Request your International Advantages quote Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 2Who is the policy for? Individual Couple Do you want cover for dependent children? Yes No Indicative prices for child(ren) are with the understanding that any child over age 17 is a full-time student (up to and including age 23).How many children are to be covered? 123+Main policyholider TitleDrMrMsMxName *FirstLastEmail *PhoneDate of birth *Spouse / domestic partner Name *FirstLastEmail *PhoneDate of birthCurrency US Dollar $ Euro € Pound Sterling £ What deductible would you like? $0$100$200$500$1,000$5,000What deductible would you like? €0€75€150€400€750€4,000What deductible would you like? £0£65£125£300£650£3,000CoverageWorldwideWorldwide excluding the USA / CanadaPreferred start dateNextHas anyone to be covered on this policy been treated or diagnosed for a medical condition in the last 15 years for anything other than colds, flu, or routine checkup? (Routine checkup is defined as a physical exam and / or blood test that are of a routine nature and not used to treat a medical condition).YesNoPlease select any conditions that have been diagnosed.Heart / Blood vesselsMental / Nervous disorderStroke / Blood pressure / HypertensionCancerRespiratory problems (including Asthma)Diabetes (and related problems)HIV / AIDS or related diseasesOrthopaedic problems and arthritis (back, joints etc)Urinary disorders (including bladder, kidney, prostate, urinary infections and incontinence)Gynaecological disorders (including heavy or irregular periods, endometriosis, infertility, fibroids, abnormal smears and polycystic ovaries)Neurological disordersStomach / IntestineHerniaEars / EyesImmune System DisordersSexually Transmitted InfectionsSkinThyroidAre any inpatient or outpatient medical/surgical or dental procedures or oral surgery (including diagnostic testing) recommended/contemplated for anyone to be covered on this policy? YesNoPlease provide detailsHas anyone to be covered on this policy experienced any symptoms of any medical problem in the last 12 months, regardless of whether a healthcare professional has been consulted?YesNoPlease provide detailsIs anyone to be covered on this policy currently taking any medication?YesNoPlease provide detailsHas anyone to be covered on this policy had an application or an application for reinstatement of Life, Accident, or Health Insurance declined, postponed, rated or modified?YesNoPlease provide detailsIs anyone to be covered on this policy pregnant? YesNoRequest your quote
