Philadelphia American Health Underwriting Questions
The following are the application questions for the Philadelphia American Fixed Benefit and supplemental plans.
You will note that some of the questions are asked more than one time with different time frames. That is because you are applying for two separate policies at the same time and each has it’s own set of questions.
To review the benefits of the specific plans associated with these questions, please visit the Philadelphia American page.
Fixed Benefit Plan Health Questions:
IMPORTANT NOTE: IF THE ANSWER TO QUESTION 1-7 IS "YES" THEN THAT APPLICANT IS NOT ELIGIBLE FOR COVERAGE.
1. Within the past 10 years, has any Applicant been diagnosed with or received treatment, tested positive or taken medication for any of the following conditions? Liver cirrhosis, Hepatitis B, insulin-diabetes including neuropathy, ulcerative colitis or Crohn’s, Down’s syndrome, mental retardation, Autism, Rheumatoid Arthritis, ALS (Lou Gehrig’s Disease), Alzheimer’s, Parkinson’s, Dementia, cystic fibrosis, heart attack, coronary bypass, cerebral palsy, sickle cell or aplastic anemia, leukemia, transplant recipient, multiple sclerosis, muscular dystrophy, lupus, COPD, suicide attempt, Stroke or TIA, paraplegia or quadriplegia, kidney or renal failure, or been hospitalized more than 3 times in the past year?
2. In the past 10 years, has any Applicant tested positive or been diagnosed with or treated as having Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC)?
3. Is the primary Applicant or any of the Applicant’s dependent’s (spouse, child(ren) under age 25), whether applying for coverage or not, currently pregnant or have a pending adoption?
4. Within the past 5 years has any Applicant been diagnosed with, taken medication or been treated for internal cancer, malignant melanoma or any other malignancy or been advised to have any diagnostic tests relating to cancer which have not been completed or for which results have not been received?
5. Within the past 4 years has any Applicant used drugs, been diagnosed with or received any medical treatment, taken medication for or been advised to have a medical test for alcohol or drug abuse?
6. In the past 6 months, has any Applicant been confined to a nursing facility (except for short term rehabilitation), bedridden, or been told they are disabled?
7. Does any proposed insured intend to reside outside the US?
THE FOLLOWING QUESTIONS APPLY TO THOSE FAMILY MEMBERS THAT ARE ABLE TO QUALIFY FOR COVERAGE BASED ON THE ANSWERS ABOVE, OTHERWISE DO NOT CONTINUE.
8. Has anyone to be insured used any form of tobacco (including smokeless) or nicotine (e-cigarettes, cigars, pipe or chewing tobacco) within the past 24 months?
9. In the last 12 months has any proposed insured been treated, tested or taken medication for any of the following conditions and has seen a physician more than twice for any of these conditions? Add one (1) point for each condition
a. kidney stones, kidney/bladder or urinary infections, hepatitis A,
b. asthma or bronchitis, sleep apnea, unoperated hernia, pituitary, thyroid, stomach, disc or back,
c. (TMJ) temporomandibular joint, carpal tunnel syndrome, pelvic inflammatory disease,
d. obsessive-compulsive disorder, psychosis, schizophrenia,
e. migraines, endometriosis, uterine fibroids or uterine cyst.
10. If any proposed insured had a cesarean section, more than one miscarriage or seen a physician for infertility treatment and has not had a tubal-ligation or hysterectomy and is still of childbearing age, add two (2) points.
11. In the last 12 months has any proposed insured been treated, tested or taken medication for any of the following conditions?
Add two (2) points for each condition(s).
a. Emphysema and not smoking, non-insulin Diabetes, glaucoma,
b. Osteoarthritis, bariatric surgery (weight loss)-bypass, stapling, or lap band
c. cataracts or glaucoma, macular degeneration,
d. cardiac ablation, epilepsy-seizures, hip or knee replacement,
e. mitral valve prolapse, tachycardia-bradycardia or arrhythmia.
f. Hepatitis C
12. In the last 12 months, other than conditions mentioned above, has any Applicant had any medical or surgical advice including treatment, prescriptions, operations or been advised to have medical test(s) (excluding HIV and AIDS) or surgery that has not yet been performed, or is awaiting a medical test (excluding HIV and AIDS)?
13. Is there any other condition that will require a rate up?
NOTE: In reference to “points” in the questions above, each point is equal to a 15% additional premium.
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