Questions for Group Health Insurance
Who do you need to cover?	Employees only Employees and Dependants
Concerning your international employees do you wish to cover	Expatriates/Third Country Nationals Expats and Key Local Hires Local Hires Only
What type of cover do you require	Comprehensive health only Comprehensive health & dental Comprehensive health, dental & vision
How many staff do you need to cover	less than 10 10 - 50 50 -250 over 250
Do you require continuous worldwide portable coverage for your staff?	yes no
Do you need access to US medical care and direct pay arrangements with US medical care providers?	yes no
Would you like to have access to a 24 hour member service center and claim unit?	yes no
Does your staff require foreign currency claims reimbursement and/or direct payments?	yes no
Do you require 24 hour Emergency Evacuation and Medical Assistance Services?	yes no
Would you like routine medical exams covered?	yes no
Would you like simplified plan administration for all your international employees?	yes no
Would you like to make claim inquiries and download forms via the Internet?	yes no
What deductible would you like?	$ 100 $ 250 $ 500 $1,000
Covered medical expenses should be paid/reimbursed at:	100% 90% 80%

Name		Postal Code
Address		City
Telephone		Country
Fax		E-Mail
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