Introduction	In brief	Description	GTCI	flyer	online application	FAQs

Care Primo - Affordable health insurance abroad

online application

Instructions on completing the form

After you have filled out and sent the online form, you will receive a printable declaration page (Versicherungsschein) by e-mail, assuming all information is complete and valid.

Help: auxiliary information you will find touching the next to the respective fields.

Enabling JavaScript is required for the application form to work. Below you get specific instructions on enabling JavaScript in your browser. If your browser isn't listed, please consult its help resources.

Internet Explorer 6.0+

Click the Tools menu.
Select Internet Options.
Click the Security tab.
Click the Custom Level button.
Scroll down until you see the 'Scripting' section. Select the 'Enable' radio button for 'Active Scripting.'
Click the OK button.
If you see a confirmation window, click the Yes button.

Firefox 3.6+

Click the Tools menu.
Select Options.
Click the Content tab.
Select the 'Enable JavaScript' checkbox.
Click the OK button.

Important questions

Has the insured person previously been insured with us? Yes No

Please enter the old policy number here.

Was the IP medically insured in the country of destination before commencement of coverage? Yes No

Please specify the insurance company with which the IP was previously insured.

Until when was the insured person covered there?

Does the IP plan to leave the country of destination again?

YesNo

This means that the insured person intends to return to his/her home country or that he/she only holds a temporary residency permit.

If the insured person intends to stay abroad in the country of destination indefinitely, he/she cannot be covered by this plan rate.In this case please contact our sales department at +49 228 97735-44.

Policyholder / contract holder

Is the insured party a company? Yes No

Salutation

First name

Last name

Date of birth

Age

Are the policyholder and the insured person identical? Yes No

Policyholder’s address/Contact information

c/o

If the policyholder’s name is not on the mailbox, please enter the recipient's name in the field, c/o.

Street building no.

Postal code

City

Region*

Country

Insured person

Salutation

First name

Last name

Date of birth

Age

Nationality

Has the insured person had their permanent residence in Germany or Austria for at least two years? Yes No

Information regarding insurance | Show premium table

**Premium overview | Care Primo**
Insurance	0 - 35 Years	36 - 65 Years
Health insurance	EUR 1.33 / Day	EUR 2.38 / Day
Liability insurance	EUR 0.06 / Day	EUR 0.11 / Day
Total premium	EUR 1.39 / Day	EUR 2.49 / Day
Minimum premium per person and term:	EUR 41.70	EUR 74.70
The max insurance period - including all possible renewals - is three years.

Care Primo

commencement of coverage

End of the insurance policy

Duration Days

Information about stay abroad

Residence before starting trip

Country of destination

Date of entry/departure date

Reason for trip abroad

Please select how you would like to pay the insurance premium

	Bank transfer one-off
	one-off
	one-off

In the case of a one-off payment, the premium will be due for the entire duration of coverage at the commencement of coverage.

	Health insurance/Liability insurance
No.	Premium	Duration	Premium Total	Premium monthly	Duration (Months)	Premium Total
		1	Premium	x Duration =	= Total		Premium	x Duration =	= Total	Premium	x Duration =	= Total
		2	Premium	x Duration =	= Total		Premium	x Duration =	= Total	Premium	x Duration =	= Total
		3	Premium	x Duration =	= Total		Premium	x Duration =	= Total	Premium	x Duration =	= Total
		4	Premium	x Duration =	= Total		Premium	x Duration =	= Total	Premium	x Duration =	= Total
		5	Premium	x Duration =	= Total		Premium	x Duration =	= Total	Premium	x Duration =	= Total
∑ Health insurance	Total		Total(one-off)	∑ Accident and liability insurance	Total		Total(one-off)	∑ Daily sickness allowance insurance	Total	Total(one-off)

Premium calculation

Health insurance / Liability insurance

Payment amount

The premium for health insurance coverage is calculated as follows::

The health insurance premium increases after 18 months monthly

Additional contact information in the event of questions

e-mail

Area code*

Telephone*

Fax no.*

How did you find us?*

Tipp for qq-user:
To be sure that you receive all documents, please fill in another (not qq-)e-mail in the field for the second e-mail

You can enter an additional e-mail-address here, to which we will also send the insurance documents.*

The fields marked with an * asterisk are not required to take out a policy, but the information provided makes it easier for us to contact you. You will not receive any unsolicited advertising material via email, and we will not forward your information on to any third parties.

Referrer / agent number

Agency number or agent number at the Care Concept AG =>

Terms and conditions health insurance / Terms and conditions of liability insurance

By clicking on the adjoining field you confirm that you have read, understood and agreed to the following conditions. At the same time you are confirming that you have printed and / or downloaded the following conditions:

Consent form

Before, during and after your stay abroad, new questions will come up surrounding the topic of insurance. For that we offer products in the area of financial services, which are tailored to suit your particular situation. To do that, we need your consent as follows.

Without affecting the contract, and revocable at any time, I hereby further consent to HanseMerkur Reiseversicherung AG and its partner, Care Concept AG, using my general application, contract and payment data, above and beyond that, also for giving advice in other financial services. Contact can take place by telephone, fax or e-mail.

I agree I do not agree

Care Primo Information x

Insurance type: Health insurance abroad

Insurable persons: Health insurance for travelers abroad

Entry age: 0-65 Years

Premium from EUR 1.33 / Day

Duration: 10 Day - 3 Years

Benefits*

Complies with all the requirements for a Schengen visa
Outpatient, inpatient and pain-deadening dental treatment
Repatriation for medical reasons (up to EUR 10,000.00)
Transportation costs to hospital

*For a complete list of benefits see the general insurance conditions (GTI).

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