Medical Declaration
All applicants of age 40 to 85 on the effective date are required to complete the medical declaration for the Enhanced Plan.
Please answer the following yes/no questions:
1. Have you had heart bypass or valve surgery more than ten (10) years ago?
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2. Do you have BOTH diabetes (for which you require the use of medication) AND a heart condition?
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3. Have you ever received an organ transplant?
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4. In the past 2 years, have you:
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- been prescribed or taken Lasix or furosemide for any condition; and/or
- had congestive heart failure; and/or
- required treatment with oxygen or prednisone (or other oral steroid medication, not including puffers) for a lung condition?
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5. In the past 12 months, have you:
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- started treatment for and/or been diagnosed with a heart attack; stroke; transient ischemic attack (TIA); mini-stroke; or internal bleeding; and/or
- been diagnosed with cancer, or received chemotherapy or radiotherapy or any other treatment of cancer; and/or
- been hospitalized for 24 hours or more for a gastrointestinal disease or disorder?
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