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Health Insurance Refused Because I Take Statins.


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On 7/18/2024 at 7:34 PM, Jumbo1968 said:

I recently applied for Health Insurance, aged 72 with a company whose name is what you use for chopping firewood, I don’t want to mention their name. I have been taking 20mg statins for 2 years, my cholesterol was around 6 now around 4 after taking the statins.

Their reply was, I don’t have heart disease. I thought they would refuse me because I had Prostate Cancer but was discharged in 2017.

 

The company will not pay benefits for investigations and treatment related to

- Hyperlipidaemia & associated conditions . By this we mean ischaemic heart disease stroke and cardiac

arrhythmias.

 

I don’t have heart disease. I thought they would refuse me because I had Prostate Cancer but was discharged in 2017 after radiotherapy, do they refuse insurance to everyone on statins then ?

 

I applied for health insurance a couple years after heart surgery.  Fresh policy with no age cutoff included a 5-year moratorium on cardiac-related issues, which has since been removed.

 

Just spend some time, keep looking.  Might take a good part of a year.  If you give up as early as March, you might miss it.

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2 hours ago, Baht Simpson said:

Do they take account of family history, say, of heart disease or genetic problems? 

Not usually.

 

A known genetic condition suffered by the insurance applicant of course would be a consideration. 

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1 hour ago, Jumbo1968 said:

If you have a heart attack or a stroke some thing has caused it, it’s not a natural occurrence so any insurance company could say it was caused by pre existing conditions and wouldn’t pay out.

Pre existing means already known (or could  reasonably been known) at the time the policy was issued.

 

Insurance companies usually do pay out for heart attacks and strokes, and when they don't it is usually because of a clearcut condition known present before policy took effect. 

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Posted (edited)
20 minutes ago, Sheryl said:

Pre existing means already known (or could  reasonably been known) at the time the policy was issued.

 

Insurance companies usually do pay out for heart attacks and strokes, and when they don't it is usually because of a clearcut condition known present before policy took effect. 

If you have high blood pressure or high cholesterol and you weren’t aware of it and it caused a heart attack would the insurance company pay out as it’s ‘self inflicted’ ? Heart attacks and strokes occur for a reason they are not a natural occurrence. I take statins not because my heart is unhealthy but can prevent me from a heart attack. My cholesterol with statins is 4.5 and 6 with out taking statins which isn’t unnaturally high. My doctor advised it was up to me to take statins as my cholesterol wasn’t dangerously high.

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7 minutes ago, Jumbo1968 said:

If you have high blood pressure

 

Remember how they love taking blood pressure in hospitals here even if you have to take allergy test or have your zits popped?

 

White coat, walk in heat, hot nurse effect....

Do insurance companies have access to this? 

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11 hours ago, Kalasin Jo said:

About right. When I practiced as a defence civil litigation lawyer, acting for the insurers of those being sued, a part of my practice involved detailed study of policy terms and conditions to advise on whether any of said T&C's especially exclusion clauses allowed them to decline cover.

Fascinating!

I took out travel insurance earlier this year and studied the policy ,took me days 

I even posted excerpts from the policy's,not that these "academics" on here were interested 

But yes very very fascinating 

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On 7/18/2024 at 2:34 PM, Jumbo1968 said:

I recently applied for Health Insurance, aged 72 with a company whose name is what you use for chopping firewood, I don’t want to mention their name. I have been taking 20mg statins for 2 years, my cholesterol was around 6 now around 4 after taking the statins.

Their reply was, I don’t have heart disease. I thought they would refuse me because I had Prostate Cancer but was discharged in 2017.

 

The company will not pay benefits for investigations and treatment related to

- Hyperlipidaemia & associated conditions . By this we mean ischaemic heart disease stroke and cardiac

arrhythmias.

 

I don’t have heart disease. I thought they would refuse me because I had Prostate Cancer but was discharged in 2017 after radiotherapy, do they refuse insurance to everyone on statins then ?

Statins will kill you before anything else will. Just stop it! It is all due to many doctors lack of knowledge on the matter. Cholesterol do NOT lead to heart failure/disease! That is a lie!

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2 hours ago, harryviking said:

Statins will kill you before anything else will. Just stop it! It is all due to many doctors lack of knowledge on the matter. Cholesterol do NOT lead to heart failure/disease! That is a lie!

 

Bingo.. !!!      Most doctors still follow the  "Kellogs"  bought and paid for propaganda research 

 it makes big pharma lots of $$$$$$$$$$$       change your diet ! 

 Quality protein ( RED meat ...  BEEF  ) and plenty of saturated fats  ... stay away from carbs, processed foods, seed oils and usless fiber.    

  The info is out there ..    

 

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Many of the comments are written from a biased perspective and incorrect assumptions. An insurance policy is a risk transfer contract. You, the insured are asking a third party to assume the financial liability for expenses arising from circumstances or events as set out in the contract. The intent is to transfer the sudden and accidental losses of a few amongst the many. The third party accepting the risk sets a cost for that assumption of the risk. It includes the medical costs associated with the covered events, claims management, selling and administration expenses. Loss ratios for Asian health insurers typically range from 80-85%. That does not leave the excessive profits some of the comments claim. It also means that contrary to the comments made, the insurers are paying claims.

 

Why is there an expectation that  the insurer should take on a high risk at a cost that does not cover that assumed risk?   If you believe that your risk is so low, keep the risk. Don’t expect another party to subsidize your healthcare. 

 

The core clauses of a health insurance policy are similar. Where they differ is on the extensions, the deductibles, and treatment of pre-existing conditions.  The actuarial tables used by insurers are similar and they know which age groups are likely to experience health crises, and which health conditions will result in expensive medical costs. Some insurers  invest more in their actuarial analysis.  If an insurer is excluding  cardiac and circulatory events for some people it is because the  actuarial results show that the X% of people who have certain characteristics will incur X amount of losses. Some insurers will provide coverage if there is a stability of the condition, i.e. 6 or 12 months.

 

Read the policy wording. It is your obligation to read the contract and to know what you are agreeing to. If you don't read the contract and then have a problem  because you claim you did not know, that's your responsibility. 

17 hours ago, Jumbo1968 said:

I ask them if they would pay out if a person needed treatment for,

Hyperlipidaemia & associated conditions . By this we mean ischaemic heart disease stroke and cardiac arrhythmias.who was not on statins would they pay out, no they would not, what’s the point of having insurance then ?

 

If you are hit by a car or fall down and suffer a critical brain injury or if have food poisoning and subsequent kidney damage, there would be coverage. If you develop colon cancer or an eye disease, or have parasites all needing treatment, you would have coverage.  You have a serious health condition related to your lipid levels and cannot expect an insurer to cover that existing medical problem. However there are 1001+ other ailments that you can have that benefit from having the coverage.

 

16 hours ago, The Fugitive said:

Absolutely. I emailed Cigna Global requesting they attach a sample of their Health Questionnaire. Their answer was that the questionnaire is completed over the 'phone and only takes a few minutes!

A questionnaire forms part of the insurance policy. The questionnaire might be completed on the phone for the purposes of an estimate, but you would still be required to complete a more detailed form, sign and submit that form. Coverage would only be  granted upon acceptance of the complete underwriting questionnaire.

 

16 hours ago, Kalasin Jo said:

About right. When I practiced as a defence civil litigation lawyer, acting for the insurers of those being sued, a part of my practice involved detailed study of policy terms and conditions to advise on whether any of said T&C's especially exclusion clauses allowed them to decline cover.

That is not how claims are managed. When there are contestable claims, a reservation of rights letter is first issued, stating where coverage is available and what is payable. If there is a basis for denying all or part of a claim, the relevant sections are cited. Insurers have their own in house legal counsels and paralegals who draft these letters. The burden of proof is on the insurer to show why a claim is not payable. If an insurer cites sections of a policy that excludes coverage, an claimant just responds with an explanation or with documentation  countering that position. An insurer has an obligation to protect the best interests of its shareholders and other policy holders by responsibly managing claims.

 

15 hours ago, brewsterbudgen said:

My policy document states clearly the medication I take for mild hypertension and cholesterol.  I've assumed that a related problem (heart attack, stroke) would mean I'm covered.  Maybe I have too much faith!

Read the sections that apply for pre-existing conditions, and for conditions deemed stable.  If you have  doubts, ask  the specific question in writing and request a written response.

 

13 hours ago, Jumbo1968 said:

Being the ever pessimist the broker will say yes but he is not the insurance company who decide wether a claim is met or not.

The broker is not the claim adjuster and does not control the  grant of coverage. Only the insurer has that power. When in doubt, as for an opinion from the insurer claims manager.

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Posted (edited)
6 hours ago, Sheryl said:

 

Actually both heart attacks and strokes can be the natural result of aging.

 

And neither ius considered a slef-inflicted injury. That e=termionology has a very narrow and specific meaning.

 

Heart attacks and strokes  can also occur due to cardiovascular disease, for which dyslipedemias and hypertension are risk factors.  Not immediate direct causes, but risk factors.

 

Unless you failed to declare a known pre-existing condition, a health insurer under a full underwriting policy is obligated to cover it. And indeed, these things are usually paid for. Ditto cancers and many other things that, by their nature, take years to develop. 

 

I have age-related spinal problems. These will have been brewing for a long time, probably decades, but the first I knew of it was when it became painful, about 1-2 years after taking out my s=current health insurance. One does not, after all, have spinal MRIs , or even spinal Xrays, without a reasion and until then I'd had no reason. But for sure, the problem that then showed, took many, many years to develop.

 

A non-issue insurance wise. I'd not been previously diagnosed with it so not a pre-existing condition. Insuance paid in full.

 

 

"Cholesterol" per se is not meaningful. What exactly do you refer to? Cholesterol ratio? LDL? or what?

My last blood test, I take 20mg statins 1 a day.
image.jpeg.3845798d13e240ea5d08898f83d3cd3f.jpeg

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6 hours ago, harryviking said:

Statins will kill you before anything else will. Just stop it! It is all due to many doctors lack of knowledge on the matter. Cholesterol do NOT lead to heart failure/disease! That is a lie!

Why would I believe what you say, rather then my specialist doctor?  

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11 hours ago, Jumbo1968 said:

If you have high blood pressure or high cholesterol and you weren’t aware of it and it caused a heart attack would the insurance company pay out as it’s ‘self inflicted’ ? Heart attacks and strokes occur for a reason they are not a natural occurrence. I take statins not because my heart is unhealthy but can prevent me from a heart attack. My cholesterol with statins is 4.5 and 6 with out taking statins which isn’t unnaturally high. My doctor advised it was up to me to take statins as my cholesterol wasn’t dangerously high.

A friend, neighbour and self-employed plumber and central heating engineer went for his annual medical. Doctor told him; ‘I’d like to fit a stent. You are not at risk and might never be. However, certain places can become blocked and I believe in prevention rather than cure’. My friend agreed. He declared this to his health insurance company. His premiums tripled. 

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1 hour ago, brewsterbudgen said:
7 hours ago, harryviking said:

Statins will kill you before anything else will. Just stop it! It is all due to many doctors lack of knowledge on the matter. Cholesterol do NOT lead to heart failure/disease! That is a lie!

Why would I believe what you say, rather then my specialist doctor?  

Because he saw it on YouTube where all the best doctors post only the truth.

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4 hours ago, Patong2021 said:

A questionnaire forms part of the insurance policy. The questionnaire might be completed on the phone for the purposes of an estimate, but you would still be required to complete a more detailed form, sign and submit that form. Coverage would only be granted upon acceptance of the complete underwriting questionnaire.

Not the case with Cigna Global. Immediately after you have answered their questions via telephone your application is referred to their underwriting team who confirm within a minute if your application has been successful and, if so, whether any exclusions apply. Another member has reported and kindly supplied screenshots in the last week to confirm that, after making his first payment, his policy documentation arrived clearly stating the commencement date and 'No exclusions'.

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30 minutes ago, georgegeorgia said:

How long do you think you have ?

 

When it's my time it's my time. Not going to fret about it either way.

 

I think most of the people afraid of death are religious. Most religions are based on threats and fears. “Do this or you'll suffer forever in hell', etc. Thankfully I'm an atheist that doesn't believe any of that nonsense, so death doesn't scare me.

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21 hours ago, Kalasin Jo said:

About right. When I practiced as a defence civil litigation lawyer, acting for the insurers of those being sued, a part of my practice involved detailed study of policy terms and conditions to advise on whether any of said T&C's especially exclusion clauses allowed them to decline cover.

Hello Jo, quick question please, I have VITILIGO ( loss of skin pigment ) for which there appears to be very little information regarding the causes and in so far as I am aware no ongoing research into it because it is not life threatening, however it is wide spread in all races and the medical profession for the sake of medical expediency log it down as reduced immunity, at 78 years old I am not taking any medication for anything nor have I ever been put on meds, so without holding you to any answer you may give may I ask if i should notify my health insurer?

Thank you in advance

jimjim

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1 hour ago, The Fugitive said:

Not the case with Cigna Global. Immediately after you have answered their questions via telephone your application is referred to their underwriting team who confirm within a minute if your application has been successful and, if so, whether any exclusions apply. Another member has reported and kindly supplied screenshots in the last week to confirm that, after making his first payment, his policy documentation arrived clearly stating the commencement date and 'No exclusions'.

Your attention is directed to the Cigna Global Health website that provides the health insurance portal for Thailand.

Health insurance quotes are issued with the following disclaimer;

 

The Current Quote price shown above is based only on the information you have currently provided and benefits you have selected. If you proceed, you will be required to complete a medical questionnaire for yourself and all other persons to be covered by this policy. Cover will be considered by our medical underwriting team and shall be subject to the policy terms and conditions.

 

The CIGNA health questionnaire contains the following warranty;

DECLARATION FOR ALL CUSTOMERS

I hereby declare that I have taken reasonable care to answer all questions accurately, honestly and completely. I acknowledge that if I do not answer all questions accurately and completely as a result of my carelessness or as a result of deliberate or reckless misrepresentation, Cigna Healthcare may reject claims, and/or cancel cover as per the terms and conditions of this policy. The duty to answer our questions accurately, honestly and completely applies in respect of each person who is covered by this policy. Although failure to fulfil this duty by one covered person may affect coverage or payment of their claims, it will not affect coverage or payment of claims in relation to any other covered person, unless that person has also made careless, deliberate or reckless misrepresentations in relation to our questions. I warrant and represent that I have each covered person’s consent to disclose the personal information, including the sensitive personal information (e.g. medical information) contained in this form to you. I confirm that each covered person is aware of their duty to take reasonable care to answer your questions accurately, honestly, completely and to the best of their knowledge. (Please note that if you are declaring the above on another person’s behalf, it is your obligation to keep evidence of the consent you are providing hereto of your covered family members’ actual declarations and consents.) I hereby propose to Cigna Healthcare for cover to begin on the cover date or such other agreed date. In the event that it is found that I, or any covered person, have deliberately or recklessly provided any information which is false or inaccurate, Cigna Healthcare may void the contract of insurance as it relates to me or the covered person and refuse all claims and need not return any premiums paid in, except for where it would be unfair for the premiums to be retained. I have carefully read, understood and agree to abide by the Policy Rules and Customer Guide as they form part of my contract of insurance

 

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11 minutes ago, Patong2021 said:

Your attention is directed to the Cigna Global Health website that provides the health insurance portal for Thailand.

Health insurance quotes are issued with the following disclaimer;

 

The Current Quote price shown above is based only on the information you have currently provided and benefits you have selected. If you proceed, you will be required to complete a medical questionnaire for yourself and all other persons to be covered by this policy. Cover will be considered by our medical underwriting team and shall be subject to the policy terms and conditions.

 

The CIGNA health questionnaire contains the following warranty;

DECLARATION FOR ALL CUSTOMERS

I hereby declare that I have taken reasonable care to answer all questions accurately, honestly and completely. I acknowledge that if I do not answer all questions accurately and completely as a result of my carelessness or as a result of deliberate or reckless misrepresentation, Cigna Healthcare may reject claims, and/or cancel cover as per the terms and conditions of this policy. The duty to answer our questions accurately, honestly and completely applies in respect of each person who is covered by this policy. Although failure to fulfil this duty by one covered person may affect coverage or payment of their claims, it will not affect coverage or payment of claims in relation to any other covered person, unless that person has also made careless, deliberate or reckless misrepresentations in relation to our questions. I warrant and represent that I have each covered person’s consent to disclose the personal information, including the sensitive personal information (e.g. medical information) contained in this form to you. I confirm that each covered person is aware of their duty to take reasonable care to answer your questions accurately, honestly, completely and to the best of their knowledge. (Please note that if you are declaring the above on another person’s behalf, it is your obligation to keep evidence of the consent you are providing hereto of your covered family members’ actual declarations and consents.) I hereby propose to Cigna Healthcare for cover to begin on the cover date or such other agreed date. In the event that it is found that I, or any covered person, have deliberately or recklessly provided any information which is false or inaccurate, Cigna Healthcare may void the contract of insurance as it relates to me or the covered person and refuse all claims and need not return any premiums paid in, except for where it would be unfair for the premiums to be retained. I have carefully read, understood and agree to abide by the Policy Rules and Customer Guide as they form part of my contract of insurance

Thanks, I have read this. Hopefully (how241) will be along sometime to confirm whether he has since received a medical questionnaire to complete since taking out his silver policy. I applied because I wished to know whether two previous condition/incident (hypertension and collapse due to low blood glucose) would result in exclusions. I asked for a sample of their Medical Questionnaire via email attachment. Cigna Global told me they could complete their Medical Questionnaire over the phone in 5-10 minutes. This is what I did and their underwriting team decided within a minute or so to accept my application and provide cover without any exclusions. I haven't proceeded due to Sheryl's warning that too much is at stake to do things over the phone. Best to apply via application form, submit full details and keep copies. I have also been advised by a very helpful member (Etaoin Shrdlu) to obtain and supply my full medical records, thus there can be no accusations of 'failing to disclose'.

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12 hours ago, The Fugitive said:

Not the case with Cigna Global. Immediately after you have answered their questions via telephone your application is referred to their underwriting team who confirm within a minute if your application has been successful and, if so, whether any exclusions apply. Another member has reported and kindly supplied screenshots in the last week to confirm that, after making his first payment, his policy documentation arrived clearly stating the commencement date and 'No exclusions'.

Actually what is referred to the underwriting team is what the people on the phone (brokers, with a financial bias, and no medical training) wrote down based on this phone call.

 

Not an advisable way to proceed. You don't even know exactly what info was supplied to the insurer. Even if not inaccurate per se it will usually not have been exhaustive.

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13 hours ago, The Fugitive said:

A friend, neighbour and self-employed plumber and central heating engineer went for his annual medical. Doctor told him; ‘I’d like to fit a stent. You are not at risk and might never be. However, certain places can become blocked and I believe in prevention rather than cure’. My friend agreed. He declared this to his health insurance company. His premiums tripled. 

 

i have never -- ever -- heard of stents being placed solely for prevention in people without any existing blockage. Suspect your friend misunderstood or mis-remembered what he heard.

 

As for the "declared this to his insurance company and his premiums tripled" - if this was an existing policy the insurer did not need to have it declared as they would have paid for it so already know. In which case a Thai insurer could indeed raise premiums  (but not three fold - maximum is 25% plus whatever age/inflation based increases would have happened anyway), but a western-based one could not. If it was a newly applied for policy premiums could not have increased as he would not yet have had any.

 

 

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11 hours ago, The Fugitive said:

Hopefully (how241) will be along sometime to confirm whether he has since received a medical questionnaire to complete since taking out his silver policy.

I already posted the 8-9 questions that I answered when I applied to the policy.  My answers were accepted by Cigna and my policy has been in force(fully active) for several weeks. 

I have not receive any other medical questionnaires.

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45 minutes ago, how241 said:

I already posted the 8-9 questions that I answered when I applied to the policy.  My answers were accepted by Cigna and my policy has been in force(fully active) for several weeks. 

I have not receive any other medical questionnaires.

How exactly did you answer these?

 

If only on the phone I suggest you request a hard copy of the responses as they may differ from what you verbally told the broker (who is mainly interested in closing the sale)  or have insufficient detail.

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This is a really tough nut I think for most above the age of 65.

 

For the OP it is almost surprising at 72 a Thai company is even talking to you.

 

Also tough for many is that even if they don't drink or smoke & are a good weight & exercise that is no guarantee 

of passing any physical required especially a coronary calcium scan. Because even though as I said a person may be a healthy adult many were raised thru the 50's & 60's when diets like the American diet were in reality quite terrible.

 

I know many including myself who went for the scan just out of curiosity & was surprised at the results.

Not that the scan is really definitive as it does not say really if the calcium is inside or out etc etc (aka: need more testing angiogram etc)

Then that shows a number & suddenly what was an ok cholesterol level is now deemed too high

example 99 LDL oh no we need that under 70 now as your at risk due to recent cac score.....Statins or PSK9 Inhibitor etc etc needed.

 

Its a really tangled web for retired folks & really I think only nation provided insurance like Medicare or UK NHS etc is there for the retired

Because as many now see getting insured after 65 or remaining insured in a foreign country after 65 is a crap shoot. If they don't purposely price you out of the policy they may find a reason to deny coverage

 

Yep tough nut

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After reading all the posts I think the only way to ensure what you are actually covered for is to have a medical check up first, buying a policy over the telephone is definitely not an option when you become older.. A friend of a friend was receiving daily radiotherapy for Prostate Cancer, no overnight stay, the insurance company would not pay out because they classed it as out patient treatment which wasn’t included in his policy.

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10 hours ago, how241 said:

I already posted the 8-9 questions that I answered when I applied to the policy.  My answers were accepted by Cigna and my policy has been in force(fully active) for several weeks. 

I have not receive any other medical questionnaires.

Thanks for confirming. Sheryl is only looking after our interests. $600 US dollars per month is a lot of money for me. I’d hate any claim to be denied for ‘lack of information/failure to disclose’. It appears that Cigna Global are not following ‘the norm’ or even the customer information on their web application system. I was asked about my collapse due to low blood glucose in 2018. ‘What were the symptoms? How long did they last? What treatment did you receive? What did the doctor say? Any repetition since? Do you currently take any medication for this? Then, I was prompted to confirm whether diabetes was diagnosed or not? My truthful answer was not! The problem is that this may be good enough to issue my policy with no exclusions but would they pay out for a similar incident in the future?

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11 hours ago, Sheryl said:

How exactly did you answer these?

 

If only on the phone I suggest you request a hard copy of the responses as they may differ from what you verbally told the broker (who is mainly interested in closing the sale)  or have insufficient detail.

I believe you are confusing me (how241)  with another.  I have already posted almost all the details of  my acct. application. I dealt directly with Cigna online.  

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It sounds like they're specifically excluding conditions tied to high cholesterol and heart disease, not just statin use. Since you’ve been clear of prostate cancer since 2017 and don’t have heart disease, it might just be their standard policy on cholesterol-related conditions. 

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7 hours ago, The Fugitive said:

Thanks for confirming. Sheryl is only looking after our interests. $600 US dollars per month is a lot of money for me. I’d hate any claim to be denied for ‘lack of information/failure to disclose’. It appears that Cigna Global are not following ‘the norm’ or even the customer information on their web application system. I was asked about my collapse due to low blood glucose in 2018. ‘What were the symptoms? How long did they last? What treatment did you receive? What did the doctor say? Any repetition since? Do you currently take any medication for this? Then, I was prompted to confirm whether diabetes was diagnosed or not? My truthful answer was not! The problem is that this may be good enough to issue my policy with no exclusions but would they pay out for a similar incident in the future?

 

I don't see why not since you fully reported the event.

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