MediGap Plans in NY,NJ,OH,FL,VA,MD

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Quotes only available in NY,NJ,MD,FL,OH,VA

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Have you used tobacco products in the past year? Yes No

Do you currently have a MediGap Policy? Yes No

Has the applicant lived in the US for less than 1 year? Yes No

Does the applicant have high blood pressure? Yes No

Have you been diagnosed with: Cirrhosis; Hemophilia; Multiple Sclerosis; Leukemia: Amputations Due to Diabetes? * : Yes No

Have you been diagnosed with: Renal Dialysis; Kidney Dialysis; X-Ray Therapy; Radium or Chemotherapy; Degenerative (Crippling) Arthritis; Internal Cancer; Stroke? * : Yes No

Have you been diagnosed with: Emphysema (under treatment); Hodgkins Disease; Disease or Disorder of Lungs or Respiratory Systems which requires the outsideassistance of a Mechanical Breathing Device? * : Yes No

Have you been diagnosed with: Heart Attack; Angina; Transient Ischemic Attach (TIA); Heart Failure; Heart Surgery; Angioplasty or Coronary by-pass Surgery? * : Yes No

Have you been diagnosed with: Parkinson's Disease; Alzheimer's Disease; Senile Dementia; Organic Brain Disease or other Senility Disorders? * : Yes No

Have you been confined to a nursing home or a wheelchair within the past 2 years or has such care been medically advised? * : Yes No

Are you currently hospitalized, or receiving Medicare approved home health care; or have you been hospitalized or received Medicare approved home health care three or more times in the past 2 years? * : Yes No

Within the past year have you been advised to have surgery but not had such surgery? * : Yes No

Within the past 5 years, have you been diagnosed by a member of the medical profession as having any disease or disorder of the immune system, AIDS Related Complex (ARC), or have you tested positive for the HIV infection? * : Yes No

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