EXCLUSIONS, PREMIUM DETERMINATION AND PRE-EXISTING CONDITIONS

Answers determine the applicant's personalized premium.

Section 1: Excluded Medical Conditions
Questions determining if certain medical conditions are covered, excluded or require a medical questionnaire to be sent.
Have you ever been diagnosed with a cardiovascular condition? *
Have you ever been diagnosed with or treated for kidney failure? *
Have you ever had a transplant of one of the following organs: heart, liver, pancreas, lung, bone marrow? *
In the past 24 months, have you been hospitalized or taken cortisone pills for a chronic pulmonary condition, such as asthma, emphysema, chronic bronchitis, pulmonary fibrosis? *
In the past 12 months, have you been diagnosed with or treated for cancer (with the exception of basal cell carcinoma)? *
In the past 12 months, have you been treated for a gastrointestinal condition, such as cirrhosis, hepatitis B or C, intestinal obstruction, diverticulitis, Crohn's disease, pancreatitis, ulcerative colitis? *
Section 2: Determination of Personalized Premium
Questions determining the client's personalized premium.
Skip if you prefer not to answer
Skip if you prefer not to answer
Have you ever been diagnosed with a CVA (Cerebrovascular accident or stroke), a TIA (Transient Ischemic Attack), Parkinson's disease or Alzheimer's disease? *
In the past 12 months, have you been diagnosed with or treated for high blood pressure? *
In the past 12 months, have you been diagnosed with or treated for high cholesterol? *
Have you ever been diagnosed with diabetes? *
In the past 2 years, have you used tobacco? *
Have you had a medical check-up in the past 18 months? *
Have you been hospitalized in the past 6 months? *
Are you awaiting surgery or treatments or do you have any symptoms for which investigations are now being carried out? *
Have you received a diagnosis of osteoporosis? *
In the past 12 months, did you consult a doctor because of a fall? *
I confirm that I entered the exact answers on this form *

Login
Welcome, (First Name)!

Forgot? Show
Log In
Enter Login Area
Log Out