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Professional indemnity insurance

Professional indemnity (PI) insurance protects professionals against claims of negligence or mistakes that lead to financial loss for their clients.

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I am Client
I am Broker

Insurance product required(Required)

Name of the applicant(Required)

Company name (only for legal entities)

Address(Required)

Broker name (if legal entity has mandated broker)

Town(Required)

Country(Required)

Contact phone number(Required)

Contact e-mail address(Required)

Please describe your needs in details as much you can: 1) desired coverage 2) desired sum insured 3) desired deductible 4) desired inception date of the policy 5) in case of the group cover the size of the group 6) other relevant information(Required)

If exist, upload EXCEL file of the group census here (only for legal entities)

Max. file size: 10 MB.

Broker company name(Required)

Broker name(Required)

Broker contact phone number(Required)

Broker e-mail address(Required)

Description of the policyholder (legal entity / individual)(Required)

If policyholder is legal entity then describe it's 1)main activity 2)number of insured persons or size of the business(Required)

Insurance product required(Required)

Country of risk(Required)

Desired coverage(Required)

Desired sum insured(Required)

Desired deductible(Required)

Desired inception date of the policy(Required)

Other information you find necessary to share

If exist, upload EXCEL file of the group census here

Max. file size: 10 MB.

11.General information

22. Required coverage

Name of the applicant(Required)

Date of birth(Required)

MM slash DD slash YYYY

Email(Required)

Phone (optional)

Nationality(Required)

Country of residence(Required)

Please indicate if you want to add family member(s) to the cover (eg. spouse, son, daughter) and their age

Your desired payment frequency(Required)

Monthly payment

Quarterly payment

Annual payment

Don't know yet

Your preferred currency for payment(Required)

EUR

USD

GBP

Do you want to include:(Required)

Deductible - fixed amount you must pay each year before your health insurance benefits begin to cover the costs

Co-insurance - fixed amount you pay for covered medical services

Don't know yet

Your desired policy inception date

MM slash DD slash YYYY

Your health insurance product preference (if know)

Describe your main needs and demands in terms of health insurance cover(Required)

Area of coverage(Required)

Europe only

Worldwide exc. USA

Worldwide inc. USA

Don't know yet

Do you require to cover pre-existing conditions?(Required)

Yes

No

Don't know yet

A pre-existing condition is typically when you have received treatment or diagnosis before you enrolled in a new health plan.

Do you require evacuation/repatriation cover?(Required)

Evacuation cover

Repatriation cover

Evacuation and repatriation cover

Don't know yet

Generally speaking, evacuation refers to the services required to transport you to nearest medical facility, whereas repatriation refers to the transportation back home for recovery or rehabilitation after emergency services in another country.

Do you require preventative cover?(Required)

Yes

No

Don't know yet

Preventive care helps detect or prevent serious diseases and medical problems before they can become major. Annual check-ups (dental, optics), immunizations, and flu shots, as well as certain tests and screenings, are a few examples of preventive care.

Do you require maternity cover?(Required)

Yes

No

Don't know yet

Maternity coverage is health insurance coverage for costs associated with pregnancy, childbirth, and the care of a newborn.

Are you currenty insured with another health provider? If yes, please indicate the name of the insurance provider.

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11.General information

22. Required coverage

Name and position of the applicant(Required)

Contact e-mail address(Required)

Contact phone number (optional)

Name of the company (potential future policyholder)(Required)

Company's country of main activity(Required)

Company's registration number(Required)

Number of company's employees* to be included into health group cover(Required)

*Minimum number of employees required is 5.

Desired payment frequency(Required)

Monthly payment

Quarterly payment

Annual payment

Don't know yet

Preferred currency for payment(Required)

EUR

USD

GBP

Should policy include:(Required)

Deductible - fixed amount each insured person must pay each year before your health insurance benefits begin to cover the costs

Co-insurance - fixed amount each insured person pay for covered medical services

Don't know yet

Desired policy inception date

MM slash DD slash YYYY

Expat health insurance product preference (if know)

Describe the main needs and demands in terms of health insurance cover(Required)

Area of coverage(Required)

Europe only

Worldwide exc. USA

Worldwide inc. USA

Don't know yet

Should pre-existing conditions be covered?(Required)

Yes

No

Don't know yet

A pre-existing condition is typically when you have received treatment or diagnosis before you enrolled in a new health plan.

Should evacuation/repatriation be covered?(Required)

Evacuation cover

Repatriation cover

Evacuation and repatriation cover

Don't know yet

Generally speaking, evacuation refers to the services required to transport you to nearest medical facility, whereas repatriation refers to the transportation back home for recovery or rehabilitation after emergency services in another country.

Should preventative treatments be covered?(Required)

Yes

No

Don't know yet

Preventive care helps detect or prevent serious diseases and medical problems before they can become major. Annual check-ups (dental, optics), immunizations, and flu shots, as well as certain tests and screenings, are a few examples of preventive care.

Is corporate group currently covered with another health provider? If yes, please indicate the name of the insurance provider.

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NORTHERN1 INTERNATIONAL INSURANCE BROKERS OÜ

Veskiposti tn 2-1002
Tallinn 10138
Estonia, European Union

CONTACT

+372 7 12 12 14 (Estonia)
+33 770 123 645 (France)
+33 783 834 509 (France)

Email: Support@Northern1.eu

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© 2023 Northern1 international insurance brokers OÜ (firm registration number 12806139) is authorized to carry on insurance intermediary regulated activities under the permissions granted by the Estonian Financial Supervision and Resolution Authority (EFSRA) under the Insurance Activities Act 2004. You can check this on the EFRSA’s register by visiting the website www.fi.ee or by contacting the EFSRA +3726680500. Northern1 International Insurance Brokers OÜ has rights to provide insurance mediation activities in all EU member states and Iceland.

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