Hospital Indemnity - Underwriting

1a Internal cancer, leukemia, melanoma, Hodgkin's disease or lymphoma?

Yes

No

1b Parkinson's disease, Multiple Sclerosis, ALS, Alzheimer's, dementia or drug/alcohol abuse?

Yes

No

1c Congestive heart failure, stroke, heart attack, heart disease, cardiomyopathy, aneurysm or peripheral vascular disease?

Yes

No

1d Chronic kidney disease, kidney failure, organ transplant, cirrhosis or chronic pancreatitis?

Yes

No

1e Complications of diabetes (neuropathy, eye/kidney disease) or take more than 50 units of insulin per day?

Yes

No

1f AIDS or HIV?

Yes

No

1g COPD, emphysema or require CPAP, nebulizer or oxygen?

Yes

No

1h Osteoporosis with related fractures or any connective tissue disorder?

Yes

No

2a Been confined to a nursing facility, bed or wheelchair or received home health care?

Yes

No

2b Been hospitalized 2+ times or advised to have surgery not yet completed?

Yes

No

2c Used a walker, TENS unit or quad cane?

Yes

No

3 Pacemaker, defibrillator or amputation due to disease?

Yes

No

Hospital Indemnity - Underwriting Questions