Apply online (Private plans)

Your details

Title

Gender*

Date of Birth*

Why do you need my gender and date of birth?

We need this in order to identify you and check eligibility for cover.

Why do you need my gender and date of birth?

We need this in order to identify you and check eligibility for cover.

Why do you need my gender and date of birth?

We need this in order to identify you and check eligibility for cover.

Why do you need my gender and date of birth?

We need this in order to identify you and check eligibility for cover.

Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City ZIP / Postal Code

GDPR- personal details

Why do you need my contact details?

We need this in order to identify you and communicate with you.

Why do you need my contact details?

We need this in order to identify you and communicate with you.

Why do you need my contact details?

We need this in order to identify you and communicate with you.

Why do you need my contact details?

We need this in order to identify you and communicate with you.

How and why are you going to contact me?

We will need to make contact with you for the purpose of administrating your Paycare cover. Our preferred method of contact is email, and we will use this as default if no other preferences are set. You are can amend your contact preferences at any time at: paycare.org/my-paycare Our Privacy Notice can be viewed at: paycare.org/site-map/privacy

How and why are you going to contact me?

We will need to make contact with you for the purpose of administrating your Paycare cover. Our preferred method of contact is email, and we will use this as default if no other preferences are set. You are can amend your contact preferences at any time at: paycare.org/my-paycare Our Privacy Notice can be viewed at: paycare.org/site-map/privacy

How and why are you going to contact me?

We will need to make contact with you for the purpose of administrating your Paycare cover. Our preferred method of contact is email, and we will use this as default if no other preferences are set. You are can amend your contact preferences at any time at: paycare.org/my-paycare Our Privacy Notice can be viewed at: paycare.org/site-map/privacy

How and why are you going to contact me?

We will need to make contact with you for the purpose of administrating your Paycare cover. Our preferred method of contact is email, and we will use this as default if no other preferences are set. You are can amend your contact preferences at any time at: paycare.org/my-paycare Our Privacy Notice can be viewed at: paycare.org/site-map/privacy

Medical details

Please select one box only.

I have no pre existing medical conditions to declare.
I have a medical condition or symptoms that may need medical consultation or treatment in the future.

Please enter description of medical condition or symptoms below

GDPR- medical details

Why do you need my medical history?

We need this in order to identify you and check eligibility for cover. We also use this data for anonymised internal data analysis.

Why do you need my medical history?

We need this in order to identify you and check eligibility for cover. We also use this data for anonymised internal data analysis. Our Privacy Notice can be viewed at: paycare.org/site-map/privacy

Why do you need my medical history?

We need this in order to identify you and check eligibility for cover. We also use this data for anonymised internal data analysis. Our Privacy Notice can be viewed at: paycare.org/site-map/privacy

Why do you need my medical history?

We need this in order to identify you and check eligibility for cover. We also use this data for anonymised internal data analysis. Our Privacy Notice can be viewed at: paycare.org/site-map/privacy

Direct - Terms

*

I have read and understand fully the Privacy Statement, IPID and Policy Documents. View full Policy document

Family - Terms

*

I have read and understand fully the Privacy Statement, IPID and Policy Documents. View full Policy document

Under 25s - Terms

*

I have read and understand fully the Privacy Statement, IPID and Policy Documents. View full Policy document

Gold - Terms

*

I have read and understand fully the Privacy Statement, IPID and Policy Documents. View full Policy document

Please note there is a Waiting Period of thirteen weeks from the commencement of cover, except for New Child Payment where there is a 12 month Waiting Period. During this time you will not be eligible to claim any Benefits.

Apply now - Private Health Cash Plan

Step 1 of 3

Your details

Why do you need my gender and date of birth?

Why do you need my gender and date of birth?

Why do you need my gender and date of birth?

Why do you need my gender and date of birth?

GDPR- personal details

Why do you need my contact details?

Why do you need my contact details?

Why do you need my contact details?

Why do you need my contact details?

How and why are you going to contact me?

How and why are you going to contact me?

How and why are you going to contact me?

How and why are you going to contact me?

Medical details

GDPR- medical details

Why do you need my medical history?

Why do you need my medical history?

Why do you need my medical history?

Why do you need my medical history?

Direct - Terms

Family - Terms

Under 25s - Terms

Gold - Terms

Bank details

bank details

Why do you need my bank details?

Why do you need my bank details?

Why do you need my bank details?

Why do you need my bank details?

Additional details