ADD SOMEONE TO A POLICY

Add somebody to your policy

    Would you like a quotation before adding this new member?
    No, I’m happy for you to add the member and confirm the costs.Yes, I’d like a quote first and then we’ll decide.
    Do you want quote variations to include partner and/or children?
    NoYes

    Please complete the details of all the people you’d like quotes for.


    Please select one of the following options:

    Please select your policy type:

    Which policies do you want to add them to: (tick all that apply)
    Medical InsuranceMedex ProtectCashplanDental InsuranceTravel InsuranceGroup Life Insurance/Death in ServiceGroup Income ProtectionGroup Critical Illness

    Company information:


    Employee information:



    Does the employee or anyone to be added to the policy already have health insurance in place?

    NoYes

    Please provide details of their current insurer and renewal date:

    Has the employee or anyone to be added to the policy had health insurance (either via their employer or a family/individual plan) in the previous three months?

    NoYes



    Add another employee


    Add a second employee:



    Does the employee or anyone to be added to the policy already have health insurance in place?

    NoYes

    Please provide details of their current insurer and renewal date:

    Has the employee or anyone to be added to the policy had health insurance (either via their employer or a family/individual plan) in the previous three months?

    NoYes



    Add another employee


    Add a third employee:



    Does the employee or anyone to be added to the policy already have health insurance in place?

    NoYes

    Please provide details of their current insurer and renewal date:

    Has the employee or anyone to be added to the policy had health insurance (either via their employer or a family/individual plan) in the previous three months?

    NoYes



    Add another employee


    Add a forth employee:



    Does the employee or anyone to be added to the policy already have health insurance in place?

    NoYes

    Please provide details of their current insurer and renewal date:

    Has the employee or anyone to be added to the policy had health insurance (either via their employer or a family/individual plan) in the previous three months?

    NoYes



    Add another employee


    Add a fifth employee



    Does the employee or anyone to be added to the policy already have health insurance in place?

    NoYes

    Please provide details of their current insurer and renewal date:

    Has the employee or anyone to be added to the policy had health insurance (either via their employer or a family/individual plan) in the previous three months?

    NoYes



    You may submit a maximum of 5 employees at once using this form. To submit more employees please click submit and then start the process again.


    Company information:


    Employee information:


    Policy holder information:


    Dependant information:




    Does the dependant already have a health insurance policy in place?

    NoYes

    Please provide details of their current insurer and renewal date:

    Has the dependant had health insurance (either via their employer or a family/individual plan) in the previous three months?

    NoYes



    Add another dependant


    Add a second dependant:




    Does the dependant already have a health insurance policy in place?

    NoYes

    Please provide details of their current insurer and renewal date:

    Has the dependant had health insurance (either via their employer or a family/individual plan) in the previous three months?

    NoYes



    Add another dependant


    Add a third dependant:




    Does the dependant already have a health insurance policy in place?

    NoYes

    Please provide details of their current insurer and renewal date:

    Has the dependant had health insurance (either via their employer or a family/individual plan) in the previous three months?

    NoYes



    Add another dependant


    Add a forth dependant:




    Does the dependant already have a health insurance policy in place?

    NoYes

    Please provide details of their current insurer and renewal date:

    Has the dependant had health insurance (either via their employer or a family/individual plan) in the previous three months?

    NoYes



    Add another dependant


    Add a fifth dependant:




    Does the dependant already have a health insurance policy in place?

    NoYes

    Please provide details of their current insurer and renewal date:

    Has the dependant had health insurance (either via their employer or a family/individual plan) in the previous three months?

    NoYes


    You may submit a maximum of 5 dependants at once using this form. To submit more dependants please click submit and then start the process again.