Short term health insurance does NOT cover pre-existing conditions and is designed to protect you in case the unexpected illness or accident happens.

1. Are you, your spouse, or any dependent, (whether listed on the application or not) now pregnant or are you an expectant father of any unborn child?
2. Have you, or any person to be insured been declined for insurance due to health reasons?
3. Have you or any applicant to be insured in the past five years received any treatment, medication, or medical or surgical advice for heart or circulatory system disorder, including heart attack or chest pain, stroke, diabetes, cancer or tumor, leukemia or any blood disorder, alcohol or drug abuse or dependency, immune system disorder or been tested positive for exposure to the HIV infection or been diagnosed as having ARC or AIDS caused by the HIV infection or other sickness or condition derived from such infection?

1. Are you, your spouse, or any dependent, (whether listed on the application or not) now pregnant or are you an expectant father of any unborn child?
2. Have you, or any person to be insured been declined for insurance due to health reasons?
3. Have you or any applicant to be insured in the past five years received any treatment, medication, or medical or surgical advice for heart or circulatory system disorder, including heart attack or chest pain, stroke, diabetes, cancer or tumor, leukemia or any blood disorder, alcohol or drug abuse or dependency, immune system disorder or been tested positive for exposure to the HIV infection or been diagnosed as having ARC or AIDS caused by the HIV infection or other sickness or condition derived from such infection?

1. Are you, your spouse, or any dependent now pregnant or an expectant parent?
2. Have you or any dependent to be covered ever received any medical or surgical consultation, advice, treatment, or medication for: Cancer or tumors, Diabetes, Heart attack, Angina, or other heart disorder, Stroke, Excessive use of alcohol or alcoholism, Drug abuse, dependence or addiction, Emotional, psychological, psychiatric, or nervous condition or disorder.
3. Have you or any dependents to be insured ever been diagnosed by a member of he medical profession as having acquired immune system disorders; or ever tested positive for antibodies to Human Immunodeficiency Virus (HIV)? (Only disclose results of FDA - licensed blood tests. Also you need not disclose the results of tests conducted at an anonymous testing site.)

1. Are you, your spouse, or any dependent, now pregnant?
2. Have you, or any person to be insured been declined for insurance due to health reasons?
3. Within the last five 5 years, have you, your spouse or any dependent to be covered, ever been diagnosed or treated by a member of the medical profession for: heart or circulatory system disorder including heart attack or chest pain; stroke; diabetes; cancer or tumor; immune system disorder including acquired immune deficiency syndrome (AIDS) (Applicant need not disclose F D A licensed blood test results obtained from an alternate test site); alcoholism or alcohol abuse; drug abuse or chemical dependency?

1. Within the last 3 years, have you or any person to be insured been aware of, diagnosed and/or been treated by a member of the medical profession for: heart disease or disorder, stroke, cancer (excluding basal cell skin cancer), diabetes, alcohol or drug dependency, mental disorder, Emphysema, airway or pulmonary disease, Crohn's disease or Ulcerative Colitis, nervous system disorder, liver disorder, kidney disorder, crippling or disabling arthritis, spinal disc disease, knee or hip disorders?
2. Have you or any person to be insured been hospitalized (except for childbirth) within the past 12 months, due to be so confined or disabled for more than a total of five days within the past 12 months?
3. Have you or any person to be insured been declined for insurance due to health reasons in the last 3 years?
4. Are you, your spouse or any dependent currently pregnant?
5. During the last five years, have you or any person to be insured been diagnosed by a member of the medical profession as having Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) or received treatment from a member of the medical profession for AIDS or ARC, or tested positive for HIV?

This information is provided so you can determine if you are eligible for short term health insurance with a specific insurance company.  The medical questions and wording were last updated on 01/01/2004 and my vary by state.  This is not a solicitation, offer or application for insurance.

Long Term Consumer Care, Inc.

Updated 01/01/2004