Apply for an ASISA Health Insurance Policy Paso 1 de 3 - Seguros y Complementos 33% X/TwitterEste campo es un campo de validación y debe quedar sin cambios.Insurance and Add-onsNOTE: If it is for a visa or a residence permit, it must be ‘ASISA Health Residents’ only.Type of health insurance(Obligatorio)Please select the ASISA insurance policy you wish to take out.ASISA Ya (With co-payments)ASISA Esencial (No co-payments)ASISA Esencial+ (With co-payments)ASISA Completa (No co-payments)ASISA Completa+ (With co-payments)ASISA Completa++ (With co-payments)ASISA Health Students (No co-payments)ASISA Health Residents (No co-payments - Visas, Residence Permits, NIE numbers, Digital Nomads)ASISA DentalASISA Dental FamilyWhat additional cover would you like to add to your policy?Extras are optional. Each one incurs an additional charge. Please ask us if you’re not sure how much each one costs. Compensation for accidental death: €10,000 Compensation for accidental death: €20,000 Compensation for accidental death: €30,000 Hospitalisation allowance: €30 per day Hospitalisation allowance: €60 per day Hospitalisation allowance: €90 per day Dental When would you like the policy to come into effect?(Obligatorio) Number of insured persons(Obligatorio)12345Payment method(Obligatorio)Visa insurance policies can only be paid for by credit card. Bank transfer Credit Card Policyholder detailsThe policyholder may also be the insured person, or it may be a different person.Policyholder Full Name Date of birth Is the policyholder also the insured person? Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Details of the primary insured personIf the insured person is the same as the policyholder, there is no need to complete the following fields: name, gender, date of birth, nationality, type of identity document, identity document number, telephone number, email address and postal address. Otherwise, please complete all the fields.Insured persons Full Name Date of birth Relationship with the policyholder Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Consent to the processing of personal dataUsing this information, we will complete the application form on your behalf and email it to you for you to check and sign.Consent(Obligatorio) I give my consent for my policy to be issued using the information provided on this form.
