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Health and Hospitalisation Insurance
Premium Rates
All premiums quoted are Annual and apply to each person to be covered,
unless otherwise stated. If you wish to pay your premiums in an alternative
currency to US Dollars, please contact Trafalgar International Limited
for confirmation of the applicable exchange rate.
For calculation purposes, there are 3 geographical areas and you should
choose the country/area in which you will be resident at the time
of inception of the policy. However, cover is not restricted to each
geographical area as all cover is world-wide but excludes Elective
Treatment in the USA (i.e. for Areas 1 and 2 cover is for accident
and emergency treatment only, unless the Optional Module for USA Elective
Treatment is selected).
| Geographic Area |
|
| Area 1 |
Europe and Middle East |
Excluding Elective Treatment in USA |
| Area 2 |
Worldwide |
| Area 3 |
Worldwide |
| Foundation Module - Base Premiums
(all premiums in US$) |
|
| Age |
Area 1 |
Area 2 |
Area 3 |
| - 17 |
485 |
551 |
1,087 |
| 18 - 20 |
572 |
735 |
1,357 |
| 21 - 24 |
696 |
821 |
1,716 |
| 25 - 29 |
747 |
893 |
1,872 |
| 30 - 34 |
833 |
957 |
2,003 |
| 35 - 39 |
906 |
1,051 |
2,225 |
| 40 - 44 |
1,076 |
1,209 |
2,702 |
| 45 - 49 |
1,284 |
1,359 |
3,052 |
| 50 - 54 |
1,592 |
1,648 |
3,570 |
| 55 - 59 |
2,101 |
2,123 |
4,704 |
| 60 - 64 |
2,660 |
2,712 |
6,292 |
| 65 - 69 |
3,208 |
3,674 |
8,009 |
| 70 - 74 |
3,873 |
4,378 |
9,478 |
| 74 - 79 |
4,480 |
5,041 |
10,900 |
| 80 + |
5,289 |
5,697 |
12,361 |
| Optional Modules |
|
Please note that all persons to be covered under this Policy must
select the same level of cover.
Module 001 Chronic Conditions
(all premiums in US$) |
| Age |
Additional premium per person |
| - 17 |
85 |
| 18 - 64 |
255 |
| 65 - 69 |
850 |
| 70 - 74 |
1,275 |
| 75 + |
1,700 |
Module 002 Routine Dental Treatment
Module 003 Major Restorative Dental Work
(all premiums in
US$) |
| |
Routine |
Major Restorative |
Combined |
| Child |
170 |
120 |
255 |
| Adult |
250 |
170 |
375 |
| Module 004 Normal Pregnancy & Childbirth |
Additional Premium US $ 425
This additional premium applies per policy and not per
person |
| Module 005 Evacuation/Repatriation Extension |
Additional Premium US $ 85
This additional premium applies per person and not per
policy |
Module 006 Policy Excess
(The Foundation Module carries a US $ 100 Excess as standard) |
| Excess Amount |
Premium Adjustment |
| Nil |
+ 25 % |
| 50 |
+ 15 % |
| 200 |
- 10 % |
| 300 |
- 12 % |
| 500 |
- 17 % |
| 1,000 |
- 25 % |
| 2,000 |
- 35 % |
| 5,000 |
- 50 % |
| Module 007 In-Patient Only Cover |
| Premium Adjustment -30% |
| Module 008 USA Elective Treatment |
| Foundation Module Area 3 rates apply |
| Group and Affinity Schemes |
|
Premium discounts can be obtained for
Group and Affinity Schemes where the initial enrolment numbers are
in excess of 3 members (plus dependants). The higher the enrolment
numbers the greater the discount.
| Insurance Premium Tax |
|
In certain countries, Insurance Premium
Tax and other local taxes may need to be added to these premiums.
Please contact Trafalgar International Limited for details.
In order to calculate your premium,
please refer to the Premium Calculation Table contained within the
Application Form.
All premiums quoted above are in US
Dollars. This Plan is also available with premiums and benefits in
Pounds Sterling.
Health and Hospitalisation Insurance
Frequently Asked Questions
Premium Rates
Benefit Schedule
Application Form
Claim Form
Sample Policy Wording
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