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VHIS Health Questionnaire

A simulation of the Standardised Underwriting Questionnaire (SUQ) mandated by the Hong Kong Federation of Insurers (HKFI). Filling this in is completely private — answers stay in your browser on this device unless you choose at the end to send them to Leo for a pre-check.

This tool is not a formal application, nor an insurance assessment. Final underwriting decisions rest with the insurer.

Your basics

Used to filter which questions apply

Gender

Part A — General Information

If your answer to any of the questions 3 - 6 below is "Yes", please proceed to answer the relevant follow-up questions in Part C.

3. Smoking habit: Do you smoke or have you smoked in the last 5 years?

"Smoking" includes but is not limited to cigarettes, cigars, tobacco pipes, chewing tobacco and the use of nicotine replacement products (such as e-cigarettes).

4. Alcohol consumption: In the last 12 months, on average do you drink alcoholic beverage for more than 3 times in a week?
5. Taking of drugs not prescribed by doctors: In the last 5 years, have you used any drugs (excluding dietary supplements) which are not prescribed by doctors (including habit-forming or recreational drugs such as cocaine, ecstasy, heroin, methadone, anabolic steroids) for a continuous period of more than 1 month?
6(a). Have you engaged in the last 12 months or will you engage / intend to engage in the next 12 months in any hazardous sports or activities? (e.g. diving, motor racing, mountaineering or rock climbing, parachuting, sky diving, hang gliding)
6(b). Have you engaged in the last 12 months or will you engage / intend to engage in the next 12 months in flying activities other than as a fare-paying passenger of a licensed air service operating within recognised scheduled routes?

Part B — Health Information

Note for applicants: Part B questions do NOT require disclosure of: cold/flu/sore throat, gastroenteritis/food poisoning (fully recovered), indigestion (no investigations required), acne, muscle sprain (fully recovered), thrush, routine antenatal scan, blood test (normal result), routine cervical smear (normal), routine health check (normal), preventive vaccination, hormonal replacement therapy (menopause), infertility treatment or uncomplicated pregnancy, myopia, hyperopia, astigmatism, presbyopia. If your answer to any of questions 7 - 17 below is "Yes", please answer the relevant follow-up questions in Part D.

7. Have you ever been diagnosed with any of the following diseases or medical conditions? (Tick the applicable items)

7(a). Cancer or carcinoma in situ
7(b). Brain tumor
7(c). Heart disease
7(d). Stroke (including transient ischemic attack, TIA)
7(e). Hypertension
7(f). Diabetes mellitus or impaired glucose tolerance
7(g). Kidney disease
7(h). Prolapsed intervertebral disc or degenerative spine conditions
7(i). Diseases / medical conditions requiring a medical device or prosthesis to be implanted within the body
7(j). Human immunodeficiency virus (HIV) infection
7(k). Congenital conditions (medical / physical / mental abnormalities existing at or before birth)
7(l). Physical defects, impairments, deformities, and/or conditions affecting mobility, sight, speech or hearing
7(m). Mental health conditions (such as depression, anxiety, schizophrenia, eating disorders, or bipolar disorders)
7(n). Hypercholesterolemia or Hyperlipidemia
7(o). Liver disorder (such as hepatitis B or hepatitis C including tested positive, fatty liver or cirrhosis of liver)
7(p). Multiple sclerosis

8. Do you currently have any of the following diseases or medical conditions?

8(a). Hernia
8(b). Breast lesion (tumour / mass / lump / cyst / nodule / growth)
8(c). Uterine or ovarian lesion (tumour / mass / lump / cyst / polyp / nodule / growth)
8(d). Benign prostatic hypertrophy
8(e). Gall bladder stone or urinary stone (renal / ureteric / urinary bladder stone)
8(f). Cataract, glaucoma or retinopathy
8(g). Arthritis or other joint disorder
9. In the last 5 years, have you ever had or been advised to have any regular or ongoing (e.g. monthly, every 2 months, half-yearly, annually) follow-up consultations or medical care with a healthcare professional (such as specialist doctor, physiotherapist, psychiatrist) for any disease or medical condition?
10. In the last 5 years, have you been advised by your doctor to take any medications (such as to be taken daily / once per week / as needed as directed by doctor) for a continuous period of more than 1 month?
11. In the last 5 years, have you been admitted into a hospital?
12. In the last 5 years, have you undergone a surgical procedure (including endoscopy or biopsy) without being admitted into a hospital?
13. In the last 5 years, have you ever had or been advised to undergo investigations (such as blood or urine test, ECG, X-ray, ultrasound, CT scan, MRI, PET scan, HIV test, Hepatitis B test, Hepatitis C test)?

14. Apart from anything you have already disclosed in Questions 7 - 13, do you have any of the following conditions?

14(a). Unintentional weight loss by more than 5 kg (11 lbs) over the past 1 year
14(b). Abnormal bleeding (vaginal / rectal / nose / coughing up blood) for at least one month
14(c). In the last 1 year, you had or have been required to have follow-up consultation with a healthcare professional for any medical condition or sign and symptom
14(d). Other medical conditions or sign and symptom (such as lump, headache, persistent coughing, chest pain or epigastric pain) that you are seeking or intend to seek medical advice
15. [For female only] Are you currently pregnant?
16. [For insured children aged 6 or below only] Was the insured child born before the 37th week of pregnancy and/or born with body weight less than 2.5 kg (5.5 lbs)?

17. At your best knowledge, have any of your parents or siblings by blood been diagnosed with any of the following diseases or medical conditions at or before age 60:

17(a). Cancer
17(b). Coronary heart disease
17(c). Diabetes mellitus
17(d). Motor neuron disease
17(e). Multiple sclerosis
17(f). Stroke
17(g). Parkinson's disease
17(h). Hereditary diseases (including cystic fibrosis, familial adenomatous polyposis, Alzheimer's disease, familial cardiomyopathy, inherited blood disorders (hemophilia, thalassemia, sickle cell disease), muscular dystrophy, polycystic kidney disease or Huntington's disease)

Submitting confirms you have read and agreed to the terms.