If you answer "yes" to any of the conditions listed in the following question, you will likely be denied for a short-term plan:
Within the last 5 years if you have been diagnosed, treated, or taken medication for any of the following conditions, term health insurance cannot be issued: Cancer or tumor, stroke, heart disease including heart attack, chest pain or had heart surgery, COPD (chronic obstructive pulmonary disease) or emphysema, Crohn's disease, liver disorder, degenerative disc disease, rheumatoid arthritis, kidney disorder, diabetes, degenerative joint disease of the knee, alcohol abuse or chemical dependency, or any neurological disorder; HIV or AIDS; or if you are now pregnant or in the process of adoption.
If you are looking for insurance to cover your pre-existing conditions, we can refer you to an agent who can help you find a health insurance plan that to cover these conditions:
For ACA/Obamacare Plans: (312) 726-6565
If you answer "yes" to any of the questions below, you are not eligible for a short term plan.
Eligibility
Please answer the following medical questions for all individuals, including dependents, applying for coverage:
* Will any person to be covered be eligible for a government sponsored health insurance plan (Medicare or Medicaid)?
Yes / No
* Are you or is any immediate family member (whether named or not named in this enrollment form) pregnant, an expectant parent, in the process of adopting a child, or undergoing fertility treatment?
Yes / No
* Are you or any person applying for coverage currently over 300 pounds if male or 250 pounds if female OR has anyone to be insured undergone weight loss or bariatric surgery?
Yes / No
* WITHIN THE LAST 5 YEARS, HAS ANY PERSON LISTED ON THIS APPLICATION RECEIVED ANY MEDICAL OR SURGICAL ADVICE, CONSULTATION OR TREATMENT, INCLUDING MEDICATION, FOR:
Stem cell transplant
Heart disorder, heart attack, coronary artery disease or circulatory system disorder (includes by-pass or stent surgery or carotid artery disease/surgery
Stroke, seizures disorder or other neurological disorder
Cancer or tumor OR taking medication to prevent recurrence of cancer or tumorous growth
Paraplegia, quadriplegia or multiple sclerosis
Emphysema, chronic bronchitis or COPD (chronic obstructive pulmonary disease)
Insulin dependent diabetes
Kidney disorder other than stones and/or liver disease
Degenerative arthritis (degenerative disc disease, herniated disc, rheumatoid or psoriatic arthritis or degenerative joint disease)
Alcohol or drug abuse or dependency OR chemical dependency
Yes / No
* Have you or any person proposed for coverage been diagnosed or treated by a Medical Professional or Medically Diagnosed 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
Yes / No
* Is this plan intended to replace your current coverage?
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