High Limit Accidental Death & Dismemberment / Medical, Disability & Kidnap/Ransom Insurance
Quote Request Online
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 / Contractor name :
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 to start & end ?
Principal sum life insurance benefit
(not more than 10x your annual income)?
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.
[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 monthly, 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. Monthly modes are available only with Auto Checking Acct Debit and not by CreditCard. Modal payments are only available with annual policy periods.
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To calculate the premium cost to pay Monthly, multiply the annual premium by 0.086; this is your Monthly payment. Note: only with Automatic Checking Debit
Example:
Est Annual cost = $3000 / year;
Monthly = $3000 x 0.086 or $258 / Monthly
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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 = $3000 / year;
Quarterly = $3000 x 0.285 or $855 / 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 = $3000 / year;
Semi-Annual = $3000 x 0.55 or $1650 / Semi-Annually
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Derek Patterson, Managing Member / Owner
3rd Generation Global Risk Agency
eGlobalHealth Insurers Agency, LLC
Serving Since 1941
