FREE International Private Health Insurance Quotation

Please complete the Free, No Obligation quotation form below. 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.

*Required Fields
PERSONAL DETAILS
*MR./ MRS. /OTHER
*FIRST NAME
*LAST NAME
*DATE OF BIRTH
Day:  Month:  Year:
ADDRESS
TOWN/CITY
STATE/PROVINCE/COUNTY
POST/ZIP CODE
*NATIONALITY, AS ON PASSPORT
*COUNTRY/COUNTRIES IN WHICH COVER IS REQUIRED

If you require cover in more than one country, please advise the amount of time you are likely to spend in each country per year

*E-MAIL
*CONFIRM E-MAIL
*DAYTIME TELEPHONE NUMBER
HOME/MOBILE TELEPHONE NUMBER

*OCCUPATION
YOUR NEW POLICY
*DATE YOU REQUIRE COVER TO START
Day:  Month:  Year:
*TYPE OF COVER Single
Married Couple
Family
Parent and Child
PLEASE PROVIDE DETAILS
OF OTHER PEOPLE REQUIRING COVER
(NAMES AND DATES OF BIRTH)
ARE YOU LOOKING FOR
COMPREHENSIVE OR STANDARD COVER? 		Standard (no outpatient cover)
Comprehensive
Fully Comprehensive (maternity and dental)
DO YOU WISH TO PAY PREMIUMS Monthly Quarterly Annually
WHO WILL BE PAYING THE PREMIUMS? Myself My Employer
THE LENGTH OF TIME YOU WILL REQUIRE INTERNATIONAL HEALTH COVERAGE? One to two years
Indefinitely
CURRENCY Euros
Pounds Sterling
Dollar
No preference
OTHER COMMENTS & QUESTIONS
USE THIS BOX FOR ANY QUESTIONS THAT YOU MAY HAVE FOR US

IF YOU HAVE ANY PRE-EXISTING MEDICAL CONDITION OR ARE RECEIVING TREATMENT NOW OR IN THE RECENT PAST, YOU SHOULD ENTER DETAILS IN THIS SECTION.
WOULD YOU LIKE TO SUBSCRIBE TO THE APRIL MEDIBROKER NEWSLETTER? Yes - please send

On an annual basis we do 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. If you wish to be considered for this survey, please tick here.

Yes - I would like to participate in your customer satisfaction survey
HOW DID YOU DISCOVER OUR SITE? Search Engine:


Other, Please Specify:
IMAGE VERIFICATION
PLEASE SEND ME A FREE NO OBLIGATION QUOTATION BASED ON THE ABOVE

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.

   

Contact Us

  • International Telephone

+44 (0)191 297 2411

  • Freephone

0800 980 1082 (UK)

  • Email
clientservices@
medibroker.com

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We will be able to advise you on the best plan with the best premium according to your specific situation.

Medibroker Limited is regulated in the United Kingdom by the Financial Services Authority.
Our regulated Firm number is 304773.
Full details can be found on the FSA Register
You can contact the Financial Services Authority (FSA) at:
25 The North Colonnade, Canary Wharf, London E14 5HS.
You can also call their Consumer Helpline on 0845 606 1234.
Additional information can be obtained from www.fsa.gov.uk

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