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....

Submit Quote Request Form or QUOTE/Apply ONLINE 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):

Employer name (optional):

Is this a US based agency:

Are you a US citizen or resident:

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 Details:

Please provide some detail as to the nature and risk of your travels. Please include ALL foreign countries in which you will be visiting or wanting coverage. If requesting K&R quote, the more details you can provide, the more accurate we can quote you. Download K&R brochure / application .

Dates requested for coverage?

Principal sum life insurance benefit

(not more than 10x your annual income)?

What life product are you wanting quoted ?

Select the additional life coverage riders you want coverage to include:

Other quote options include Kidnap & Ransom and Medical / Medical EVAC / Repatriation benefits . Please check here any of these you wish to have quoted as well :

Allow us from 12 to 24 hours to respond to your quote request. We may call or email for additional details or questions. We look forward to assisting.

If you are in a hurry and wish to Quote AND APPLY online -- view our secure link for quoting High Limit Accident Life Insurance Online

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

[We will need page 2 (application) 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

Since 1941*