HI Select Agent Guide

Agent Guide | Hospital Indemnity Select

ManhattanLife

Health History Within the past 12 months, has any proposed insured been advised to have any of the tests listed below, or a treatment or surgery that has not yet been performed, or which has pending test results? Below are examples of medical services that could be requested or recommended that have not yet been performed or performed with results pending: Diagnostic Tests • Bone Marrow Aspiration • Biopsy • Colonoscopy • Endoscopy • MRI • Ultrasounds • X-Ray • Bone Scintigraphy • Blood Tests • Electroencephalography • Mammogram • PET Scan • Urine Tests Scope Procedures • Colonoscopy • EGD • Sigmoidoscopy • Cystoscopy • Endoscopy

• Thoracoscopy • Hysteroscopy

• Laparoscopy • Proctoscopy

Cardiac Tests • Coronary Calcium Scan • Cardiac Stress Tests • Cardiac Catheterization • Transesophageal Echocardiogram (TEE) • Tilt Table Test • Myocardial Perfusion Imaging

• Electrocardiography (ECG Or EKG) • Echocardiogram • Holter Monitor • Coronary Ct Angiography • Angiography • Doppler Echocardiography

AGT-HIS 0824

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