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210 Health Questions from the Kaiser Application

We finally ditched our amazingly expensive COBRA health care plan in favor of individual health care policies. Unlike the plans I've had from employers in the past, this individual plan required each of us to answer questions about our healthcare history. Presumably this is so they can disqualify people who already live with expensive health conditions.

I was pretty impressed by the application. The PDF was 24 pages, letter-sized, with the majority of the questions related to health. It starts like this:

Basic Questions
Name 
Address 
SSN 
Gender 
Date of Birth 
Marital Status 
Height 
Weight 
Language 


Then they ask you the medical history questions.

Medical Questions
1.
Hospitalizations - Within the last 12 months, were you hospitalized (excluding labor and delivery. or treated at an Emergency Department, hospital, outpatient surgery center, or skilled nursing facility?
YN?
2.
Office Visits - Within the last 12 months, have you sought advice or treatment from a medical professional's office?
YN?
2a.
Physical exam 
YN?
2b.
Minor illness or injury now resolved and without a recommendation of further treatment; for example, cold, allergic reaction, flu, sore throat, cut requiring stitches 
YN?
2c.
Chiropractic visits 
YN?
2d.
Prenatal care 
YN?
2e.
Psychological counseling 
YN?
2f.
Medication management 
YN?
2g.
A reason not listed above 
YN?
3.
Pending Treatment - Within the last 3 years, have you been advised by a medical professional to have, but have not yet had, surgery, treatment, examination, evaluation, or test for any medical condition? 
YN?
4.
Substance Abuse Treatment - Within the last 3 years, have you been instructed to attend, attended, or participated in a program that deals with your alcohol or substance abuse? 
YN?
5.
Skin/Dermatological - Within the last 3 years, have you been treated for, or has a medical professional advised you that you have, any skin/dermatological disorders?  
YN?
5a.
Acne 
YN?
5b.
Psoriasis 
YN?
5c.
Burns
YN?
5d.
Keloids requiring plastic surgery 
YN?
5e.
Cosmetic or reconstructive surgeries, revisions 
YN?
5f.
A skin or dermatological condition not listed above 
YN?
6.
Eyes/Ear/Nose/Throat - Within the last 3 years, have you been treated for, or has a medical professional advised you that you have, any disorders of the eyes, ears, nose, or throat?
YN?
6a.
Glaucoma 
YN?
6b.
Cataracts, cataract surgery for one or both eyes 
YN?
6c.
Crossed eyes 
YN?
6d.
Detached retina 
YN?
6e.
Macular degeneration 
YN?
6f.
Deviated septum 
YN?
6g.
Sleep apnea, chronic snoring, or unresolved insomnia 
YN?
6h.
Nasal and/or throat polyps 
YN?
6i.
A condition of the eyes, ears, nose, or throat not listed above
YN?
7.
Tobacco History - Have you ever used tobacco, including snuff and chewing or other smokeless tobacco? 
YN?
8.
Illegal Drugs - Within the last 5 years, have you taken or used illegal drugs or prescription drugs not prescribed by a medical professional? 
YN?
9.
Nervous System - Within the last 5 years, have you been treated for, or has a medical professional advised you that you have, any brain neurological, or nervous disorder?  
YN?
9a.
Multiple sclerosis 
YN?
9b.
Autism 
YN?
9c.
Attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)
YN?
9d.
Seizures treated with more than 2 medications for control 
YN?
9e.
Seizures under control with 2 or fewer medications 
YN?
9f.
Most recent seizure within the last 12 months 
YN?
9g.
Alzheimer's disease 
YN?
9h.
A brain, neurological, or nervous disorder not listed above 
YN?
10.
Cardiovascular System - Within the last 5 years, have you been treated for, or has a medical professional advised youthat you have, any heart or cardiovascular disorders?  
YN?
10a.
Aneurysm 
YN?
10b.
Heart murmur or mitral valve prolapse, with recommendation for ongoing treatment 
YN?
10c.
Chest pain 
YN?
10d.
Heart attack or angina 
YN?
10e.
Congestive heart failure 
YN?
10f.
Angioplasty or coronary artery bypass 
YN?
10g.
Pacemaker 
YN?
10h.
Tachycardia or other heart arrhythmia 
YN?
10i.
Other heart disease or valve disease 
YN?
10j.
Current medications to control heart disease or cardiovascular symptoms 
YN?
10k.
A heart or cardiovascular condition not listed above
YN?
11.
Respiratory System - Within the last 5 years, have you been treated for, or has a medical professional advised you that you have, any respiratory disorders?  
YN?
11a.
Chronic asthma treated with medications for control 
YN?
11b.
Asthma treated with prednisone therapy 
YN?
11c.
Asthma treated only with occasional use of inhalers 
YN?
11d.
Asthma history of 3 or more Emergency Department visits or hospital admissions within the last 12 months 
YN?
11e.
Emphysema 
YN?
11f.
Chronic bronchitis 
YN?
11g.
Chronic obstructive pulmonary disease 
YN?
11h.
Cystic fibrosis 
YN?
11i.
Pulmonary tuberculosis, active or arrested 
YN?
11j.
A lung or respiratory disorder not listed above 
YN?
12.
Musculo-skeletal System - Within the last 5 years, have you been treated for, or has a medical professional advised you that you have, any muscle or bone disorders?  
YN?
12a.
Back or neck pain or injury currently under treatment or controlled with medication 
YN?
12b.
Back or neck pain or injury within the last 12 months fully resolved and no longer under treatment 
YN?
12c.
Back or neck pain or injury for which further treatment or surgery has been recommended 
YN?
12d.
Inguinal hernia that has been repaired 
YN?
12e.
Inguinal hernia not repaired 
YN?
12f.
Umbilical hernia that has been repaired 
YN?
12g.
Umbilical hernia not repaired 
YN?
12h.
Lupus/SLE 
YN?
12i.
Chronic disabling arthritis 
YN?
12j.
Arthritis requiring daily prescription medication 
YN?
12k.
Osteomyelitis 
YN?
12l.
Joint replacement surgery 
YN?
12m.
Orthopedic or arthritic conditions that interfere with daily living (Examples of daily living include bathing, dressing, grooming, or walking).
YN?
12n.
A musculoskeletal condition not listed above 
YN?
13.
Metabolic/Endocrine System - Within the last 5 years, have you been treated for, or has a medical professional advised you that you have, any metabolic or endocrine (hormone) disorders?  
YN?
13a.
AIDS 
YN?
13b.
Diabetes controlled with oral medication 
YN?
13c.
Diabetes controlled with insulin 
YN?
13d.
Diabetes controlled exclusively with diet and exercise 
YN?
13e.
Gestational diabetes 
YN?
13f.
High cholesterol 
YN?
13g.
Rheumatoid arthritis 
YN?
13h.
Muscular dystrophy 
YN?
13i.
Other immunological condition 
YN?
13j.
A metabolic or endocrine disorder not listed above 
YN?
14.
Congenital/Developmental - Within the last 5 years, have you been treated for, or has a medical professional advised you that you have, any congenital defects or developmental disorders?  
YN?
14a.
Down's syndrome 
YN?
14b.
Cerebral palsy 
YN?
14c.
Cleft palate or lip 
YN?
14d.
Club foot 
YN?
14e.
Congenital heart defect (specify type)
YN?
14f.
Developmental delay 
YN?
14g.
Prematurity (for children up to 2 years old.
YN?
14h.
A neurological or physical abnormality not listed above (specify) 
YN?
15.
For Males only: Within the last 5 years, have you been treated for, or has a medical professional advised you that you have, any of the following:  
YN?
15a.
Prostate condition requiring treatment, medication, or surgery 
YN?
15b.
Genital herpes with a history of daily treatment or more than 3 outbreaks in the last 12 months 
YN?
15c.
Genital warts 
YN?
15d.
Syphilis 
YN?
15e.
Gonorrhea 
YN?
15f.
Other sexually transmitted disease 
YN?
15g.
Impotence or erectile dysfunction 
YN?
15h.
Infertility 
YN?
15i.
Gender identity (role) disorder 
YN?
15j.
A male reproductive or genital disorder not listed above 
YN?
16.
(Womans questions)
 
17.
Digestive System - Within the last 5 years, have you been treated for, or has a medical professional advised you that you have, any digestive system disorders?  
YN?
17a.
Ulcerative colitis or Crohn's disease 
YN?
17b.
Gastrointestinal bleeding 
YN?
17c.
Gastrointestinal polyps 
YN?
17d.
Unrepaired cystocele or rectocele 
YN?
17e.
Gallstones and gallbladder has not been removed 
YN?
17f.
Hepatitis A, B, C, or other, currently under treatment 
YN?
17g.
Hepatitis A, B, C, or other, chronic and ongoing (including carrier status.
YN?
17h.
Cirrhosis 
YN?
17i.
Hepatitis A, fully recovered with no symptoms and normal liver function tests 
YN?
17j.
Other liver condition
YN?
17k.
A digestive system disorder not listed above 
YN?
18.
Urinary Tract - Within the last 5 years, have you been treated for, or has a medical professional advised you that you have, any urinary tract disorders?  
YN?
18a.
Chronic kidney failure 
YN?
18b.
Nephrotic  syndrome 
YN?
18c.
Polycystic kidneys 
YN?
18d.
Kidney failure 
YN?
18e.
Chronic kidney infections (more than 2 per year.
YN?
18f.
Kidney infection, resolved with no further treatment required 
YN?
18g.
Kidney removed with remaining kidney functioning without any medical problems and normal kidney function tests 
YN?
18h.
Kidney removed with a recommendation for further treatment 
YN?
18i.
Kidney stones, currently 
YN?
18j.
Kidney stones within the last 24 months 
YN?
18k.
Interstitial cystitis 
YN?
18l.
A kidney or urinary tract disorder not listed above 
YN?
19.
Lab Results - Within the last 5 years, has a medical professional advised you that you have any abnormal lab results? 
YN?
20.
Circulatory System - Within the last 10 years, have you been treated for, or has a medical professional advised you that you have, any blood or circulatory system disorders?  
YN?
20a.
Stroke 
YN?
20b.
Transient ischemic attacks (TIA)
YN?
20c.
Hemophilia 
YN?
20d.
Thalassemia major 
YN?
20e.
Von Willebrand's disease 
YN?
20f.
Other blood disorder 
YN?
20g.
Blood pressure over 150/90 
YN?
20h.
Currently taking 3 or more medications for hypertension 
YN?
20i.
Hypertension under control with medication 
YN?
20j.
A blood or circulatory system disorder not listed above 
YN?
21.
Cancer - Within the last 10 years, have you been treated for, or has a medical professional advised you that you have, any cancer?  
YN?
21a.
Any cancer with lymph node involvement or metastasis (spread to other tissue)
YN?
21b.
Cancer of the brain, breast, blood, pancreas, prostate, urinary bladder, esophagus; or myeloma, Kaposi's sarcoma, or non-Hodgkin's lymphoma 
YN?
21c.
Cancer of the cervix, uterus, thyroid, larynx, or oral cavity, with no further treatment recommended
YN?
21d.
Cancer of the colon, kidney, liver, lung, ovary, or stomach 
YN?
21e.
Skin cancer that has not been removed and requires further treatment 
YN?
21f.
Skin cancer other than melanoma that has been completely removed and no further treatment recommended
YN?
21g.
Melanoma 
YN?
21h.
A cancer not listed above 
YN?
22.
Prosthetics/Implants/Transplants - Within the last 10 years, have you been treated for, or has a medical professional advised you that you have, any condition for which prosthetics, implants, or transplants (including organ transplants. have been recommended? 
YN?
23.
Mental Health - Within the last 10 years, have you been treated for, or has a medical professional advised you that you have, any psychological or mental health disorders?  
YN?
23a.
Mild depression/anxiety 
YN?
23b.
Major depression or neurosis 
YN?
23c.
Situational stress, anxiety, or depression no longer requiring treatment or medication
YN?
23d.
Eating disorder (anorexia nervosa or bulimia)
YN?
23e.
Suicide attempt 
YN?
23f.
Psychosis, senile dementia, multiple personalities, bipolar disorder, depressive psychosis, schizophrenia 
YN?
23g.
Hospitalization for a mental health condition 
YN?
23h.
A psychological or mental health condition not listed above 
YN?
24.
Prescriptions - Are you taking any prescription medications? 
YN?
25.
Alcohol - Do you drink alcoholic beverages? 
YN?
26.
Pregnancy - Are you currently pregnant or an expectant father? Or, do you expect to be providing medical insurance coverage for a newborn or new adoptee within the next 9 months? 
YN?
27.
Surrogacy - Do you plan to be a surrogate parent (mother or father) within the next year or to engage someone to provide that service within the next year? 
YN?
28.
Some female questions
YN?
29.
Other: Within the last 5 years, have you been treated for, or advised by a medical professional that you have, a medical or health-related condition which you haven't indicated on this Medical Questionnaire? 
YN?

Almost done!

Medical Details
Except, if you answered Yes or "?" to any of those 210 health questions, you've got to clarify what happened in each instance, as shown in the Medical Detail section below. These questions need to be addressed if you, for example, answered "?" to Question 20e: Von Willebrand's disease :

Medical Detail
20e. Circulatory System - Von Willebrand's disease
*If you answered ? to this question, please check all boxes that apply
I don't understand the question.
I had the condition listed but can't remember when.
I don't understand the medical terms being used in question.
I don't remember the date that I consulted a physician or was admitted to a hospital.
I don't remember the information that I need to provide in order to answer the question correctly.
I don't know if I have or have had this condition.
*Please provide a complete explanation of why you answered "?".

This is where you'll give details about when you visited the urologist to get Viagra, just so you could write an article about it.

These forms are simpler to fill out if you haven't had a lot of health problems, just one of the benefits of clean livin'.

After you fill out the paper application, you can mail it in, or fax it in. You'll have to include your first month's insurance premium, although they don't yet guarantee that they will enroll you for the plan. You are only applying.

It was our experience that upon receiving the application, a Kaiser representative will call and ask about each and every unaddressed question from the application. They don't seem too terribly anxious to determine if you are lying, though. I have a feeling that if you show up with stage 3 Cystic Fibrosis a week after applying, they'll use your fraudulent application to avoid having to administer care at the insured rates.

So, that's it. Two hundred ten health questions, plus details, and you are ready to go. You can do it.

The guys at H & R Block can't.

I already asked.


 


  The Oatmeal Markup | Antiques Roadshow - The Ultimate "Neat Stuff" Show | Iphone vs. Kia | Let us Dilute that For You | Razor and Blades Business Model | Short-Circuiting the Facebook Tease Video Link | Other Websites Besides Healthcare.org which are Broken | Visualizing the Price of a Television | Personal account of working for commision at Banker's Life Insurance | The Three Problems with Child Car Seats | How Much Time is Really Left in the Basketball Game? | Who Uses Their Turn Signal? | Other Web Problems not related to Healthcare.org | The Cross-Section of a Couch | Comparing the Price of Used Car to the Price of a New Car | Rental Car Keys are Horrible | The Actual Amount of Time it Takes | Incorrect Shelf Prices at Walmart | Two Prices for Auto Body Repair | Roadside Sobriety Test | Cash in your Pennies | Get it Together Walmart | Price Increases at Fast Food Restaurants | Yard Sale is Shoe Store Scam | Disaster Casualties Visualization Tool | Walmart vs Target: 2013 | The 146 Drugs in Walmart's $4 Prescription Drug Plan | Email Concealer Codes | accumulating credit card debt | Selling a Structured Settlement | The Torn-up Credit Card Application ! Kirby Vacuum Cleaners
Photographic Height/Weight Chart | Comparing the Odds of a Royal Flush in Poker to Winning the Mega Millions Lottery Jackpot | The Television Commercial Database
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