Step 1: Personal Information
Name
Email
Phone Number
Date of Birth
Gender
Male
Female
Other
Back
Next
Step 2: Coverage Preferences
Coverage Type
Individual Health Insurance
Family Health Insurance
Group Health Insurance
Critical Illness Insurance
Back
Next
Step 3: Coverage Amount
Desired Sum Insured
$50,000
$100,000
$250,000
$500,000
Other
Back
Next
Step 4: Network Hospitals
Do you prefer a specific network of hospitals?
Yes
No
Back
Next
Step 5: Add-Ons
Add-Ons
Maternity Cover
Dental and Vision Care
Wellness Programs
Back
Next
Step 6: Budget
Annual Premium Budget
Less than $500
$500 - $1,000
$1,000 - $2,000
More than $2,000
Back
Next
Step 7: Health Information
Do you smoke?
Yes
No
Do you have any pre-existing medical conditions?
Yes
No
Back
Finish