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This is an inquiry form for customers who want to have their own personal insurance different from their employer sponsored/enable one. If you are looking for a employer sponsored/enabled one, request you to please login through the button in the top right.
Fields marked with
*
are mandatory
Information about you
First Name
*
Last Name
*
Company
Location
*
Select
Mumbai
Delhi/NCR
Bangalore
Chennai
Pune
Kolkata
Ahmedabad
Rest of India
Overseas
Phone No.
Mobile No.
*
Email id
*
Family Members to be insured for Health Insurance
Name
Date of Birth
Relation
Coverage
Health History
Medical Test
Remove
Name of the person to be insured
*
Date of Birth
*
Relationship
with you
*
Select
Self
Father
Mother
Husband
Wife
Son
Daughter
Father-in-Law
Mother-in-Law
Sister
Brother
Sister-in-Law
Brother-in-Law
Coverage
*
Select
100000
200000
300000
400000
500000
600000
700000
800000
900000
1000000
Any Illness/Adverse Health History
*
Is a Medical Test Convenient
*
Select
Yes
No
Anything else you want us to know:
[Any Special Requests, Budget of Premium, Any Health Insurance Company you want/or don’t want in the comparison]
Where did you find us?
*
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Company
Google
Yahoo Search
Bing
Newspapers/Magazines
Friends & Relatives
SMS
Email
Jago Investor
Blogs
Yahoo Answers
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FAQ
Is Medimanage an Insurance Company?
What is the process once, I have submitted the form here?
How will the Claims be paid?
more...
Did you know?
Medimanage is the only Dedicated Health Insurance Broker in India.
Medimanage has managed more than 25000 claims end-to-end.
Medimanage insures more than 2 Lakh lives every year.
Testimonials
I am extremely grateful to you for the efficient way in which you handled the issue, while I only had to focus on my mother's health.Along with you I am sure there must have been a team who works together to solve issues which are outside our control. This is to thank you and your team for silently working behind the scenes to make life comfortable and smooth when we here have some challenging issues.
Mr. Neville Cardmaster
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