Pre-determine your Health Option before completing the application

To receive the rates for the Health Option you and/or your spouse qualify for, you and/or your spouse must complete the Health Option Questionnaire on the application form (see "Sign Me Up").

The health option and rates you qualify for is based on your answers to the Health Option Questionnaire. To pre-determine the Health Option you would qualify for, please review the following questions:

Optimum Health Option  
 1.   Have you EVER in your lifetime been diagnosed with, or have you taken medication or been prescribed medication or received treatment for ANY of the following:  Yes   No 
    a)   heart condition,
    b)   lung condition (except an acute infection not requiring ongoing physician care or medication),
    c)   high/low blood pressure,
    d)   diabetes,
    e)   stroke,
    f)   mini-stroke (TIA or transient ischemic attack),
    g)   peripheral vascular disease,
    h)   liver disorder,
    i)   kidney failure,
    j)   gastrointestinal bleeding, or
    k)   cancer (except basal cell and squamous cell skin cancer)
 2.   In the past 60 months (5 years) have you used any tobacco product?
 3.   Was your last regular check-up with a physician or with a licensed nurse practitioner more than 18-months ago?
  • For questions 1 to 3, if you have answered YES in ANY box above, you do not qualify for the Optimum Health Option and must complete questions 4 to 6.
  • If you have answered NO in ALL boxes above, you qualify for the Optimum Health Option.
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Preferred Health Option  
 4.   Have you ever in your lifetime taken medication, or been prescribed medication or received treatment for a heart condition?  Yes 
  No 
 5.   Are you currently taking or been prescribed medication for diabetes and/or blood pressure, either to control or prevent diabetes and/or high/low blood pressure?
 6.   In the past 12 months have you been diagnosed with or have you taken medication or been prescribed medication or received treatment for ANY of the following:    
    a)   lung condition (except an acute infection not requiring hospitalization, ongoing physician care or ongoing medication)
    b)   stroke,
    c)   mini-stroke (TIA or transient ischemic attack),
    d)   peripheral vascular disease,
    e)   liver disorder,
    f)   kidney failure,
    g)   gastrointestinal bleeding, or
    h)   cancer (except basal cell and squamous cell skin cancer)?
For questions 4 to 6, have you checked:
  • NO in ALL boxes? You qualify for Preferred Health Option.
  • YES in ANY box? You qualify for Standard Health Option.
To receive the rates for the Health Option you and/or your spouse qualify for, you and/or your spouse must complete the Health Option Questionnaire on the application form (see "Sign Me Up").
Click here to
apply now