Short Term Cover

Call Back Request

Country Guides

Why do I need Insurance?

Why Choose April Medibroker?

FAQ's

Free Quote

Please complete the free, no obligation quotation form below. APRIL Medibroker will email international health insurance quotations to you within one working day.

We appreciate the time you take to provide us with all of this information – information which allows us to properly survey the market on your behalf to find the best and most suitable plans for your needs.

Alternatively, you may complete a call back request form and we will call you at a convenient time to give you information about our plans and answer any questions that you may have.

US citizens - Please note that we are unable to offer coverage to US citizens permanently resident in the USA (ie living in the USA for more than six months per year).

Short term cover - If you require cover for less than twelve months, please click here.

* Compulsory fields

1 - About you

Title  * : Mr Mrs Ms Miss Master Other

First name  * :

Last name  * :

Date of birth DD/MM/YYYY  * :  /   /

Nationality, as on passport  * :

Country/countries where cover required  * :

Occupation  :

Do you wish to include spouse/dependant  * : Yes No

2 - Cover required

Level of cover  * : Standard Comprehensive Fully Comprehensive

Length of cover  * : Less than 12 Months 1-2 Years 2-5 Years Indefinitely

*If less than 12 months - how many months  :

Start date required  * :  /   /

Currency required  * : Pounds Sterling US Dollars Euros

Premium frequency  * : Monthly Quartely Annually

3 - Medical history

If you have any pre-existing medical conditions or are currently receiving medical treatment, please provide details: If you don't have any pre-existing medical conditions or any medical treatment, please leave it blank.

4 - Contact details

E-mail address  * :

Confirm email address  * :

Alternative E-Mail Address  :

Daytime telephone number  * :

Address 1  :

Address 2  :

Town/ City  :

State / Province / County  :

Post/ Zip code  :

Country  * :

5 - Further information & Newsletter / Survey

Please use this box to provide any further information or ask any questions that you may have for us: If you don't have any further information or question, please leave it blank.

We offer an APRIL Medibroker newsletter by E-mail. Would you like to subscribe?  * : Yes No

On an annual basis we carry out a customer satisfaction survey (carried out in confidence by a third party market research company employed by APRIL GROUP) in order to assess our service levels and standards. Would you like to participate ?  * : Yes No

Image verification 5 + 9 =

Use of your information will solely by used by APRIL Medibroker and any personal information will remain confidential within normal procedures in advising on and completing applications for private medical insurance and associated plans. Your information will not be disclosed to any third parties outside of APRIL GROUP or used for unsolicited marketing.