Individual International Healthcare Plans - Apply Online

OPTION 1

Apply online

To purchase our plans by credit card (Visa or MasterCard) simply complete the Online Application Form which follows (click the orange button below to begin).

Apply online

Please note that this will take approximately 10-15 minutes. You will need the following items to complete your application online.

Details of all persons to be covered
Policy start date
Plan(s) and area of cover you have chosen
Credit card details (Visa or Mastercard)
Medical history for yourself and any dependants to be covered

Upon completion you will be issued with a policy number. In the case where your application does not require further underwriting* you can register and gain immediate access to your online account . You will then have 30 days to change your mind.

* Further underwriting is generally required when you answer "yes" to any of the questions in the Health or Dental Declaration parts of the online form.

OPTION 2

Download form

Alternatively, if you wish to pay by cheque or bank transfer, please download a PDF version of the Application Form, print it, complete your details and send it to Allianz Worldwide Care by email, fax or post (submission details on the form).

Important

Due to EU financial legislation if you or your dependants are resident in any of the following countries,

Belarus
Democratic Republic of Congo
Ivory Coast
Liberia
Myanmar
Somalia
Sudan
Syria
Zimbabwe

you cannot apply online. Please use this form instead.

Download form…

Personalised online application form for registered agencies

This exciting new feature allows your agency to use and distribute a personalised version of our online application forms. Click here to access this new service.