Private Medical Insurance Policy Quotation

PMI exists to cover the unexpected that happens after the policy commences, in health insurance, this means cover for the cost of medical treatment for an unexpected medical condition.

The vast majority of PMI policies don't cover pre-existing medical conditions.
Nor will the PMI policy cover conditions that are related to any pre-existing conditions.

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Please complete the form below and click the submit button

Services are available to residents of Britain and Northern Ireland only.

We require certain information to provide an accurate quotation for mailing this to you. Please include your full address (including your house number) and county, your date(s) of birth and at least one telephone contact number.

Essential Healthcare Ltd adheres strictly to The Data Protection Act. We will never pass your details onto any third party and our website is secured to ensure your privacy is protected.

* = required fields

Title:	*
First Name:	*
Surname:	*
Occupation:	*
Partners name:
Do you smoke?	Yes No *
Does your partner smoke?	Yes No *
You (DOB):
Partner (DOB):
Children (ages): Only supply this information if you wish to include your children on your policy. Include gender (M/F)
Street: (include house no.)	*
Town:
County:
Postcode:	*
Email Address:	*
Best Contact Telephone No.:	* Enter at least one
Alternative Telephone No.:
Area(s) of interest. (tick)	Dental Insurance Private Medical Insurance
Do you or any other person to be included on the policy suffer from any pre-existing medical conditions?
Yes No
In the past five years, have you suffered from any form of heart condition or problem, stroke, cancer, diabetes or mental illness including depression?
Yes No
Have you or any other person to be included on the policy had any hospital treatment in the last four years?
Yes No

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