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{
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{
"title": "30-Month Income Protection Rider",
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{
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{
"title": "Outpatient Prescription Drug Rider",
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{
"title": "Accept/Reject Medical Questions",
"items": [
{
"title": "Is any applicant currently confined to a hospital, psychiatric, nursing, long term care facility or been told by a licensed medical doctor that the applicant has less than 12 months to live?"
},
{
"title": "Within the last 12 months, has any applicant:",
"items": [
"Been hospitalized for four or more days, confined to a nursing facility, been bedridden for five or more days, used a hospital bed, used a wheelchair or used any kind of oxygen equipment?"
]
},
{
"title": "Within the last 5 years has any applicant been medically diagnosed, hospitalized, or treated for:",
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"Diabetes with complications such as high blood pressure, amputations, Macular degeneration, Retinitis pigmentosa or neuropathy?",
"Heart disease, myocardial infarction (heart attack), Angina Pectoris, Valvular disease, Aneurysm, Atrial fibrillation, Peripheral vascular disease, transient ischemic attack (TIA), Stroke, or Congestive Heart Failure angina pectoris, arteriosclerosis, sickle cell anemia, hemophilia, or treated but uncontrolled high blood pressure? Any coagulation disease such as deep venous thrombosis pulmonary embolism?",
"Chronic respiratory disease (COPD) Emphysema or Chronic bronchitis?",
"Liver disorder, Liver cirrhosis, Pancreatic disorder, chronic kidney disease or failure, Kidney dialysis, Ulcerative colitis, Crohn\u2019s disease or had or in need of an Organ Transplant?",
"Cancer, except (non-melanoma) skin cancer, abnormal mass, or tumor. Parkinson\u2019s disease, Alzheimer\u2019s disease, dementia, Memory loss that requires medication, mental disorders, AIDS or ARC (AIDS related complex)?",
"Multiple sclerosis, ALS (Amyotrophic lateral sclerosis) Lou Gehrig\u2019s disease, systemic lupus, Muscular dystrophy, Fibromyalgia, rheumatoid arthritis, or Cystic fibrosis?",
"Neurological or autoimmune disease such as epilepsy, M\u00e9ni\u00e8re\u2019s disease, multiple sclerosis, Parkinson\u2019s disease, Huntington\u2019s disease, Down\u2019s Syndrome, Schizophrenia, Bipolar, alcohol abuse, drug dependency or abuse, alcoholism?"
]
},
{
"title": "Has any applicant ever been advised to have a surgical procedure or diagnostic testing which has not been done, or is any applicant currently pregnant?"
}
]
}
]
}You are not eligible for this plan. If you have questions, please call 601.555.5555.
Restart Enrollment