Short Term Health Insurance - Secure Lite Eligibility Questions

	Are you eligible for the Secure Lite short term health insurance plan?  To be eligible, you must be able to answer NO to the following questions.  Please Note: The eligibility questions may vary in some states. Secure Lite STM Eligibility Questions - Click Here to Get a Quote or Apply Will there be any other health insurance in force on the policy date? Is the proposed insured, spouse, or any dependent child now pregnant? Is any proposed insured currently eligible for Medicaid? Within the past 5 years have you or any person applying for coverage been aware of, received an abnormal test report for, been diagnosed with, been treated by or received follow-up care with a member of the medical profession, taken medication for or had a device surgically implanted or in place for: ¦ heart disorder, heart attack, coronary artery disease, coronary bypass or stent ¦ peripheral vascular disease or carotidartery disease ¦ stroke or other neurological disorder ¦ cancer or tumor ¦ paraplegia, quadriplegia or multiple sclerosis ¦ stem cell transplant ¦ emphysema or COPD (chronic obstructive pulmonary disease) ¦ diabetes ¦ liver disorder ¦ kidney disorder other than stones ¦ degenerative disc disease or herniated disc ¦ rheumatoid or psoriatic arthritis ¦ degenerative joint disease of the knees or hips ¦ alcohol or drug abuse or dependency ¦ hemophilia Have you or any person proposed for coverage been diagnosed or treated for Acquired Immune Deficiency Syndrome (AIDS), AIDS related complex, or any other immune system disorder? Answer this question “no” if you have tested positive for HIV but have not developed symptoms of the disease AIDS
	Long Term Consumer Care, Inc. N27 W23960 Paul Road Suite 201 ~ Pewaukee, WI  53072 Toll Free: 1.800.544.9505  Fax: 1-262.523-1910