Your reliable
     health insurance partner abroad
Care Amerika / Travel NAFTA
Health insurance abroad
online application
Notes on completing the form

After having filled out the online form, you will receive a printable insurance certificate by e-mail, if all information are complete and valid. You can generally already use this to apply for or extend the visa or residence permit.

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

Note

 

Policyholder / Contracting Party
Is the insured party a company?
Salutation First name Last name Date of birth Age
Are the policyholder and the insured person identical?

Policyholder’s address/Contact information
c/o

If the policyholder’s name is not on the letter box, please enter the displayed name in the field c/o.

Street no
Postal code City
Region | Country
Insured person
Salutation First name Last name Date of birth Age Nationality
Information about health insurance | Show premium table
Field of application Inception date Ending date Duration Duration Premium *
days
NAFTA = The North American Free Trade Agreement is an agreement between the United States, Canada, and Mexico creating a trilateral trade bloc in North America.
Information about stay abroad
Residence before starting trip Country of stay Entry/departure dateReason for stay abroad

 

Information about liability- and accident insurance
Do you want to take out liability and/or accident insurance?
Please choose how you want to pay the insurance premium
Premium
  Health insurance Accident and liability insurance
No. Premium
Duration
Premium
Total
Premium
monthly
Duration
(months)
Premium
Total
1 x= x= x=
     
 
Premium calculation
Health insurance
Liability insurance
Accident and liability insurance
Amount
The health insurance premium increases as of the month 18 up to monthly
Additional information for contact in the event of questions
e-mail Area code* Telephone* Fax-no.* Where did you hear about us?*
Here you can fill in a further e-mail-address, to which we will send the insurance documents aditionally.*

The fields marked with an * asterisc are not compulsory for conclusion of the policy, but it makes easier to approach you. You won’t get unrequested advertising by e-mail.

Agency/broker number
Agency number or broker number at the Care Concept AG =>
Conditions health insurance
By clicking on the adjoining field you are confirming that you have read, understand and agreed the following conditions.
  • Terms and conditions
  • Ich habe die wichtigen Unterlagen wie die Einwilligungserklärung zum Datenschutz, die Verbraucherinformationen und die ausgedruckt oder heruntergeladen und zur Kenntnis genommen.
  • Ich willige ein, dass meine Daten entsprechend der Einwilligung zum Datenschutz durch die AXA Krankenversicherung AG verarbeitet werden dürfen.
  • Einwilligung in die Erhebung und Verwendung von Gesundheitsdaten und Schweigepflichtentbindungserklärung gemäß beiliegender Erklärung:
    Ich willige ein, dass meine Daten, insbesondere auch Gesundheitsdaten, entsprechend der Einwilligungserklärung des AXA Konzerns verarbeitet werden dürfen und entbinde zu diesem Zweck die AXA Krankenversicherung AG sowie die in der Einwilligungserklärung genannten weiteren Personen von ihrer Schweigepflicht.
  • Mit Zugang des Versicherungsscheins, spätestens zu Versicherungsbeginn steht Ihnen ein 14tägiges Widerrufsrecht zu.
  • Ich bestätige, dass ich hiermit einen rechtsgültigen Versicherungsvertrag eingehe und dass ich diesen Vertragsschluss in Deutschland aufgegeben habe.
Send application
By sending the form you are entering into a binding agreement to conclude an insurance policy via Care Concept AG in Bonn with AXA Krankenversicherung AG . After sending you will receive a confirmation of receipt of your application and a few minutes later an e-mail with your documentation. Should a blank screen appear after sending, please get in touch with us at +49 228 97735-77. In the event of further questions Care Concept is only to be pleased to be of service in several languages on the free number from the fixed-line telephone network in Germany 0800 977 35 00 otherwise dial +49 228 97735-11.

Product information sheet
General contract information Explicit statements
Consent form
Conditions health insurance
Auslandskrankenversicherung - Ecke Links untenAuslandsversicherung - Ecke Links UntenAuslandsversicherung - Bogen Links UntenAuslandsversicherung - Bogen rechts UntenAuslandsversicherung - Ecke rechts Unten
Imprint | Home page | Sitemap | Landingpages | Terms and conditions

Care Amerika Care Concept AG • overseas health cover for travellers / travelers 	 • Care Travel • online application

Insurance type
Health insurance abroad + USA
Insurable persons
German and Austrian private / business travellers worldwide
Age at beginning
0+ Years
Premium Care Travel
from €2.24 / day
Duration
1 - 365 days
Benefits*
  • Outpatient, inpatient and dental treatment
  • Repatriation for medical reasons
  • Secondary liability in case a patient is not moveable
Information
online application

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