Health insurance quote

Request insurance quote private health insurance

Please fill in the details below. Boxes marked with " * " are required fields. Incomplete application forms may be refused.

- Step 1 of 4

Policyholder data

Name *

First name

Last name

E-mail *

Phone - Mobile *

Do you have an N.I.E. number? *

N.I.E. number policy holder *

Vul het nummer correct in bijvoorbeeld > Y9991122E <

Why don't you have an N.I.E. number? *

We can always help you get this number.

Nationality *

Date of birth *

day/month/year

Are you married? *

Address of my permanent residence *

Address Line 1

City

State / Province / Region

Postal Code

Country

Data of the persons to be insured

How many persons do you wish to insure? *

Insured 1

Name of insured person 1 *

Date of birth insured person 1 *

Gender insured 1 *

Man
Woman

Do you have any children? *

How many children do you have? *

Gender insured 1 *

Man
Woman

Height in cm *

Weight *

Medical situation insured 1: Have you previously or are currently suffering from: a serious illness/surgery, cancer, heart problem, diabetes, transplant, back problems, chronic illness, ... *

Insured 2

Name of the insured 2 *

Date of birth insured person 2 *

Gender insured 2 *

Man
Woman

Do you have any children? *

How many children do you have?

Height in cm *

Weight *

Medical situation insured 2: Have you previously or are currently suffering from: a serious illness/surgery, cancer, heart problem, diabetes, transplant, back problems, chronic illness, ... *

Insured 3

Name of the insured person 3 *

Date of birth insured person 3 *

Gender insured 3 *

Man
Woman

Height in cm *

Weight *

Medical situation insured 3: Have you previously or are currently suffering from: a serious illness/surgery, cancer, heart problem, diabetes, transplant, back problems, chronic illness, ... *

Insured 4

Name of the insured person 4 *

Date of birth insured person 4 *

Gender insured 4 *

Man
Woman

Height in cm *

Weight *

Medical situation insured 4: Have you previously or are currently suffering from: a serious illness/surgery, cancer, heart problem, diabetes, transplant, back problems, chronic illness, ... *

Insured 5

Name of insured person 5 *

Date of birth of the insured person 5 *

Gender insured 5 *

Man
Woman

Height in cm *

Weight *

Medical situation insured 5: Have you previously or are currently suffering from: a serious illness/surgery, cancer, heart problem, diabetes, transplant, back problems, chronic illness, ... *

Insured 6

Name of the insured person 6 *

Date of birth of insured person 6 *

Gender insured 6 *

Man
Woman

Height in cm *

Weight *

Medical situation insured 6: Have you previously or are currently suffering from: a serious illness/surgery, cancer, heart problem, diabetes, transplant, back problems, chronic illness, ... *

Additional information

Are the persons to be insured currently members of the social security system of Spain? *

Are the persons to be insured currently affiliated with the social security system of another country? *

Which country are you affiliated with? *

How long do you stay in Spain per year? *

More than 183 days
Less than 183 days

How many months are you / will you be travelling for afterwards? *

Less than 1 month, 1 month, 2 months. 3 ...

Are you currently insured elsewhere in a private health insurance plan? *

If yes, with whom? *

Do you know the renewal date / expiry date of your contract? *

Expiry date *

What is the current premium you are paying now?

What do you think are the biggest drawbacks of your current insurance?

What do you expect from private health insurance?

What do you wish to take out private health insurance for *?

Avoid long waiting times
Be helped in your own language
I want to be additionally insured to the standard social security of Spain
I have a preference for certain private clinics / doctors
I don't fully trust the Spanish health care system
To apply for my residency
I travel a lot so I want to be adequately insured abroad

Multiple choices are possible.

What cover do you want? *

Full coverage with free choice of doctors
Full coverage with the doctors of the medical network with which the insurance works
Supplementary cover (no hospitalisation)
Consultations only

Multiple choices are possible.

Do you have a maximum budget in mind? *

What is the maximum budget you wish to spend per month? *

What do you consider important in health insurance? *

The price is the most important thing for me
The price/quality ratio is the most important thing for me
The price is not important, I want to be well and adequately insured.

Would you also like to receive information about death cover/insurance? *

Spain has different rules than many other countries in this area.

Documents and files

You can already send these documents along - If you wish to take out the insurance then we must be in possession of copies of these documents.

Documents of the policyholder and the persons to be insured

Click or drag files to this area to upload. You can upload up to 12 files.

Please already send us a copy of the identity card, N.I.E. number or resident card and a document showing the address of the property (water or electricity bill, suma bill, padron, ...)

Additional info you want to share with us

Request for a quotation private health insurance ready to send

Read and approved *

I agree to the Segurantis terms and conditions

I hereby confirm that I have correctly filled in all the details so that a quotation can be made. Segurantis can use my details to make an offer. A quote is not binding. Based on this information Segurantis can also refuse to send you a quote. Segurantis is not responsible for any mistakes we made. After entering into an insurance contract, you as the policyholder are responsible for checking the data. If there are any errors, please inform Segurantis immediately so that changes can be made. The insurance contracts are always at least 1-year contracts and must be cancelled in writing directly to the insurance company you are insured with at least 1 month before the renewal date.

Phone

Quote health care insurance

Request insurance quote private health insurance

Policyholder data

Data of the persons to be insured

Insured 1

Insured 2

Insured 3

Insured 4

Insured 5

Insured 6

Additional information

What do you expect from private health insurance?

Documents and files

Request for a quotation private health insurance ready to send