Detailed health insurance quote request

When do you want cover to start?
Are you looking for... Local cover International cover including US International cover excluding US	Do you want to... Top up existing cover Cover the bigger bills Cover 'everything'

Are you an expat? Yes
No

If yes, do you want the option to retain cover if you move 'home' to your home country? Yes
No

How Important is the Guarantee of Renewal? Very important
Not important

Title	First name	Last name
E-mail	Phone number

Notes / more persons to be insured / questions

Where did you learn about us?

About Us
Our Services
Our Staff
Terms & Conditions
US Website

Contact Us
Email: crew@navigator-insurance.com
Call: +852 2530 2530
Fax: +852 2530 2535

Address:
Navigator Insurance Brokers Ltd
Unit E, 8/F Golden Sun Centre
No. 59-67 Bonham Strand West
Sheung Wan, Hong Kong

Hospital accommodation Private room Semi-Private room	Maternity coverage Yes No	Evacuation coverage Yes No
Outpatient coverage High coverage Medium coverage Basic coverage No coverage	Dental coverage High coverage Medium coverage Basic coverage No coverage	Routine Check-Ups Yes No

Desired annual deductible
Hospital No deductible <=US$1,000 <=US$5,000 <=US$10,000	Outpatient No deductible <US$500 US$500-1,000 US$1000-1,500	Outpatient co-insurance 100%:0% 90%:10% 85%:15% 80%:20% 75%:25% 70%:30%	Out of pocket limitation None US$1,000 individual US$2,000 individual US$5,000 individual

	First name	Last name	Date of birth	Sex	Country of residence	Nationality
#1				M F
	Preexisting conditions
#2				M F
	Preexisting conditions
#3				M F
	Preexisting conditions
#4				M F
	Preexisting conditions
#5				M F
	Preexisting conditions
#6				M F
	Preexisting conditions
			If there are more people to be insured, please list them below in "notes".