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Email Address*

Policy Quotation and Documents will be emailed to this address.

Journey Start Date*

Which currency would you like to use*

Type of cover required*

A Family or Single Parent Family includes up to 3 children. There will be an increase in premium for each additional child.

Family (no children) implies a Married Couple (not partners or cohabitants)

You can apply for a child if they are over 12 years of age and accompanied by a guardian or the airline.

Number of adults over 65 to be covered*

Please insert the number of adults over the age of 65 years to be covered.

Quotes for applicants aged over 75 are subject to further underwriting considerations. Please email enquiries@ healthcareinternational.com requesting a quote and stating your age, nationality and country of residence. We will be in touch.

Select the type of policy required*

Annual policies are automatically renewed on an Annual basis, unless you instruct us not to. You need to let us know in writing that you wish to cancel before the policy renews. If you require cover for a lengthy period or for multiple trips each year, the Annual policy may be best suited to your needs.

Should you be a frequent flyer and require cover more multiple trips, then the Annual policy is also recommended.

Single Trip policies excludes multiple trips and covers you abroad between 30 and 90 days.

Select the area of cover required*

Worldwide includes all countries

Worldwide excl USA excludes the following country: USA

Europe includes the following countries:
Austria,
Belgium,
Denmark,
Finland,
France,
Germany,
Greece,
Iceland,
Ireland,
Italy,
Liechtenstein,
Luxembourg,
Malta,
Monaco,
Netherlands,
Norway,
Portugal,
San Marino,
Spain,
Sweden,
Switzerland,
United Kingdom

Select your country of departure*

Your cover starts from flight departure date & time.

Your cover will not start before this time.

Agent Code*

Agent Email Address*

Promotional code

If you have received any promotional codes, please insert them here for discounts or any other complimentary benefits. Discounts will be applied at the end of the application.

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