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Critical Illness Insurance
Eligibility Test

Are You Eligible For Critical Illness Insurance?

Take The Eligibility Test And Find Out!

Critical Illness (C.I.) Insurance applications are assessed differently than Life Insurance applications.

Life Insurance statistical records have been in existence for over 300 years. C.I. Insurance was just invented in 1982. C.I. claims statistics and underwriting experiences are still evolving. Benefits are paid based upon the diagnosis of any one of a number of covered conditions, regardless of severity, degree of disability or ability to work. Benefits are paid in a lump sum, tax free, usually 30 days after confirmation of the diagnosis.

This 10 point pre-screening exercise will help determine if you are eligible for a personal C.I. Insurance policy. The exercise analyzes the following factors:

Age , Gender and Smoking status
Build (Height and Weight)
Present Health Vitals
Personal Health History
Family Health History
Lifestyle (Occupation / Sports & Hobbies)
Driving Record
Alcohol use
Drug use
Travel destinations

Let's start Eligibility Test

Age, Gender and Smoking Status:

Longevity continues to increase due in part to healthier lifestyles, pharmacological advances, medical breakthroughs, public awareness and medical care. Women tend to live longer than men and any one under age 50 today has a 25% likelihood of celebrating their 90th birthday.

Smoking has proven harmful to one’s health and a 50 year study by physicians has linked 25 diseases to smoking. In fact, longevity amongst smokers has actually been declining since the 1970’s.

You present age, gender and smoking status help predict how long you might live and the longer one lives the greater the possibility of suffering a critical illness. Your smoking status will indicate whether you are at an increased risk for certain illnesses.

Build (Height and Weight):

Present Health Vitals:

Blood Pressure:

Uncontrolled hypertension or high blood pressure can lead to serious health problems or even death. High Blood Pressure often goes untreated because many individuals, estimates are over 25%, aren’t even aware they have it. High blood pressure can arise from various conditions such as heart enlargement, circulatory disorders, diabetes, elevated lipids, family history, being overweight, proteinuria or tobacco usage.

Personal Health History:

Your health history is important when assessing a critical illness insurance application.

Family Health History:

Family history is an important predictive factor for incidences of cancer and cardiovascular diseases. Assessment of the family history risk will vary based on: (1.) the number of affected first-degree relatives; (2.) their age at diagnosis (not at death); (3.) the current age of the applicant; and (4.) sometimes the sex of the applicant. The nature of the diseases involved and its frequency among family members and the age of onset are all important.

Lifestyle:

Driving Record:

Alcohol Use:

Drug Use:

Travel Destinations:

Thank you for taking the Eligibility Test. Although this exercise may not have considered all circumstances or factors that apply to you it would appear from these results that you would be:


	?

Enter your age, gender and smoking status below:

Age	Male	Female
Nonsmoker	Smoker	Maximum issue Age is 65

Enter your height and weight below:

How tall are you in: Feet Inches
Enter your weight: Lbs.
What Does It Mean?
Your Body Mass Index (BMI) is:

Indicate below which answer best describes you:

1. Normal blood pressure readings, checked regularly.
2. High blood pressure under control with medication.
3. High blood pressure, unstable and not under control.
4. Don’t know my blood pressure, not checked for years.

Indicate either Yes or No, if you have every suffered from or been diagnosed with any of the following:

Active Hepatitis
AIDS or AIDS related diseases
Down’s Syndrome
Cystic Fibrosis
Cerebral Palsy
Lupus
Huntington’s Chorea
Sickle Cell Disease
Hemophilia
Muscular Dystrophy
Severe Epilepsy
Diabetes - Insulin Dependent
Attempted Suicide within last 3 years
Any typical covered conditions of a C.I.I. Policy

YES NO

First-degree relatives (FDR) are: Mother, Father, Brothers and Sisters.

There are 5 parts to the Family Health History section, which are:

Cardiovascular and cerebrovascular problems
Neurological problems
Breast Cancer
Colorectal Cancer
Other Cancers

FDR = First Degree Relative (Mother, Father, Brothers, Sisters)

(A) Cardiovascular and cerebrovascular problems:

Indicate below which answer best describes your family’s history:
Only count cases of FDR diagnosed before age 60.

1. 2 with Heart Attacks or Heart Disease (cardiovascular).
2. 2 with Strokes (cerebrovascular).
3. 3 or more with cardiovascular or cerebrovascular problem.
4. None of the above.

(B) Neurological problems:

Indicate below which answer best describes your family’s history:
Only count FDR diagnosed cases.

1. 2 or more with Alzheimer’s Disease before age 70.
2. 2 or more with Parkinson’s Disease before age 60.
3. 2 or more with Multiple Sclerosis before age 45.
4. 2 or more with ALS (Lou Gerhig’s Disease).
5. None of the above.

(C) Breast Cancer:

Indicate below which answer best describes your family’s history:
Only count FDR diagnosed cases.

1. 2 with Breast Cancer before age 60.
2. 3 or more with Breast Cancer before age 60.
3. None of the above.

(D) Colorectal Cancer:

Indicate below which answer best describes your family’s history:
Only count FDR diagnosed cases.

1. 2 with Colorectal Cancer before age 60.
2. 3 or more with Colorectal Cancer before age 60.
3. None of the above.

(E) Other Cancers:

Other Cancers refers to any and all types of Cancer other than Breast Cancer or Colorectal Cancer.

Indicate below which answer best describes your family’s history:

1. 2 with Cancer before age 60.
2. 3 or more with Cancer before age 60.
3. None of the above.

(A) Occupation:

Most occupations are eligible for standard Critical Illness Insurance coverage. Applicants whose occupations expose them to a higher risk of injury or unusual health risk factors may be declined or have restrictions imposed.

Indicate below which answer best describes your occupation:

1. Handle hazardous chemicals or explosives.
2. In active military services.
3. Involved in mining or commercial construction.
4. None of the above.

(B) Sports & Hobbies:

Many sports can present a higher risk of injury or death and therefore an increased likelihood of suffering a critical condition. Such sports, when acceptable, will be subject to restrictions or surcharges.

Indicate below which answer best describes your sports & hobbies:

1. Motor vehicle racing
2. Sky diving
3. Bungee jumping
4. Hang gliding
5. Mountain or Rock climbing
6. Scuba diving
7. Boxing / Kick Boxing
8. None of the above.

Reckless driving or abuse of driving privileges are highly linked to death and disability and therefore increase the likelihood of one suffering a critical condition. Such conditions associated with poor driving records are loss of limbs, paralysis, coma, blindness and severe burns.

Indicate below which answer best describes your driving record:

1. No accidents or speeding violations in the past 3 years
2. 1-3 speeding violations or accidents in the past 3 years
3. More than 3 speeding violations in the past 3 years
4. License suspended for dangerous driving in past 5 years
5. Charged or convicted of being intoxicated in the past 5 years

Alcohol abuse can result in organ damage to the heart, lungs, kidneys, brain and liver, thus creating an extreme risk for Critical Illness Insurance Coverage.

Drinking moderately may actually be good for you; however,excessive drinking leads to vehicle accidents and numerous diseases. Responsible drinking consumption is 2 drinks per day for males and 1 for females.

Indicate below which answer best describes your drinking habits:

1. Don’t drink and never have
2. Have 3-4 drinks per day
3. Have more than 21 drinks per week
4. None of the above

Drug abuse can result in organ damage to the heart, lungs, kidneys, brain and liver. All too often use of illegal drugs leads to criminal activity. Drug addiction can be life threatening and financially devastating.

If you are using hard drugs such as crack cocaine or heroin you can forget about your eligibility status right now.

Indicate below which answer best describes your drug habits:

1. Never use recreational drugs
2. Experimented with recreational drugs over 10 years ago
3. Use recreational drugs on a regular basis

Today, more than at any other time travel itineraries outlining planned destinations and lengths of visits are being examined to see if applicants might be placing themselves at greater than normal risk.

Travel can increase the risk of being exposed to exotic diseases as well as injury or terrorist acts. Any of which could cause serious illness.

Depending on whether your travel is for business or pleasure; to remote areas or urban centres; how long your visit is; and country involved are all taken into consideration when assessing a critical illness insurance application.

Indicate below your travel destinations:

1. North America only
2. Europe only
3. Any other destination will be given individual consideration (please indicate below)

Planned Destination
Number of weeks