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Preferred Checklist Questions

Preferred Checklist Questions

Paramedical exams, if required, will be arranged by AFBA at no additional cost. In most cases, exams may be performed in the privacy of your home or office. All applicants requesting Ultra-Preferred or Preferred pricing will require a paramedical exam regardless of age or coverage amount.

For Standard contribution applicants residing overseas only, AFBA may accept a copy of a complete military physical less than twelve (12) months old, provided it includes blood lipids (long physical with bloodwork/SF88 & SF93 or equivalents). Additional information may be required at the discretion of AFBA and its underwriter.

	Complete Statement of Health (SOH)

	Complete Statement of Health (SOH), Paramedical Exam, Blood Profile and Urinalysis

	Complete (SOH), Paramedical Exam, Blood Profile, Urinalysis and Resting EKG

If applying for Preferred pricing, these questions will be asked during the medical interview. These questions are only one factor considered in making a determination of eligibility for a preferred price class. All applicants seeking a preferred price class will be subject to a paramedical exam, including blood and urine samples. A final decision regarding the price class will be based on our underwriting guidelines and experience.

In the past 24 months, have you used any tobacco products, nicotine gum, nicotine patch, nicotine nasal spray, or similar nicotine-containing products?
Have you been treated for or been advised to have treatment for the use of drugs or alcohol?
Do you have a record of conviction for driving while intoxicated (DWI) or driving under the influence of alcohol (DUI) in the last 10 years, or for any moving violations in the last 5 years? (If "yes," list all incidents below, giving the month, year, and offense.)
Have you been treated for or been advised to have treatment for any of the following:
1. Blood pressure?
2. Cholesterol?
3. Heart disease?
4. Diabetes?
5. Any cardiovascular disease?
6. Cancer (excluding non-melanoma skin cancer)?
Do you engage in any of the following hazardous activities: aviation; parachuting; hang-gliding; ultralighting; ballooning; gliding; space travel; SCUBA diving below 60 feet; cave, air-supplied or salvage diving; white water rafting or kayaking; auto, motorcycle or motorboat racing or stunting; rock or mountain climbing; bungee jumping? (If "yes," describe below, giving your level of expertise, frequency of participation, and level of risk. For aviation activities, give purpose of flights, crew position, type of aircraft, and number of hours flown yearly. Do not include flight in regularly scheduled commercial aircraft or any activities performed only pursuant to military, police, fire, or EMS duty.)
Did either parent die of a heart attack (i.e., myocardial infarction, coronary artery disease) or congestive heart failure before age 60, to the best of your knowledge?
If 5Star Life is unable to offer you the price class you applied for, will you accept another price class for an additional cost?

$100,000

$101,000 -
$150,000

$151,000 -
$200,000

$201,000 -
$250,000

$251,000 -
$300,000

$301,000 -
$500,000