Who is this coverage for?
1. Beneficiary?
___________________________________________________
2. Used Tobacco past 2 years?
___________________________________________________
3. Cancer Ever?
___________________________________________________
4. COPD Ever?
___________________________________________________
5. Heart Attack / Stroke Ever?
___________________________________________________
6. Insulin for Diabetes Ever?
___________________________________________________
7. HIV / AIDS Ever?
___________________________________________________
8. Disabled?
___________________________________________________
9. Kidney or Liver Disease Ever?
___________________________________________________
10. Diabetes Type 2 - Pills Only?
___________________________________________________
Quote - By Text Message
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