Health Insurance Application Form

apply-and-payThank you for applying for our high-quality, cost-effective Health Insurance Plans. Your Security is of the utmost importance. Therefore, the data you enter below is sent directly to a real person and not to any database. Your data is totally secure and will NEVER be shared nor exported. Each application form is individually reviewed by an experienced underwriter who you may speak with directly in English. You will receive an email confirmation upon submission of this application form.

IMPORTANT! If you need proof of Health Insurance for a visa or residency permit, be sure that the start date and end date of the coverage period you select, meet or exceed the full term and length of your visa or residency permit.