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Generali Health Insurance Form

Once you provide us with the below information, you will receive a quote on your health insurance plan within 2 working days


Family name First name

Gender Male Female
Date of Birth

Occupation
Address

E-mail

Quote for


6 months contract

annual contract


Medical safety card:
Accepted for this type of insurance are people from 2 months and people up to 60 years old
Please choose


A)   Room and food class



Lux
 

Class A (private room)
 

Class B (room for 2 people)
 

Class C (room for 3 people)

B)   Amount of excess applying when receiving medical care in a private clinic / hospital
      (Excess: example; 1.000 Euros excess = the first 1.000 Euros is paid by the insured person, any amount exceeding the above mentioned is paid by Generali)



0 Euros - full coverage by Generali
 

1.000 Euros
 

2.500 Euros
 

5.000 Euros
  10.000 Euros

C)   Amount insured



150.000 Euros
 

300.000 Euros
 

500.000 Euros
  1.000.000 Euros
   
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