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International Insurance

A Fresh Perspective on changing landscape of healthcare.

Our patient centric advisory service is a bespoke model for "patients without borders" that connects you safely and economically to world class medical doctors and globally recognized and accredited hospitals providing highest quality of patient care.

New Applicant
Benefits
Individual Quote
Group Quote
  • Personal Details
  • Eligibility
  • Build A Plan
  • Quote Summary
  • Apply
Oops, you missed something. Please enter the information for the required (*) fields.
First Name *
Middle Name
Last Name*
Create user id (email) *
Corporate user id
Password *
Confirm password *
Password protection question *
Answer *
Tel #
Please provide country code/ area code
Mobile #
Please provide country code/ area code
Primary Policy Holder*
Date of birth :
Gender :
First Name:
Last Name:
Date of birth :
Gender :
Coverage Effective Date *
Broker Code
 
DMAGroup registered broker pls enter your broker code
 
Oops, you missed something. Please enter the information for the required (*) fields.
Primary Policy Holder Nationality*
Primary Policy Holder Country of Residence*
Is this coverage for your country of nationality and/country of residence?*
Country of coverage cannot be same as country of Nationality/ Residence
Yes
No
Do you have a pre-existing conditions?
Yes
No
Describe your pre-existing conditions
20 words
Do you / dependent have disability, pre-existing conditions or a chronic disease? *
Yes
No
Not sure
Pls. explain
20 words
Any of your dependents has disability, pre-existing conditions or a chronic disease? *
Yes
No
Not sure
Pls. explain
20 words
Have you or dependent on this application been admitted to hospital in last five years? *
Yes
No
Pls. explain
20 words
Have you or dependent on this application been prescribed with a course of drugs or medication, or treatments for the period in excess of fourteen days in last two years? *
Yes
No
Pls. explain
20 words
Are there any other facts you should state which can be responsible or deteriorating the health condition for you or your dependent? *
Yes
No
Pls. explain
20 words
Are you or your dependent alcholic? *
Yes
No
Are you or your dependent frequent smoker? *
Yes
No
Do you or your dependent has any kind of travel restrictions? *
Yes
No
 
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Select Global in-Network coverage*
Select
Cost
Gold
Platinum
Summary/Total
PLAN A
Core coverage
Inclusive
PLAN B
Core + Executive coverage
Inclusive
Plan-z
Concierge Services
Complimentary
Value Added Products/Services
Product
Maternity Plan
Inclusive
or
Product
Dental Plan
Inclusive
or
Oops, you missed something. Please enter the information for the required (*) fields.
Summary of the plan
1 Plan A Amount
2
Covered individuals:
3
Coupon or promotion code
4 Total
 
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Address 1*
Address 2(apt/suite#)
City *
 
Country*
State/province
Zip/postal code*
 
LET'S CHAT
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Please provide country code/ area code
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Please provide day format as dd/mm/yyyy.
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DMA GROUPS
Pvt. Health International Insurance- Core Plan
Download a DMAGroup® Plus Infosheet
 
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