Health Insurance Application Form


Thank you for applying for our high quality, cost effective health insurance plans. Your Security is of the utmost importance. Please, read our Information for clients about Protection of personal data according to EU General Data Protection Regulation (2016/679).
By using our site, you agree to our privacy policy.

Dear Valued Client,
Please be advised that Your earliest Effective Date of Coverage under Private Comprehensive Health Insurance shall not occur within 1-2 business days (not including weekends nor Czech National Hollidays), Until total credit/debit card or authorized bank payment is received and verified. Please note that Partial or monthly installment payments are NOT accepted.

You are not automatically covered by applying and paying the premium. We will contact you before issuing your insurance coverage.

In an effort to keep your insurance costs low, we do NOT maintain a physical full-time office in Prague. You can find more information at our FAQ or you can contact us at:
Thank You for Your Cooperation.