Corporate | AOC Insurance Broker - International Health Insurance Comparison

Group (Full name) /Organisation (Nom complet)

Contact person at the company / Interlocuteur entreprise

Job Title / Fonction

International phone number /téléphone international

What's App (optional)

Email address/ adresse courriel

Company address/ adresse de l’entreprise (optional)

Country Head office/Pays du siege social (optional)

Contract start date/Date de départ de l’assurance (optional)

Current group renewal date/ date de renouvellement de la police actuelle (optional)

Write a label for No of Employees / VEUILLEZ INDIQUER LE NOMBRE D’EMPLOYÉS (optional)

Number of dependent/ Nombre d’ayants droits ? (optional)

DO YOU NEED IN-PATIENT BENEFITS INCLUDING ASSISTANCE / BESOIN D'UNE COUVERTURE HOSPITALISATION INCLUANT L'ASSISTANCE ? (optional)

Yes

DO YOU NEED OUT-PATIENT BENEFITS / BESOIN DE MÉDECINE COURANTE ? (optional)

Yes

DO YOU NEED A CO-INSURANCE / BESOIN D'UNE FRANCHISE? (optional)

Yes

PERCENTAGE MAXIMUM CO-INSURANCE/DEDUCTIBLE/POURCENTAGE FRANCHISE/DEDUCTIBLE? (optional)

DO YOU NEED PREVENTIVE CARE/MEDICAL CHECK-UP/BESOIN DE PREVENTION/BILAN DE SANTE ? (optional)

Yes

DO YOU NEED MATERNITY CARE / BESOIN D'UNE COUVERTURE MATERNITÉ ? (optional)

Yes

DO YOU NEED DENTAL & VISION CARE / BESOIN DE DENTAIRE ET D'OPTIQUE ? (optional)

Yes

DO YOU NEED LIFE & PROTECTION INCOME INSURANCE / AVEZ-VOUS BESOIN DE PREVOYANCE? (optional)

Yes

HOW DID YOU HEAR ABOUT AOC INSURANCE BROKER / COMMENT CONNAISSEZ-VOUS AOC INSURANCE BROKER ? (optional)

REMARKS/REMARQUES (optional)

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