Quote request.

High Limit Accidental Death & Dismemberment / Medical, Disability & Kidnap/Ransom Insurance

Quote Request Online

Before completing a request to quote, please review an estimate of AD&D (life) premiums based on real scenarios as presented in 2006. The annual premium costs are typically not small. As many contracting agencies typically leave it up to the individual to pay for the premium for optional life insurance on their own, our underwriter is willing to offer options for quarterly and semi-annual modes of payment. Contact us by email if any questions or use our quote request form below for faster service. Be sure to review our FAQ section as well.

Although you may have DBA coverage under your contractor agency, additional coverage may be necessary due to potential gaps in coverage and lower limits of coverage under DBA . Note that you may be exposed when OFF the JOB under DBA ! Learn more here....

Please complete our quote request below or QUOTE NOW:

First and last name:

Date of Birth (dd/mm/year):

Contact phone #:

Email contact:

Retype email for accuracy check:

FAX number (if want quote faxed):

Contracting agency you are working with:

Is this a US based agency:

Are you a US citizen:

If not a US citizen or resident of the US, can you show a US address upon application (ie; work, relative, friend, collegue, etc) ?

Occupation:

Please provide some detail as to the nature and risk of your assignment. Please include ALL foreign countries in which you will be visiting:

How long is your assignment (length of coverage needed)?

Principal sum life insurance benefit

(not more than 10x your annual income)?

What products are you wanting quoted ?

Select the additional coverages you want coverage to include:

Allow us up to 24 hours to respond to your quote request. We may call or email for additional details or questions. We look forward to assisting.

Download and print application, complete and return fax to 417-459-4623

[We will need pages 2 (application) & 6 (HIPPA release) completed and signed]

Application download requires Adobe Reader

Be sure you have noted the information already on our Premiums Estimate page to better understand the costs of such high limit accident policies. You knowing the costs involved will ultimately help us to better service your needs more effectively.

If you haven't already, please visit our FAQ page to review all the common questions our independent contractors have regarding this coverage.

Notes on assistance with making payments for premiums:

Our underwriter will allow the individual to pay quarterly or semi-annual if they

either have someone outside of the assignment country to be billed or they do a pre-authorized credit card billing.

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To calculate the premium cost to pay Quarterly, multiply the annual premium by 0.285; this is your Quarterly payment.

Example:

Est Annual cost = $5,575 / year;

Quarterly = $5,575 x 0.285 or $1,588.88 / Quarterly

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To calculate the premium cost to pay Semi-Annually, multiply the annual premium by 0.55; this is your Semi-Annual payment.

Example:

Est Annual cost = $5,575 / year;

Semi-Annual = $5,575 x 0.55 or $3,066.25 / Semi-Annually

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Derek Patterson, President

3rd Generation Global Risk Broker / Agent

eGlobalHealth Insurers Agency, LLC

/dba

The Patterson Insurance Agency*

Since 1941*