Travel Insurance - Signup Form

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Are you a return customer who has signed up with us for Travel Insurance before?

If so, save time filling out the form by entering your cell/email and te'udat zehut.
If your mobile phone cannot receive SMS's, please use your email address.
Note, these must be the details you used when signing up previously:

Travel Details

 

Personal Details

 
Name
Gender
TZ/Passport
Birth Date
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Health Details

We are unable to provide insurance cover in this case

If one or more of the following options is checked off, you will need to send your doctors report to us at tali@egertcohen.co.il and then call to confirm receipt.

Are you under or was it recommended that you receive one of the following treatments?






Have you been diagnosed with one or more of the following conditions?







Medication Details:

Did the hospitalization/surgery/catheterization take place during the past three months or was it not performed?


If you answer YES, email us an updated certificate from the attending physician regarding the surgery, hospitalization/catheterization that you were advised to undergo, and regarding your current health and functional condition in this respect.
If you answered NO, you must purchase a rider for worsening of preexisting medical conditions

If you answered YES, you will need to send your doctors report to us at tali@egertcohen.co.il and then call to confirm receipt.
When was the last event and/or surgery that you underwent due to this problem?

If you answered that it was during the past year, send us an updated certificate from the attending physician regarding your updated medical condition: diagnosis, medications, treatments and monitoring
If you answered that it was more than a year ago, you must purchase a rider for worsening of a previous medical condition
We unfortunately cannot cover high-risk pregnancies under this policy.
We cannot provide insurance beyond week 32

Cover Details



Costs by age:
0-17: $0.30 per day
18-40: $0.35 per day
41-50: $0.70 per day
51-60: $1.10 per day
61-70: $1.50 per day
71-75: $1.70 per day
76-85: $2.55 per day
86-95: $3.85 per day
This covers cancellation due to:
Having Corona symptoms before the flight; Testing positive before the flight; Coverage for extending or shortening the trip due Corona or Corona symptoms. There is NO COVER for cancellation due to going into bidud

Billing Details