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Sample Health Questions

United American features simplified underwriting on applications with “Yes/No” health questions. Sample questions from a standard Medicare Supplement application are shown below. This sample does not constitute the entire application. Questions may vary by state and are subject to change.

  1. Are you currently hospitalized, confined to a nursing facility or receiving Medicare approved home health care, or have you been hospitalized or received Medicare approved home health care 2 or more times in the past 12 months?
  2. Do you have emphysema, Chronic Obstructive Pulmonary Disease (COPD), or pulmonary fibrosis?
  3. Are you bedridden or do you use a wheelchair for any daily activity, or have you been diagnosed with Gaucher’s Disease or any other type of lysosomal storage disorder, or have you had any type of amputation caused by disease?
  4. Have you been advised that surgery may be required within the next twelve months for cataracts?
  5. Have you been diagnosed or treated for Parkinson’s disease, Multiple or Lateral Sclerosis, Alzheimer’s disease, senile dementia, or organic brain disorder?
  6. Have you been treated, diagnosed or tested positive as having Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) or ever tested positive for antibodies for the AIDS (HIV) virus?
  7. Do you have diabetes requiring more than 50 units of insulin daily?
  8. Within the past 2 years, have you been diagnosed or treated for internal cancer, melanoma, leukemia, alcoholism or drug abuse, cirrhosis, mental or nervous disorder requiring psychiatric care, or have you been advised to have kidney dialysis?
  9. Within the past 2 years, have you been diagnosed or treated for heart attack, peripheral vascular disease, congestive heart failure, heart valve disorder, stroke, or transient ischemic attacks (TIA)?
  10. Within the past 2 years, have you been diagnosed or treated for rheumatoid arthritis or crippling arthritis?
  11. Within the past year, have you been fed intravenously or through a tube, have you been medically advised to have surgery for joint replacement or for a heart condition, but not had such surgery, or have you been advised to have other surgery that has not been performed?