You NeedTo Answer An Assessment Questionnaire

Do you already have medical coverage?
If so, are you happy with it? If not, a broker should try to identify what’s not working — it’ll help you see what gaps need to be filled.

Have you gone through a Qualifying Life Event (QLE)?
A QLE is any big life change that can open up new options for health coverage outside of the usual Open Enrollment Period. Some common examples include:

• Family changes: Getting married, divorced, having a baby, adopting, gaining a foster child, legal separation, or losing a spouse or dependent.
   
• Moving: Changing ZIP codes, counties, or even a student moving to or from campus.
   
• Loss of other coverage: Losing job-based or student health plans, or losing eligibility for Medicare, Medicaid, or CHIP.
   
• Income changes: A change that affects the coverage they qualify for, especially if household income drops below certain thresholds.
   

What’s your budget?
Understanding your budget upfront helps you and your broker find options you can realistically afford. Additionally, do you qualify for subsidies or assistance programs that can help reduce your monthly costs? For example, an ACA "Marketplacce Plan"

Do you have favorite doctors, specialists, or hospitals?
Many plans have provider networks, so knowing who you want to keep seeing will make it easier to choose plans that include those providers.

Any specific health services they rely on?
For individual clients, do you need ongoing or unique medical care. For businesses, think about the types of care your employees might need most.

Could you or your dependents need maternity or specialty care down the road?
Planning ahead for things like maternity services or specialized treatments will help narrow down the best plans for your situation.

How often do you usually go to the doctor?
If you visit frequently, it might be worth choosing a plan with lower copays or broader provider access.

Are your dependents in need of coverage?
Ensure that you determine if your family members or other dependents need to be included in the plan. Also, keep in mind that the size and demographics of the family can significantly influence the choice of coverage, especially if you or your dependents require frequent medical care.

How comfortable are you with health insurance terms and processes?
Determine how well you comprehend the workings of health insurance. This will help you assess how much guidance you may need to feel confident about your potential plan and its benefits. You may need to consult a broker.

What is your employment situation and income to earn a living?
Keeping in mind your employment status is important because some plans aren’t available to everyone. Your answer can help you figure out what other plan options might work best for you.

Would you be open to sharing your personal health and consumer insights data?
Some plans offer lower monthly contributions if you are willing to share certain health or lifestyle information. Your comfort level with this can help you decide which plans to consider.

Does you, or anyone you live with — like your spouse, partner, or kids — have any conditions they’re getting treated for now, or expect to treat in the next year? 

1. Organ failure that might mean needing a bone marrow or organ transplant.
    
2. A genetic condition that needs special cell or gene therapy.
    
3. Cancer that will need chemo, radiation, bone marrow treatment, or cell therapy.
    
4. Kidney failure that requires regular dialysis.
    
5. A high-risk pregnancy or expecting multiple babies (like twins or triplets).
    
6. Hemophilia or any other condition that affects blood clotting.
    

Disclaimer: If you, your spouse, or any dependents answer “yes” to any of these questions, they will not be eligible for coverage.

Health Disclosures: Please answer the following Y/N

Please answer the following questions for yourself, your spouse, and any dependents included in the application for coverage. NOTE: Dependent children are covered until the end of the month in which they turn 26. Domestic partners are not eligible for coverage— only legal spouses qualify..

1. Have you or any of your dependents been under a doctor's care currently or within the past five years for any of the following conditions: cancer, heart disease (including bypass), heart attack, heart surgery, or stroke?

2. Have you or any of your dependents applying for coverage been home-bound, incapacitated, or incapable of self-support due to a medical condition within the past five years?

3. Have you or any of your dependents applying for coverage been under a doctor's care currently or within the past five years for an autoimmune or blood disease (e.g., lupus, MS, anemia, AIDS, HIV, hemophilia, IBS, or Crohn's)?

4. Have you or any of your dependents been under a doctor's care currently or within the past five years, for organ failure or an organ transplant involving the kidney, liver, lung, or heart, or for any form of organ support (e.g., dialysis)?

5. Are you or any of your dependents dependents applying for coverage currently pregnant or expecting?

6. Have you or any of your dependents currently receiving treatment for a condition that required hospitalization within the past five years?

7. Have you or any of your dependen been under a doctor's care currently or

within the past five years for a respiratory disorder, such as emphysema, chronic bronchitis, COPD, or chronic pneumonia?

8. Has the prospective client or any of his/her dependents seeking coverage been under a doctor's care

currently or within the past five years for a musculoskeletal disorder, such as back disorders, muscula

dystrophy, cerebral palsy, dermatomyositis, compartment syndrome, sciatica, or osteoporosis?

9. Has the prospective client or any of his/her dependents seeking coverage been under a doctor's care

currently or within the past five years for alcohol or substance abuse or dependency?

10. Has the prospective client or any of his/her dependents seeking coverage been under a doctor's

care currently or within the past five years for Type 1 diabetes, required insulin on a semi-regular or

regular basis, or been under the care of a healthcare professional for any diabetes-related conditions?

11. Has the prospective client or any of his/her dependents seeking coverage been under a doctor's

care currently or within the past five years for a previous major surgery, or have an upcoming planned

surgery?