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Health Insurance Quote
  1. To get a quote for a health insurance, please complete the form below..
  2. Your Full Name(*)
    Please type your full name.
  3. E-mail(*)
    Invalid email address.
  4. Phone number
    Invalid Input
  5. Profession
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  6. Full address
    Invalid Input
  7. Date of birth
    Invalid Input
  8. Preferred language
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  9. Policyholder country of residence
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      (where you occupy most of your time during insurance cover)
  10. Desired cover
  11. Payment currency
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  12. Geographical area of cover
    Invalid Input
  13. Payment method
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  14. Policy holder age
    Invalid Input
      (min 16 years, max 70 years)
  15. Spouse/partner age
    Invalid Input
      (only if spouse is to be included in this quote).
  16. Maternity plan for spouse/partner ?
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      (only if spouse is to be included in this quote).
  17. Age of Child 1
    Invalid Input
      (only if children are to be covered)
  18. Age of Child 2
    Invalid Input
      (only if children are to be covered)
  19. Age of Child 3
    Invalid Input
      (only if children are to be covered)
  20. Cover for outpatient treatment ?
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      ( such as visits to your Doctor, vaccinations or physiotherapy)
  21. Select a deductible
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      (this will reduce your Out-patient Plan premium)
  22. Dental cover ?
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  23. Repatriation cover ?
    Invalid Input
  24. Score
    Invalid Input
    On a scale of 1 to 4, which is more important to you, best price or cover?
  25.  
  26. How much is five + 3 ?(*)
    Invalid Input
    (antispam control)
  27.   
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Feel free to get in touch with us!

Address:
St Annalaan, 209 B-1853 Strombeek-Bever
Tel: +32 2 267.92.26
Fax: +32 2 267.28.32
FSMA 020259 A-cB
Email: expatinsurance@copper.be