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Private medical insurance : Enquiry form

This form is for requests for further information about private medical insurance for individuals. We will forward your request to suitable private health insurance brokers and providers. You can also request someone to call you to provide a quotation or discuss your requirements.


If you are seeking private medical insurance for business and the self-employed, use this enquiry form.

Private medical insurance: Get a quote

» Indicates required fields

PMI enquiry
Gender »
Are you looking for comprehensive or standard cover? »
I would like to receive a quote for »
Please fill in the ages of the first 3 of your children.
Paying your premium »
Have you smoked tobacco products in the last 3 years? »
Have you or any person included in this enquiry had an operation or hospital treatment, or visited a specialist/consultant in the last 3 years? »
Please provide further information »
Please provide a quotation
Please call me to discuss your services
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