POST v1/api/SaveLifeApplication?caseId={caseId}
Create (Save) a Life Application for 103
Request Information
URI Parameters
| Name | Description | Type | Additional information |
|---|---|---|---|
| caseId |
(optional)The unique identifier to Get, Save or Send the application. If not supplied, a unqique identifier will be created. |
string |
None. |
Body Parameters
ApplicationDto
LifeApplicationDto| Name | Description | Type | Additional information |
|---|---|---|---|
| CompanyId | string |
None. |
|
| PlatformId | string |
None. |
|
| AgencyId | string |
None. |
|
| RulebaseId | string |
None. |
|
| RulebaseIssueState | StateCodeEnum |
None. |
|
| CaseId | string |
None. |
|
| GovtIdLast4 | string |
None. |
|
| BirthDate | date |
None. |
|
| ScreenTagName | string |
None. |
|
| LastGroupId | integer |
None. |
|
| PaymentTokenId | string |
None. |
|
| PrevUpdateDate | date |
None. |
|
| UwDecision | string |
None. |
|
| UwDecisionText | string |
None. |
|
| TwoFactorContactType | string |
None. |
|
| TwoFactorContactText | string |
None. |
|
| PlanId | string |
None. |
|
| ClassId | string |
None. |
|
| Policy | PolicyDto |
Required |
|
| QuestionsAnswers | Collection of RuleEngineQuestionDto |
None. |
|
| FrontEndData | string |
None. |
|
| Tx103Data | string |
None. |
Request Formats
application/json
Sample:
REQUEST
{
"CompanyId": "CP",
"PlatformId": null,
"AgencyId": "00919",
"RulebaseId": "FinalExpense",
"RulebaseIssueState": "Massachusetts",
"CaseId": "24476",
"GovtIdLast4": "3655",
"BirthDate": "1964-02-13T00:00:00",
"ScreenTagName": "/confirmeditsyou",
"LastGroupId": 0,
"PaymentTokenId": null,
"PrevUpdateDate": "0001-01-01T00:00:00",
"UwDecision": null,
"UwDecisionText": null,
"TwoFactorContactType": null,
"TwoFactorContactText": null,
"PlanId": "FELD01",
"ClassId": "NONE",
"Policy": {
"IssueState": "Massachusetts",
"PaymentMode": "MonthOrMonthly",
"Replacement": false,
"Life": {
"FaceAmount": 2000.0,
"CoverageRecords": {
"Coverages": [
{
"BirthDate": "1964-02-13T00:00:00",
"CovProductCode": "FELD01",
"CovIndicator": "Base",
"CovParticipant": "Primary_Insured",
"CovTypeCd": "Term_Level_Death_Benefit",
"FaceAmount": 2000.0
}
]
}
},
"Producer": {
"ExistingInsurance": false,
"FinanceFromExistingInsurance": false,
"ChangeOwnership": false,
"FinancedByThirdParty": false,
"InducedToApply": false,
"LaunderingTraining": false,
"Incompliance": false
},
"PartyRecords": {
"Partys": [
{
"PartyType": "PERSON",
"Role": "INSURED",
"GovtId": "666473655",
"HasDriversLicense": true,
"DriversLicenseNumber": "5097996",
"DriversLicenseState": "Massachusetts",
"Person": {
"BestMethodOfContact": "HOMEPHONE",
"LegalResident": true,
"Email": "hcansee@aol.com",
"AddressType": "HomeAddress",
"State": "Massachusetts",
"Country": "United States of America",
"FirstName": "Judy",
"LastName": "Taylor",
"MaritalStatus": null,
"BirthDate": "1964-02-13",
"Smoker": "Never",
"Gender": "Female",
"Name": "Judy Taylor",
"HomePhone": "(617) 987-3214",
"Address1": "359 WILLOW WAY N",
"City": "ALEXANDER CITY",
"PostalCode": "35010-6259"
}
},
{
"PartyType": "PERSON",
"Role": "PRIMARYWRITINGAGENT",
"GovtId": null,
"HasDriversLicense": false,
"Agent": {
"Id": "00901",
"Name": "SBLI - DIGITAL",
"Percent": 0
},
"Person": {
"BestMethodOfContact": null,
"AddressType": "HomeAddress",
"State": "Massachusetts",
"Country": "United States of America",
"FirstName": "SBLI",
"LastName": " - Digital",
"MaritalStatus": null,
"BirthDate": null,
"Gender": null,
"Name": "SBLI - Digital",
"Address1": "1 Linscott Road",
"City": "Woburn",
"PostalCode": "01801"
},
"IDReferenceNo": "00901"
},
{
"PartyType": "PERSON",
"Role": "INSURED",
"GovtId": "666473655",
"HasDriversLicense": true,
"DriversLicenseNumber": "5097996",
"DriversLicenseState": "Massachusetts",
"Person": {
"BestMethodOfContact": "HOMEPHONE",
"LegalResident": true,
"Email": "hcansee@aol.com",
"AddressType": "HomeAddress",
"State": "Massachusetts",
"Country": "United States of America",
"FirstName": "Judy",
"LastName": "Taylor",
"MaritalStatus": null,
"BirthDate": "1964-02-13",
"Smoker": "Never",
"Gender": "Female",
"Name": "Judy Taylor",
"HomePhone": "(617) 987-3214",
"Address1": "359 WILLOW WAY N",
"City": "ALEXANDER CITY",
"PostalCode": "35010-6259"
}
},
{
"PartyType": "PERSON",
"Role": "PRIMARYWRITINGAGENT",
"GovtId": null,
"HasDriversLicense": false,
"Agent": {
"Id": "48233",
"Name": "Christine Anderson",
"Percent": 100
},
"Person": {
"BestMethodOfContact": null,
"AddressType": "HomeAddress",
"State": "Massachusetts",
"Country": "United States of America",
"FirstName": "Christine",
"LastName": "Anderson",
"MaritalStatus": null,
"BirthDate": null,
"Gender": null,
"Name": "Christine Anderson",
"Address1": "1 Linscott Road",
"City": "Woburn",
"PostalCode": "01801"
}
},
{
"PartyType": "PERSON",
"Role": "PRIMARYWRITINGAGENT",
"GovtId": null,
"HasDriversLicense": false,
"Agent": {
"Id": "48233",
"Name": "Christine Anderson",
"Percent": 100
},
"Person": {
"BestMethodOfContact": null,
"AddressType": "HomeAddress",
"State": "Massachusetts",
"Country": "United States of America",
"FirstName": "Christine",
"LastName": "Anderson",
"MaritalStatus": null,
"BirthDate": null,
"Gender": null,
"Name": "Christine Anderson",
"Address1": "1 Linscott Road",
"City": "Woburn",
"PostalCode": "01801"
}
}
]
},
"PaymentMethod": null,
"PremiumAmount": 10.5
},
"QuestionsAnswers": null,
"FrontEndData": "{\"bAuthCoverage\":true,\"bReadonlyForm\":true,\"tmptestid\":\"666473655\",\"tmptestdob\":\"1964-02-13\",\"tmptestgdr\":\"Female\"}"
}
application/xml
Sample:
REQUEST
<LifeApplication xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request" xmlns:i="http://www.w3.org/2001/XMLSchema-instance">
<AgencyId>00919</AgencyId>
<BirthDate>1964-02-13T00:00:00</BirthDate>
<CaseId>10814</CaseId>
<ClassId>NONE</ClassId>
<CompanyId>CP</CompanyId>
<FrontEndData>{"bAuthCoverage":true,"bReadonlyForm":true,"tmptestid":"666473655","tmptestdob":"1964-02-13","tmptestgdr":"Female"}</FrontEndData>
<GovtIdLast4>3655</GovtIdLast4>
<LastGroupId>0</LastGroupId>
<PaymentTokenId i:nil="true"/>
<PlanId>FELD01</PlanId>
<PlatformId i:nil="true"/>
<Policy>
<IssueState xmlns="">Massachusetts</IssueState>
<Life xmlns="">
<FaceAmount>2000</FaceAmount>
<CoverageRecords>
<Coverages xmlns:a="http://schemas.datacontract.org/2004/07/LPESService">
<a:SBLICoverage>
<a:BirthDate>1964-02-13T00:00:00</a:BirthDate>
<a:CovProductCode>FELD01</a:CovProductCode>
<a:CovIndicator>Base</a:CovIndicator>
<a:CovParticipant>Primary_Insured</a:CovParticipant>
<a:CovTypeCd>Term_Level_Death_Benefit</a:CovTypeCd>
<a:FaceAmount>2000</a:FaceAmount>
</a:SBLICoverage>
</Coverages>
</CoverageRecords>
</Life>
<PartyRecords xmlns="">
<Partys>
<Party>
<DriversLicenseNumber>5097996</DriversLicenseNumber>
<DriversLicenseState>Massachusetts</DriversLicenseState>
<GovtId>666473655</GovtId>
<HasDriversLicense>true</HasDriversLicense>
<PartyType>PERSON</PartyType>
<Person>
<Name>Judy Taylor</Name>
<Address1>359 WILLOW WAY N</Address1>
<City>ALEXANDER CITY</City>
<State>Massachusetts</State>
<PostalCode>35010-6259</PostalCode>
<Country>United States of America</Country>
<AddressType xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">HomeAddress</AddressType>
<Email xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">hcansee@aol.com</Email>
<BestMethodOfContact>HOMEPHONE</BestMethodOfContact>
<LegalResident>true</LegalResident>
<FirstName>Judy</FirstName>
<LastName>Taylor</LastName>
<MaritalStatus i:nil="true"/>
<BirthDate>1964-02-13</BirthDate>
<Smoker>Never</Smoker>
<Gender>Female</Gender>
<HomePhone>(617) 987-3214</HomePhone>
</Person>
<Role>INSURED</Role>
</Party>
<Party>
<Agent>
<Id>00901</Id>
<Name>SBLI - DIGITAL</Name>
<Percent>0</Percent>
</Agent>
<GovtId i:nil="true"/>
<HasDriversLicense>false</HasDriversLicense>
<IDReferenceNo>00901</IDReferenceNo>
<PartyType>PERSON</PartyType>
<Person>
<Name>SBLI - Digital</Name>
<Address1>1 Linscott Road</Address1>
<City>Woburn</City>
<State>Massachusetts</State>
<PostalCode>01801</PostalCode>
<Country>United States of America</Country>
<AddressType xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">HomeAddress</AddressType>
<BestMethodOfContact i:nil="true"/>
<FirstName>SBLI</FirstName>
<LastName> - Digital</LastName>
<MaritalStatus i:nil="true"/>
<BirthDate i:nil="true"/>
<Gender i:nil="true"/>
</Person>
<Role>PRIMARYWRITINGAGENT</Role>
</Party>
<Party>
<DriversLicenseNumber>5097996</DriversLicenseNumber>
<DriversLicenseState>Massachusetts</DriversLicenseState>
<GovtId>666473655</GovtId>
<HasDriversLicense>true</HasDriversLicense>
<PartyType>PERSON</PartyType>
<Person>
<Name>Judy Taylor</Name>
<Address1>359 WILLOW WAY N</Address1>
<City>ALEXANDER CITY</City>
<State>Massachusetts</State>
<PostalCode>35010-6259</PostalCode>
<Country>United States of America</Country>
<AddressType xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">HomeAddress</AddressType>
<Email xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">hcansee@aol.com</Email>
<BestMethodOfContact>HOMEPHONE</BestMethodOfContact>
<LegalResident>true</LegalResident>
<FirstName>Judy</FirstName>
<LastName>Taylor</LastName>
<MaritalStatus i:nil="true"/>
<BirthDate>1964-02-13</BirthDate>
<Smoker>Never</Smoker>
<Gender>Female</Gender>
<HomePhone>(617) 987-3214</HomePhone>
</Person>
<Role>INSURED</Role>
</Party>
<Party>
<Agent>
<Id>48233</Id>
<Name>Christine Anderson</Name>
<Percent>100</Percent>
</Agent>
<GovtId i:nil="true"/>
<HasDriversLicense>false</HasDriversLicense>
<PartyType>PERSON</PartyType>
<Person>
<Name>Christine Anderson</Name>
<Address1>1 Linscott Road</Address1>
<City>Woburn</City>
<State>Massachusetts</State>
<PostalCode>01801</PostalCode>
<Country>United States of America</Country>
<AddressType xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">HomeAddress</AddressType>
<BestMethodOfContact i:nil="true"/>
<FirstName>Christine</FirstName>
<LastName>Anderson</LastName>
<MaritalStatus i:nil="true"/>
<BirthDate i:nil="true"/>
<Gender i:nil="true"/>
</Person>
<Role>PRIMARYWRITINGAGENT</Role>
</Party>
<Party>
<Agent>
<Id>48233</Id>
<Name>Christine Anderson</Name>
<Percent>100</Percent>
</Agent>
<GovtId i:nil="true"/>
<HasDriversLicense>false</HasDriversLicense>
<PartyType>PERSON</PartyType>
<Person>
<Name>Christine Anderson</Name>
<Address1>1 Linscott Road</Address1>
<City>Woburn</City>
<State>Massachusetts</State>
<PostalCode>01801</PostalCode>
<Country>United States of America</Country>
<AddressType xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">HomeAddress</AddressType>
<BestMethodOfContact i:nil="true"/>
<FirstName>Christine</FirstName>
<LastName>Anderson</LastName>
<MaritalStatus i:nil="true"/>
<BirthDate i:nil="true"/>
<Gender i:nil="true"/>
</Person>
<Role>PRIMARYWRITINGAGENT</Role>
</Party>
</Partys>
</PartyRecords>
<PaymentMethod i:nil="true" xmlns=""/>
<PaymentMode xmlns="">MonthOrMonthly</PaymentMode>
<PremiumAmount xmlns="">10.5</PremiumAmount>
<Producer xmlns="">
<ExistingInsurance>false</ExistingInsurance>
<FinanceFromExistingInsurance>false</FinanceFromExistingInsurance>
<ChangeOwnership>false</ChangeOwnership>
<FinancedByThirdParty>false</FinancedByThirdParty>
<InducedToApply>false</InducedToApply>
<LaunderingTraining>false</LaunderingTraining>
<Incompliance>false</Incompliance>
</Producer>
<Replacement xmlns="">false</Replacement>
</Policy>
<PrevUpdateDate>0001-01-01T00:00:00</PrevUpdateDate>
<QuestionsAnswers i:nil="true" xmlns:a="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Response"/>
<RulebaseId>FinalExpense</RulebaseId>
<RulebaseIssueState>Massachusetts</RulebaseIssueState>
<ScreenTagName>/confirmeditsyou</ScreenTagName>
<TwoFactorContactText i:nil="true"/>
<TwoFactorContactType i:nil="true"/>
<UwDecision i:nil="true"/>
<UwDecisionText i:nil="true"/>
</LifeApplication>
Response Information
Resource Description
success
ApplicationDto| Name | Description | Type | Additional information |
|---|---|---|---|
| Policy | PolicyDto |
Required |
Response Formats
application/json
Sample:
RESPONSE
{
"CompanyId": "CP",
"PlatformId": null,
"AgencyId": "00919",
"RulebaseId": "FinalExpense",
"RulebaseIssueState": "Massachusetts",
"CaseId": "24476",
"GovtIdLast4": "3655",
"BirthDate": "1964-02-13T00:00:00",
"ScreenTagName": "/confirmeditsyou",
"LastGroupId": 0,
"PaymentTokenId": null,
"PrevUpdateDate": "0001-01-01T00:00:00",
"UwDecision": null,
"UwDecisionText": null,
"TwoFactorContactType": null,
"TwoFactorContactText": null,
"PlanId": "FELD01",
"ClassId": "NONE",
"Policy": {
"IssueState": "Massachusetts",
"PaymentMode": "MonthOrMonthly",
"Replacement": false,
"Life": {
"FaceAmount": 2000.0,
"CoverageRecords": {
"Coverages": [
{
"BirthDate": "1964-02-13T00:00:00",
"CovProductCode": "FELD01",
"CovIndicator": "Base",
"CovParticipant": "Primary_Insured",
"CovTypeCd": "Term_Level_Death_Benefit",
"FaceAmount": 2000.0
}
]
}
},
"Producer": {
"ExistingInsurance": false,
"FinanceFromExistingInsurance": false,
"ChangeOwnership": false,
"FinancedByThirdParty": false,
"InducedToApply": false,
"LaunderingTraining": false,
"Incompliance": false
},
"PartyRecords": {
"Partys": [
{
"PartyType": "PERSON",
"Role": "INSURED",
"GovtId": "666473655",
"HasDriversLicense": true,
"DriversLicenseNumber": "5097996",
"DriversLicenseState": "Massachusetts",
"Person": {
"BestMethodOfContact": "HOMEPHONE",
"LegalResident": true,
"Email": "hcansee@aol.com",
"AddressType": "HomeAddress",
"State": "Massachusetts",
"Country": "United States of America",
"FirstName": "Judy",
"LastName": "Taylor",
"MaritalStatus": null,
"BirthDate": "1964-02-13",
"Smoker": "Never",
"Gender": "Female",
"Name": "Judy Taylor",
"HomePhone": "(617) 987-3214",
"Address1": "359 WILLOW WAY N",
"City": "ALEXANDER CITY",
"PostalCode": "35010-6259"
}
},
{
"PartyType": "PERSON",
"Role": "PRIMARYWRITINGAGENT",
"GovtId": null,
"HasDriversLicense": false,
"Agent": {
"Id": "00901",
"Name": "SBLI - DIGITAL",
"Percent": 100
},
"Person": {
"BestMethodOfContact": null,
"Email": "Noreply_MBORISLOW@test.com",
"AddressType": "HomeAddress",
"State": "Massachusetts",
"Country": "United States of America",
"FirstName": "SBLI",
"LastName": " - Digital",
"MiddleName": "-",
"MaritalStatus": null,
"BirthDate": null,
"Gender": null,
"CellPhone": "",
"Name": "SBLI - Digital",
"HomePhone": "",
"Address1": "1 Linscott Road",
"City": "Woburn",
"PostalCode": "01801"
},
"IDReferenceNo": "00901"
},
{
"PartyType": "PERSON",
"Role": "INSURED",
"GovtId": "666473655",
"HasDriversLicense": true,
"DriversLicenseNumber": "5097996",
"DriversLicenseState": "Massachusetts",
"Person": {
"BestMethodOfContact": "HOMEPHONE",
"LegalResident": true,
"Email": "hcansee@aol.com",
"AddressType": "HomeAddress",
"State": "Massachusetts",
"Country": "United States of America",
"FirstName": "Judy",
"LastName": "Taylor",
"MaritalStatus": null,
"BirthDate": "1964-02-13",
"Smoker": "Never",
"Gender": "Female",
"Name": "Judy Taylor",
"HomePhone": "(617) 987-3214",
"Address1": "359 WILLOW WAY N",
"City": "ALEXANDER CITY",
"PostalCode": "35010-6259"
}
},
{
"PartyType": "PERSON",
"Role": "PRIMARYWRITINGAGENT",
"GovtId": null,
"HasDriversLicense": false,
"Agent": {
"Id": "48233",
"Name": "Christine Anderson",
"Percent": 100
},
"Person": {
"BestMethodOfContact": null,
"AddressType": "HomeAddress",
"State": "Massachusetts",
"Country": "United States of America",
"FirstName": "Christine",
"LastName": "Anderson",
"MaritalStatus": null,
"BirthDate": null,
"Gender": null,
"Name": "Christine Anderson",
"Address1": "1 Linscott Road",
"City": "Woburn",
"PostalCode": "01801"
}
},
{
"PartyType": "PERSON",
"Role": "PRIMARYWRITINGAGENT",
"GovtId": null,
"HasDriversLicense": false,
"Agent": {
"Id": "48233",
"Name": "Christine Anderson",
"Percent": 100
},
"Person": {
"BestMethodOfContact": null,
"AddressType": "HomeAddress",
"State": "Massachusetts",
"Country": "United States of America",
"FirstName": "Christine",
"LastName": "Anderson",
"MaritalStatus": null,
"BirthDate": null,
"Gender": null,
"Name": "Christine Anderson",
"Address1": "1 Linscott Road",
"City": "Woburn",
"PostalCode": "01801"
}
},
{
"PartyType": "ORGANIZATION",
"Role": "AGENCY",
"GovtId": null,
"HasDriversLicense": false,
"Agent": {
"Id": "00901",
"Name": "SBLI - WOBURN",
"Percent": 0
},
"Person": {
"BestMethodOfContact": null,
"Email": "Noreply_MBORISLOW@test.com",
"AddressType": "HomeAddress",
"State": "Massachusetts",
"Country": "United States of America",
"FirstName": "SBLI",
"LastName": " - WOBURN",
"MaritalStatus": null,
"BirthDate": null,
"Gender": null,
"CellPhone": "",
"Name": "SBLI - WOBURN",
"HomePhone": "",
"Address1": "1 Linscott Road",
"City": "Woburn",
"PostalCode": "01801"
},
"IDReferenceNo": "00901"
},
{
"PartyType": "PERSON",
"Role": "SERVICINGAGENT",
"GovtId": null,
"HasDriversLicense": false,
"Agent": {
"Id": "00901",
"Name": "SBLI - DIGITAL",
"Percent": 100
},
"Person": {
"BestMethodOfContact": null,
"Email": "Noreply_MBORISLOW@test.com",
"AddressType": "HomeAddress",
"State": "Massachusetts",
"Country": "United States of America",
"FirstName": "SBLI",
"LastName": " - Digital",
"MiddleName": "-",
"MaritalStatus": null,
"BirthDate": null,
"Gender": null,
"CellPhone": "",
"Name": "SBLI - Digital",
"HomePhone": "",
"Address1": "1 Linscott Road",
"City": "Woburn",
"PostalCode": "01801"
},
"IDReferenceNo": "00901"
}
]
},
"PaymentMethod": null,
"PremiumAmount": 10.5
},
"QuestionsAnswers": [
{
"EffectiveDate": "2020-10-16T00:00:00",
"GroupId": 1,
"QuestionId": 0,
"LayoutQuestionIds": "",
"Label": "The following pages include a Medical Information section. Your answers to these questions will determine your eligibilty for your initial Benefit Amount and any additional riders.<br/><br/><strong>Need help?</strong> Call us at <a href='tel:1-866-282-7254'>866-282-7254</a>",
"Field": "Header01",
"DefaultValue": "",
"Answer": "",
"Required": false,
"RequiredMsg": "",
"ControlType": "Label",
"Order": 0,
"ReadOnly": true,
"ControlOptions": [],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 1,
"QuestionId": 1,
"LayoutQuestionIds": "1, 2",
"Label": "Your Height",
"Field": "HEIGHT",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Dropdown",
"Order": 0,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "4' 8''",
"CtrlOptionValue": "4_8"
},
{
"CtrlOptionKey": "4' 9''",
"CtrlOptionValue": "4_9"
},
{
"CtrlOptionKey": "4' 10''",
"CtrlOptionValue": "4_10"
},
{
"CtrlOptionKey": "4' 11''",
"CtrlOptionValue": "4_11"
},
{
"CtrlOptionKey": "5' 0''",
"CtrlOptionValue": "5_0"
},
{
"CtrlOptionKey": "5' 1''",
"CtrlOptionValue": "5_1"
},
{
"CtrlOptionKey": "5' 2''",
"CtrlOptionValue": "5_2"
},
{
"CtrlOptionKey": "5' 3''",
"CtrlOptionValue": "5_3"
},
{
"CtrlOptionKey": "5' 4''",
"CtrlOptionValue": "5_4"
},
{
"CtrlOptionKey": "5' 5''",
"CtrlOptionValue": "5_5"
},
{
"CtrlOptionKey": "5' 6''",
"CtrlOptionValue": "5_6"
},
{
"CtrlOptionKey": "5' 7''",
"CtrlOptionValue": "5_7"
},
{
"CtrlOptionKey": "5' 8''",
"CtrlOptionValue": "5_8"
},
{
"CtrlOptionKey": "5' 9''",
"CtrlOptionValue": "5_9"
},
{
"CtrlOptionKey": "5' 10''",
"CtrlOptionValue": "5_10"
},
{
"CtrlOptionKey": "5' 11''",
"CtrlOptionValue": "5_11"
},
{
"CtrlOptionKey": "6' 0''",
"CtrlOptionValue": "6_0"
},
{
"CtrlOptionKey": "6' 1''",
"CtrlOptionValue": "6_1"
},
{
"CtrlOptionKey": "6' 2''",
"CtrlOptionValue": "6_2"
},
{
"CtrlOptionKey": "6' 3''",
"CtrlOptionValue": "6_3"
},
{
"CtrlOptionKey": "6' 4''",
"CtrlOptionValue": "6_4"
},
{
"CtrlOptionKey": "6' 5''",
"CtrlOptionValue": "6_5"
},
{
"CtrlOptionKey": "6' 6''",
"CtrlOptionValue": "6_6"
},
{
"CtrlOptionKey": "6' 7''",
"CtrlOptionValue": "6_7"
},
{
"CtrlOptionKey": "6' 8''",
"CtrlOptionValue": "6_8"
},
{
"CtrlOptionKey": "6' 9''",
"CtrlOptionValue": "6_9"
},
{
"CtrlOptionKey": "6' 10''",
"CtrlOptionValue": "6_10"
},
{
"CtrlOptionKey": "6' 11''",
"CtrlOptionValue": "6_11"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 1,
"QuestionId": 2,
"LayoutQuestionIds": "1, 2",
"Label": "Your Weight",
"Field": "WEIGHT",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Text",
"Order": 0,
"ReadOnly": false,
"ControlOptions": [],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 1,
"QuestionId": 3,
"LayoutQuestionIds": "",
"Label": "A 'Yes' or 'No' button must be selected for <b>every question</b> below before you can continue. Please read each question carefully.",
"Field": "LABEL01",
"DefaultValue": "",
"Answer": "",
"Required": false,
"RequiredMsg": "",
"ControlType": "Label",
"Order": 0,
"ReadOnly": false,
"ControlOptions": [],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 1,
"QuestionId": 4,
"LayoutQuestionIds": "",
"Label": "<b>Are you currently, or in the last 6 months have you been:</b> <list><li>Confined to a hospital (other than for childbirth),</li><li>Bedridden, <b>or</b></li><li>Diagnosed by a licensed medical professional as having a terminal medical condition that is expected to result in death within the next twelve (12) months?</li></list>",
"Field": "MED01",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 1,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 1,
"QuestionId": 5,
"LayoutQuestionIds": "",
"Label": "<b>In the last 5 years, have you received home health care/assisted living care, or been confined to a:</b><list><li>prison/correctional facility,</li><li>nursing home, <b>or</b></li><li>psychiatric facility?</li></list>",
"Field": "MED02",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 2,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 1,
"QuestionId": 6,
"LayoutQuestionIds": "",
"Label": "<b>Have you ever been diagnosed or treated by a licensed medical professional for Acquired Immune Deficiency Syndrome (AIDS) and/or Human Immunodeficiency Virus (HIV)?</b>",
"Field": "MED03",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 3,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 1,
"QuestionId": 7,
"LayoutQuestionIds": "",
"Label": "<b>In the past 2 years, has a licensed medical professional advised you to have any tests (excluding those related to the AIDS virus), surgery or hospitalization which have not been received or completed?</b>",
"Field": "MED04",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 4,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 1,
"QuestionId": 8,
"LayoutQuestionIds": "",
"Label": "<b>Has a licensed medical professional ever advised you to have an organ transplant, or diagnosed you with, or given you treatment for:</b> <list><li>Amyotrophic Lateral Sclerosis,</li><li>Cirrhosis of the Liver,</li><li>Dementia <b>or</b></li><li>Alzheimer's disease?</li></list>",
"Field": "MED05",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 5,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 1,
"QuestionId": 9,
"LayoutQuestionIds": "",
"Label": "<b>Are you currently diagnosed with, or receiving treatment by a licensed medical professional for, any type of Cancer except for Basal or Squamous Cell Carcinoma?</b>",
"Field": "MED06",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 6,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 1,
"QuestionId": 10,
"LayoutQuestionIds": "",
"Label": "<b>Please note:</b> once submitted, your answers cannot be changed.",
"Field": "Label02",
"DefaultValue": "",
"Answer": "",
"Required": false,
"RequiredMsg": "",
"ControlType": "Label",
"Order": 0,
"ReadOnly": true,
"ControlOptions": [],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2020-10-16T00:00:00",
"GroupId": 2,
"QuestionId": 0,
"LayoutQuestionIds": "",
"Label": "Please answer a few more questions to help us determine what level of coverage you are eligible for. Remember to read the questions carefully, and answer either 'Yes' or 'No' to <strong>every question</strong>. If you need help, call us at <a href='tel:1-866-282-7254'>866-282-7254</a>",
"Field": "Header02",
"DefaultValue": "",
"Answer": "",
"Required": false,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 0,
"ReadOnly": true,
"ControlOptions": [],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 2,
"QuestionId": 1,
"LayoutQuestionIds": "",
"Label": "<b>Have you been diagnosed with, or received treatment by a licensed medical professional for complications of Diabetes, such as:</b> <list><li>Retinopathy,</li><li>Amputation,</li><li>Neuropathy,</li><li>Diabetic shock, <b>or</b></li><li>Coma?</li></list>",
"Field": "MED07",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 1,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 2,
"QuestionId": 2,
"LayoutQuestionIds": "",
"Label": "<b>In the past 24 months, have you been diagnosed with, or received treatment by a licensed medical professional for any type of Cancer, including Melanoma (except for Basal or Squamous Cell Carcinoma), Lymphoma, or Leukemia, or has a licensed medical professional performed an amputation on you due to any complication for any impairment?</b>",
"Field": "MED08",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 2,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 2,
"QuestionId": 3,
"LayoutQuestionIds": "",
"Label": "<b>In the past 24 months, have you been diagnosed with, or received treatment by a licensed medical professional for:</b><list><li>Stroke or TIA,</li><li>Hepatitis C or Chronic Hepatitis,</li><li>Chronic Pancreatitis,</li><li>Chronic Obstructive Pulmonary Disease, <b>or</b></li><li>Emphysema?</li></list>",
"Field": "MED09",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 3,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 2,
"QuestionId": 4,
"LayoutQuestionIds": "",
"Label": "<b>In the past 24 months, have you been diagnosed with, or received treatment by a licensed medical professional for:</b> <list><li>Coronary Artery Disease,</li><li>Angina,</li><li>Aneurysm,</li><li>Heart Valve Disease,</li><li>Congestive Heart Failure, <b>or</b></li><li>Cardiomyopathy?</li></list>",
"Field": "MED10",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 4,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 2,
"QuestionId": 5,
"LayoutQuestionIds": "",
"Label": "<b>In the past 24 months, have any of the following occurred:</b> <list><li>You have used narcotics, barbiturates, amphetamines, hallucinogens, heroin, cocaine, or other habit forming drugs, except as prescribed by a licensed medical professional,</li><li>A licensed medical professional has recommended that you receive counseling or treatment for alcohol or drugs,</li><li>you have been convicted of driving under the influence of alcohol or drugs, you have been convicted of any felony?</li></list>",
"Field": "MED11",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 5,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 2,
"QuestionId": 6,
"LayoutQuestionIds": "",
"Label": "<b>In the past 24 months, has a licensed medical professional placed you on a defibrillator, advised you to use oxygen equipment, or inserted a pacemaker?</b>",
"Field": "MED12",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 6,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 2,
"QuestionId": 7,
"LayoutQuestionIds": "",
"Label": "<b>Please note:</b> once submitted, your answers cannot be changed.",
"Field": "Label02",
"DefaultValue": "",
"Answer": "",
"Required": false,
"RequiredMsg": "",
"ControlType": "Label",
"Order": 0,
"ReadOnly": true,
"ControlOptions": [],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2020-10-16T00:00:00",
"GroupId": 3,
"QuestionId": 0,
"LayoutQuestionIds": "",
"Label": "<b>Just a few questions to go... </b> <br/><br/>Please continue to read the questions carefully, and answer either 'Yes' or 'No' to <strong>every question</strong> to help us determine what level of coverage you are eligible for. If you need help, call us at <a href='tel:1-866-282-7254'>866-282-7254</a>",
"Field": "Header03",
"DefaultValue": "",
"Answer": "",
"Required": false,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 0,
"ReadOnly": true,
"ControlOptions": [],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2020-10-16T00:00:00",
"GroupId": 3,
"QuestionId": 1,
"LayoutQuestionIds": "",
"Label": "Within the last 5 years, have you been diagnosed with, received treatment by a licensed medical professional for, or been hospitalized for Bipolar, Schizophrenia or any other mental disorder?",
"Field": "MED13",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 1,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 3,
"QuestionId": 2,
"LayoutQuestionIds": "",
"Label": "<b>Within the last 5 years, have you been diagnosed with, or received treatment by a licensed medical professional for:</b> <list><li>Systemic Lupus Erythematosus,</li><li>Parkinson's Disease,</li><li>Multiple Sclerosis, <b>or</b></li><li>Sickle Cell Anemia?</li></list>",
"Field": "MED14",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 2,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 3,
"QuestionId": 3,
"LayoutQuestionIds": "",
"Label": "<b>Within the last 5 years, have you been diagnosed with, or received treatment by a licensed medical professional for:</b> <list><li>Stroke,</li><li>Heart Disease,</li><li>Aneurysm <b>or</b></li><li>Any other cardiovascular disease?</li></list>",
"Field": "MED15",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 3,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 3,
"QuestionId": 4,
"LayoutQuestionIds": "",
"Label": "<b>Within the last 5 years, have you been diagnosed with, or received treatment by a licensed medical professional for:<list><li>Chronic Obstructive Pulmonary Disease,</li><li>Emphysema, <b>or</b></li><li>Hepatitis C?</li></list></b>",
"Field": "MED16",
"DefaultValue": "",
"Answer": "",
"Required": true,
"RequiredMsg": "",
"ControlType": "Radio",
"Order": 4,
"ReadOnly": false,
"ControlOptions": [
{
"CtrlOptionKey": "Yes",
"CtrlOptionValue": "Y"
},
{
"CtrlOptionKey": "No",
"CtrlOptionValue": "N"
}
],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
},
{
"EffectiveDate": "2019-01-01T00:00:00",
"GroupId": 3,
"QuestionId": 5,
"LayoutQuestionIds": "",
"Label": "<b>Please note:</b> once submitted, your answers cannot be changed.",
"Field": "Label02",
"DefaultValue": "",
"Answer": "",
"Required": false,
"RequiredMsg": "",
"ControlType": "Label",
"Order": 0,
"ReadOnly": true,
"ControlOptions": [],
"ReflectiveExpression": "",
"ReflectiveQuestion": [],
"Decision": ""
}
],
"FrontEndData": "{\"bAuthCoverage\":true,\"bReadonlyForm\":true,\"tmptestid\":\"666473655\",\"tmptestdob\":\"1964-02-13\",\"tmptestgdr\":\"Female\"}"
}
application/xml
Sample:
RESPONSE
<LifeApplication xmlns:i="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">
<AgencyId>00919</AgencyId>
<BirthDate>1964-02-13T00:00:00</BirthDate>
<CaseId>10814</CaseId>
<ClassId>NONE</ClassId>
<CompanyId>CP</CompanyId>
<FrontEndData>{"bAuthCoverage":true,"bReadonlyForm":true,"tmptestid":"666473655","tmptestdob":"1964-02-13","tmptestgdr":"Female"}</FrontEndData>
<GovtIdLast4>3655</GovtIdLast4>
<LastGroupId>0</LastGroupId>
<PaymentTokenId i:nil="true" />
<PlanId>FELD01</PlanId>
<PlatformId i:nil="true" />
<Policy>
<IssueState xmlns="">Massachusetts</IssueState>
<Life xmlns="">
<FaceAmount>2000</FaceAmount>
<CoverageRecords>
<Coverages xmlns:d5p1="http://schemas.datacontract.org/2004/07/LPESService">
<d5p1:SBLICoverage>
<d5p1:BirthDate>1964-02-13T00:00:00</d5p1:BirthDate>
<d5p1:CovProductCode>FELD01</d5p1:CovProductCode>
<d5p1:CovIndicator>Base</d5p1:CovIndicator>
<d5p1:CovParticipant>Primary_Insured</d5p1:CovParticipant>
<d5p1:CovTypeCd>Term_Level_Death_Benefit</d5p1:CovTypeCd>
<d5p1:FaceAmount>2000</d5p1:FaceAmount>
</d5p1:SBLICoverage>
</Coverages>
</CoverageRecords>
</Life>
<PartyRecords xmlns="">
<Partys>
<Party>
<DriversLicenseNumber>5097996</DriversLicenseNumber>
<DriversLicenseState>Massachusetts</DriversLicenseState>
<GovtId>666473655</GovtId>
<HasDriversLicense>true</HasDriversLicense>
<PartyType>PERSON</PartyType>
<Person>
<Name>Judy Taylor</Name>
<Address1>359 WILLOW WAY N</Address1>
<City>ALEXANDER CITY</City>
<State>Massachusetts</State>
<PostalCode>35010-6259</PostalCode>
<Country>United States of America</Country>
<AddressType xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">HomeAddress</AddressType>
<Email xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">hcansee@aol.com</Email>
<BestMethodOfContact>HOMEPHONE</BestMethodOfContact>
<LegalResident>true</LegalResident>
<FirstName>Judy</FirstName>
<LastName>Taylor</LastName>
<MaritalStatus i:nil="true" />
<BirthDate>1964-02-13</BirthDate>
<Smoker>Never</Smoker>
<Gender>Female</Gender>
<HomePhone>(617) 987-3214</HomePhone>
</Person>
<Role>INSURED</Role>
</Party>
<Party>
<Agent>
<Id>00901</Id>
<Name>SBLI - DIGITAL</Name>
<Percent>100</Percent>
</Agent>
<GovtId i:nil="true" />
<HasDriversLicense>false</HasDriversLicense>
<IDReferenceNo>00901</IDReferenceNo>
<PartyType>PERSON</PartyType>
<Person>
<Name>SBLI - Digital</Name>
<Address1>1 Linscott Road</Address1>
<City>Woburn</City>
<State>Massachusetts</State>
<PostalCode>01801</PostalCode>
<Country>United States of America</Country>
<AddressType xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">HomeAddress</AddressType>
<Email xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">Noreply_MBORISLOW@test.com</Email>
<BestMethodOfContact i:nil="true" />
<FirstName>SBLI</FirstName>
<LastName> - Digital</LastName>
<MiddleName>-</MiddleName>
<MaritalStatus i:nil="true" />
<BirthDate i:nil="true" />
<Gender i:nil="true" />
<CellPhone></CellPhone>
<HomePhone></HomePhone>
</Person>
<Role>PRIMARYWRITINGAGENT</Role>
</Party>
<Party>
<DriversLicenseNumber>5097996</DriversLicenseNumber>
<DriversLicenseState>Massachusetts</DriversLicenseState>
<GovtId>666473655</GovtId>
<HasDriversLicense>true</HasDriversLicense>
<PartyType>PERSON</PartyType>
<Person>
<Name>Judy Taylor</Name>
<Address1>359 WILLOW WAY N</Address1>
<City>ALEXANDER CITY</City>
<State>Massachusetts</State>
<PostalCode>35010-6259</PostalCode>
<Country>United States of America</Country>
<AddressType xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">HomeAddress</AddressType>
<Email xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">hcansee@aol.com</Email>
<BestMethodOfContact>HOMEPHONE</BestMethodOfContact>
<LegalResident>true</LegalResident>
<FirstName>Judy</FirstName>
<LastName>Taylor</LastName>
<MaritalStatus i:nil="true" />
<BirthDate>1964-02-13</BirthDate>
<Smoker>Never</Smoker>
<Gender>Female</Gender>
<HomePhone>(617) 987-3214</HomePhone>
</Person>
<Role>INSURED</Role>
</Party>
<Party>
<Agent>
<Id>48233</Id>
<Name>Christine Anderson</Name>
<Percent>100</Percent>
</Agent>
<GovtId i:nil="true" />
<HasDriversLicense>false</HasDriversLicense>
<PartyType>PERSON</PartyType>
<Person>
<Name>Christine Anderson</Name>
<Address1>1 Linscott Road</Address1>
<City>Woburn</City>
<State>Massachusetts</State>
<PostalCode>01801</PostalCode>
<Country>United States of America</Country>
<AddressType xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">HomeAddress</AddressType>
<BestMethodOfContact i:nil="true" />
<FirstName>Christine</FirstName>
<LastName>Anderson</LastName>
<MaritalStatus i:nil="true" />
<BirthDate i:nil="true" />
<Gender i:nil="true" />
</Person>
<Role>PRIMARYWRITINGAGENT</Role>
</Party>
<Party>
<Agent>
<Id>48233</Id>
<Name>Christine Anderson</Name>
<Percent>100</Percent>
</Agent>
<GovtId i:nil="true" />
<HasDriversLicense>false</HasDriversLicense>
<PartyType>PERSON</PartyType>
<Person>
<Name>Christine Anderson</Name>
<Address1>1 Linscott Road</Address1>
<City>Woburn</City>
<State>Massachusetts</State>
<PostalCode>01801</PostalCode>
<Country>United States of America</Country>
<AddressType xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">HomeAddress</AddressType>
<BestMethodOfContact i:nil="true" />
<FirstName>Christine</FirstName>
<LastName>Anderson</LastName>
<MaritalStatus i:nil="true" />
<BirthDate i:nil="true" />
<Gender i:nil="true" />
</Person>
<Role>PRIMARYWRITINGAGENT</Role>
</Party>
<Party>
<Agent>
<Id>00901</Id>
<Name>SBLI - WOBURN</Name>
<Percent>0</Percent>
</Agent>
<GovtId i:nil="true" />
<HasDriversLicense>false</HasDriversLicense>
<IDReferenceNo>00901</IDReferenceNo>
<PartyType>ORGANIZATION</PartyType>
<Person>
<Name>SBLI - WOBURN</Name>
<Address1>1 Linscott Road</Address1>
<City>Woburn</City>
<State>Massachusetts</State>
<PostalCode>01801</PostalCode>
<Country>United States of America</Country>
<AddressType xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">HomeAddress</AddressType>
<Email xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">Noreply_MBORISLOW@test.com</Email>
<BestMethodOfContact i:nil="true" />
<FirstName>SBLI</FirstName>
<LastName> - WOBURN</LastName>
<MaritalStatus i:nil="true" />
<BirthDate i:nil="true" />
<Gender i:nil="true" />
<CellPhone></CellPhone>
<HomePhone></HomePhone>
</Person>
<Role>AGENCY</Role>
</Party>
<Party>
<Agent>
<Id>00901</Id>
<Name>SBLI - DIGITAL</Name>
<Percent>100</Percent>
</Agent>
<GovtId i:nil="true" />
<HasDriversLicense>false</HasDriversLicense>
<IDReferenceNo>00901</IDReferenceNo>
<PartyType>PERSON</PartyType>
<Person>
<Name>SBLI - Digital</Name>
<Address1>1 Linscott Road</Address1>
<City>Woburn</City>
<State>Massachusetts</State>
<PostalCode>01801</PostalCode>
<Country>United States of America</Country>
<AddressType xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">HomeAddress</AddressType>
<Email xmlns="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Request">Noreply_MBORISLOW@test.com</Email>
<BestMethodOfContact i:nil="true" />
<FirstName>SBLI</FirstName>
<LastName> - Digital</LastName>
<MiddleName>-</MiddleName>
<MaritalStatus i:nil="true" />
<BirthDate i:nil="true" />
<Gender i:nil="true" />
<CellPhone></CellPhone>
<HomePhone></HomePhone>
</Person>
<Role>SERVICINGAGENT</Role>
</Party>
</Partys>
</PartyRecords>
<PaymentMethod i:nil="true" xmlns="" />
<PaymentMode xmlns="">MonthOrMonthly</PaymentMode>
<PremiumAmount xmlns="">10.5</PremiumAmount>
<Producer xmlns="">
<ExistingInsurance>false</ExistingInsurance>
<FinanceFromExistingInsurance>false</FinanceFromExistingInsurance>
<ChangeOwnership>false</ChangeOwnership>
<FinancedByThirdParty>false</FinancedByThirdParty>
<InducedToApply>false</InducedToApply>
<LaunderingTraining>false</LaunderingTraining>
<Incompliance>false</Incompliance>
</Producer>
<Replacement xmlns="">false</Replacement>
</Policy>
<PrevUpdateDate>0001-01-01T00:00:00</PrevUpdateDate>
<QuestionsAnswers xmlns:d2p1="http://schemas.datacontract.org/2004/07/SAM.BusinessDto.Platform.Response">
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions />
<d2p1:ControlType>Label</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2020-10-16T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>Header01</d2p1:Field>
<d2p1:GroupId>1</d2p1:GroupId>
<d2p1:Label>The following pages include a Medical Information section. Your answers to these questions will determine your eligibilty for your initial Benefit Amount and any additional riders.<br/><br/><strong>Need help?</strong> Call us at <a href=&apos;tel:1-866-282-7254&apos;>866-282-7254</a></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>0</d2p1:Order>
<d2p1:QuestionId>0</d2p1:QuestionId>
<d2p1:ReadOnly>true</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>false</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>4' 8''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>4_8</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>4' 9''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>4_9</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>4' 10''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>4_10</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>4' 11''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>4_11</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>5' 0''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>5_0</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>5' 1''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>5_1</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>5' 2''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>5_2</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>5' 3''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>5_3</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>5' 4''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>5_4</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>5' 5''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>5_5</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>5' 6''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>5_6</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>5' 7''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>5_7</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>5' 8''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>5_8</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>5' 9''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>5_9</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>5' 10''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>5_10</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>5' 11''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>5_11</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>6' 0''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>6_0</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>6' 1''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>6_1</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>6' 2''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>6_2</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>6' 3''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>6_3</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>6' 4''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>6_4</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>6' 5''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>6_5</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>6' 6''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>6_6</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>6' 7''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>6_7</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>6' 8''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>6_8</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>6' 9''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>6_9</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>6' 10''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>6_10</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>6' 11''</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>6_11</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Dropdown</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>HEIGHT</d2p1:Field>
<d2p1:GroupId>1</d2p1:GroupId>
<d2p1:Label>Your Height</d2p1:Label>
<d2p1:LayoutQuestionIds>1, 2</d2p1:LayoutQuestionIds>
<d2p1:Order>0</d2p1:Order>
<d2p1:QuestionId>1</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions />
<d2p1:ControlType>Text</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>WEIGHT</d2p1:Field>
<d2p1:GroupId>1</d2p1:GroupId>
<d2p1:Label>Your Weight</d2p1:Label>
<d2p1:LayoutQuestionIds>1, 2</d2p1:LayoutQuestionIds>
<d2p1:Order>0</d2p1:Order>
<d2p1:QuestionId>2</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions />
<d2p1:ControlType>Label</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>LABEL01</d2p1:Field>
<d2p1:GroupId>1</d2p1:GroupId>
<d2p1:Label>A &apos;Yes&apos; or &apos;No&apos; button must be selected for <b>every question</b> below before you can continue. Please read each question carefully.</d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>0</d2p1:Order>
<d2p1:QuestionId>3</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>false</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED01</d2p1:Field>
<d2p1:GroupId>1</d2p1:GroupId>
<d2p1:Label><b>Are you currently, or in the last 6 months have you been:</b> <list><li>Confined to a hospital (other than for childbirth),</li><li>Bedridden, <b>or</b></li><li>Diagnosed by a licensed medical professional as having a terminal medical condition that is expected to result in death within the next twelve (12) months?</li></list></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>1</d2p1:Order>
<d2p1:QuestionId>4</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED02</d2p1:Field>
<d2p1:GroupId>1</d2p1:GroupId>
<d2p1:Label><b>In the last 5 years, have you received home health care/assisted living care, or been confined to a:</b><list><li>prison/correctional facility,</li><li>nursing home, <b>or</b></li><li>psychiatric facility?</li></list></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>2</d2p1:Order>
<d2p1:QuestionId>5</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED03</d2p1:Field>
<d2p1:GroupId>1</d2p1:GroupId>
<d2p1:Label><b>Have you ever been diagnosed or treated by a licensed medical professional for Acquired Immune Deficiency Syndrome (AIDS) and/or Human Immunodeficiency Virus (HIV)?</b></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>3</d2p1:Order>
<d2p1:QuestionId>6</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED04</d2p1:Field>
<d2p1:GroupId>1</d2p1:GroupId>
<d2p1:Label><b>In the past 2 years, has a licensed medical professional advised you to have any tests (excluding those related to the AIDS virus), surgery or hospitalization which have not been received or completed?</b></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>4</d2p1:Order>
<d2p1:QuestionId>7</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED05</d2p1:Field>
<d2p1:GroupId>1</d2p1:GroupId>
<d2p1:Label><b>Has a licensed medical professional ever advised you to have an organ transplant, or diagnosed you with, or given you treatment for:</b> <list><li>Amyotrophic Lateral Sclerosis,</li><li>Cirrhosis of the Liver,</li><li>Dementia <b>or</b></li><li>Alzheimer&apos;s disease?</li></list></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>5</d2p1:Order>
<d2p1:QuestionId>8</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED06</d2p1:Field>
<d2p1:GroupId>1</d2p1:GroupId>
<d2p1:Label><b>Are you currently diagnosed with, or receiving treatment by a licensed medical professional for, any type of Cancer except for Basal or Squamous Cell Carcinoma?</b></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>6</d2p1:Order>
<d2p1:QuestionId>9</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions />
<d2p1:ControlType>Label</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>Label02</d2p1:Field>
<d2p1:GroupId>1</d2p1:GroupId>
<d2p1:Label><b>Please note:</b> once submitted, your answers cannot be changed.</d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>0</d2p1:Order>
<d2p1:QuestionId>10</d2p1:QuestionId>
<d2p1:ReadOnly>true</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>false</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions />
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2020-10-16T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>Header02</d2p1:Field>
<d2p1:GroupId>2</d2p1:GroupId>
<d2p1:Label>Please answer a few more questions to help us determine what level of coverage you are eligible for. Remember to read the questions carefully, and answer either &apos;Yes&apos; or &apos;No&apos; to <strong>every question</strong>. If you need help, call us at <a href=&apos;tel:1-866-282-7254&apos;>866-282-7254</a></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>0</d2p1:Order>
<d2p1:QuestionId>0</d2p1:QuestionId>
<d2p1:ReadOnly>true</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>false</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED07</d2p1:Field>
<d2p1:GroupId>2</d2p1:GroupId>
<d2p1:Label><b>Have you been diagnosed with, or received treatment by a licensed medical professional for complications of Diabetes, such as:</b> <list><li>Retinopathy,</li><li>Amputation,</li><li>Neuropathy,</li><li>Diabetic shock, <b>or</b></li><li>Coma?</li></list></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>1</d2p1:Order>
<d2p1:QuestionId>1</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED08</d2p1:Field>
<d2p1:GroupId>2</d2p1:GroupId>
<d2p1:Label><b>In the past 24 months, have you been diagnosed with, or received treatment by a licensed medical professional for any type of Cancer, including Melanoma (except for Basal or Squamous Cell Carcinoma), Lymphoma, or Leukemia, or has a licensed medical professional performed an amputation on you due to any complication for any impairment?</b></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>2</d2p1:Order>
<d2p1:QuestionId>2</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED09</d2p1:Field>
<d2p1:GroupId>2</d2p1:GroupId>
<d2p1:Label><b>In the past 24 months, have you been diagnosed with, or received treatment by a licensed medical professional for:</b><list><li>Stroke or TIA,</li><li>Hepatitis C or Chronic Hepatitis,</li><li>Chronic Pancreatitis,</li><li>Chronic Obstructive Pulmonary Disease, <b>or</b></li><li>Emphysema?</li></list></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>3</d2p1:Order>
<d2p1:QuestionId>3</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED10</d2p1:Field>
<d2p1:GroupId>2</d2p1:GroupId>
<d2p1:Label><b>In the past 24 months, have you been diagnosed with, or received treatment by a licensed medical professional for:</b> <list><li>Coronary Artery Disease,</li><li>Angina,</li><li>Aneurysm,</li><li>Heart Valve Disease,</li><li>Congestive Heart Failure, <b>or</b></li><li>Cardiomyopathy?</li></list></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>4</d2p1:Order>
<d2p1:QuestionId>4</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED11</d2p1:Field>
<d2p1:GroupId>2</d2p1:GroupId>
<d2p1:Label><b>In the past 24 months, have any of the following occurred:</b> <list><li>You have used narcotics, barbiturates, amphetamines, hallucinogens, heroin, cocaine, or other habit forming drugs, except as prescribed by a licensed medical professional,</li><li>A licensed medical professional has recommended that you receive counseling or treatment for alcohol or drugs,</li><li>you have been convicted of driving under the influence of alcohol or drugs, you have been convicted of any felony?</li></list></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>5</d2p1:Order>
<d2p1:QuestionId>5</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED12</d2p1:Field>
<d2p1:GroupId>2</d2p1:GroupId>
<d2p1:Label><b>In the past 24 months, has a licensed medical professional placed you on a defibrillator, advised you to use oxygen equipment, or inserted a pacemaker?</b></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>6</d2p1:Order>
<d2p1:QuestionId>6</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions />
<d2p1:ControlType>Label</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>Label02</d2p1:Field>
<d2p1:GroupId>2</d2p1:GroupId>
<d2p1:Label><b>Please note:</b> once submitted, your answers cannot be changed.</d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>0</d2p1:Order>
<d2p1:QuestionId>7</d2p1:QuestionId>
<d2p1:ReadOnly>true</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>false</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions />
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2020-10-16T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>Header03</d2p1:Field>
<d2p1:GroupId>3</d2p1:GroupId>
<d2p1:Label><b>Just a few questions to go... </b> <br/><br/>Please continue to read the questions carefully, and answer either &apos;Yes&apos; or &apos;No&apos; to <strong>every question</strong> to help us determine what level of coverage you are eligible for. If you need help, call us at <a href=&apos;tel:1-866-282-7254&apos;>866-282-7254</a></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>0</d2p1:Order>
<d2p1:QuestionId>0</d2p1:QuestionId>
<d2p1:ReadOnly>true</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>false</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2020-10-16T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED13</d2p1:Field>
<d2p1:GroupId>3</d2p1:GroupId>
<d2p1:Label>Within the last 5 years, have you been diagnosed with, received treatment by a licensed medical professional for, or been hospitalized for Bipolar, Schizophrenia or any other mental disorder?</d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>1</d2p1:Order>
<d2p1:QuestionId>1</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED14</d2p1:Field>
<d2p1:GroupId>3</d2p1:GroupId>
<d2p1:Label><b>Within the last 5 years, have you been diagnosed with, or received treatment by a licensed medical professional for:</b> <list><li>Systemic Lupus Erythematosus,</li><li>Parkinson&apos;s Disease,</li><li>Multiple Sclerosis, <b>or</b></li><li>Sickle Cell Anemia?</li></list></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>2</d2p1:Order>
<d2p1:QuestionId>2</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED15</d2p1:Field>
<d2p1:GroupId>3</d2p1:GroupId>
<d2p1:Label><b>Within the last 5 years, have you been diagnosed with, or received treatment by a licensed medical professional for:</b> <list><li>Stroke,</li><li>Heart Disease,</li><li>Aneurysm <b>or</b></li><li>Any other cardiovascular disease?</li></list></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>3</d2p1:Order>
<d2p1:QuestionId>3</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>Yes</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>Y</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
<d2p1:RuleEngineCtrlOptionDto>
<d2p1:CtrlOptionKey>No</d2p1:CtrlOptionKey>
<d2p1:CtrlOptionValue>N</d2p1:CtrlOptionValue>
</d2p1:RuleEngineCtrlOptionDto>
</d2p1:ControlOptions>
<d2p1:ControlType>Radio</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>MED16</d2p1:Field>
<d2p1:GroupId>3</d2p1:GroupId>
<d2p1:Label><b>Within the last 5 years, have you been diagnosed with, or received treatment by a licensed medical professional for:<list><li>Chronic Obstructive Pulmonary Disease,</li><li>Emphysema, <b>or</b></li><li>Hepatitis C?</li></list></b></d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>4</d2p1:Order>
<d2p1:QuestionId>4</d2p1:QuestionId>
<d2p1:ReadOnly>false</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>true</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
<d2p1:RuleEngineQuestionDto>
<d2p1:Answer></d2p1:Answer>
<d2p1:ControlOptions />
<d2p1:ControlType>Label</d2p1:ControlType>
<d2p1:Decision></d2p1:Decision>
<d2p1:DefaultValue></d2p1:DefaultValue>
<d2p1:EffectiveDate>2019-01-01T00:00:00</d2p1:EffectiveDate>
<d2p1:Field>Label02</d2p1:Field>
<d2p1:GroupId>3</d2p1:GroupId>
<d2p1:Label><b>Please note:</b> once submitted, your answers cannot be changed.</d2p1:Label>
<d2p1:LayoutQuestionIds></d2p1:LayoutQuestionIds>
<d2p1:Order>0</d2p1:Order>
<d2p1:QuestionId>5</d2p1:QuestionId>
<d2p1:ReadOnly>true</d2p1:ReadOnly>
<d2p1:ReflectiveExpression></d2p1:ReflectiveExpression>
<d2p1:ReflectiveQuestion />
<d2p1:Required>false</d2p1:Required>
<d2p1:RequiredMsg></d2p1:RequiredMsg>
</d2p1:RuleEngineQuestionDto>
</QuestionsAnswers>
<RulebaseId>FinalExpense</RulebaseId>
<RulebaseIssueState>Massachusetts</RulebaseIssueState>
<ScreenTagName>/confirmeditsyou</ScreenTagName>
<TwoFactorContactText i:nil="true" />
<TwoFactorContactType i:nil="true" />
<UwDecision i:nil="true" />
<UwDecisionText i:nil="true" />
</LifeApplication>