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Yes, I give permission to Best Policy, LLC, My Health Insurance, LLC, and Insurely, LLC and their affiliates to access and to renew my 2025 insurance policy on the Federally Facilitated Marketplace (FFM), Short-term medical plans or the best option that suits needs outside of the marketplace, based on the information provided. I also give them consent to contact me through: email, SMS, phone, automated dialing systems, and AI-generated or pre-recorded calls. Consent is not required to purchase.*
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Are you currently taking any prescription medications?
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Prescription medications
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Have you ever been diagnosed with, received advice for, or been treated for any of the conditions listed below?
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Major conditions
Autoimmune and Immune-Related Disorders
Neurological and Mental Health
Other High-Risk Conditions
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Select all Major Condition that apply:
Cancer (current or history of cancer in recent years)
Heart disease (coronary artery disease, heart attack, heart surgery, stents, congestive heart failure, etc.)
Stroke or TIA (transient ischemic attack)
Chronic obstructive pulmonary disease (COPD), emphysema, or severe asthma
Diabetes (especially insulin-dependent)
Chronic kidney disease or kidney failure
Liver disease (hepatitis, cirrhosis)
Select all Autoimmune Condition that apply:
HIV/AIDS
Lupus
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Other serious autoimmune conditions
Select all Neurological and Mental Health Condition that apply:
Epilepsy or seizure disorders (uncontrolled)
Alzheimer’s, Parkinson’s, or other degenerative neurological conditions
Schizophrenia or severe mental illness requiring hospitalization
Select all Other High-Risk Condition that apply:
Organ transplant history
Hemophilia or serious blood disorders
Currently pregnant or planning pregnancy
Hospitalization, surgery, or diagnostic testing recommended but not yet completed
BMI at extreme high or low ranges (varies by insurer)
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