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Personal Informations
First name / Last Name
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Email address
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Zone
Zone 3
Zone 2
Zone 1
People to be insured
(please specify the age at the time of subscription)
Age of first over 18 years old adult
( 18-69 )
Age of second adult
( optional, 18-69 )
Age of third adult
( optional, 18-69 )
Age of fourth adult
( optional, 18-69 )
Number of less 18 years old children
( optional, 0-9 )
Apply now ! New rates will be in force next January 1st, 2025.
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Use this form to choose the right plan and the right deductible for you and your family
Zone 1
Worldwide
Zone 2
Worldwide excluding USA
Zone 3
Worldwide excluding USA, Canada, China, United Kingdom, Hong Kong, Singapore, Switzerland, Australia, Brazil, Chile, Mexico
