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Personal Details

Hi, to get started, can I have your first name?

Please provide your first name that will be used on your policy documentation.

Personal details

We need your personal details so we can generate your quotes and create the policy documentation. Please provide us with your first name as this will be used on your policy documentation.

Thanks, can I also have your last name?

Personal details

We need your personal details so we can generate your quotes and create the policy documentation.

Great, what's your sex?

Personal details

We need your sex to generate your quotes.

What is your date of birth?

Your date of birth

We ask for your date of birth as your age is a factor in determining the price of your quotes.

Great, what is your postcode?

Your postcode

Your postcode is required in order to calculate quotes appropriate to where you live. It will also enable us to identify your nearest private hospitals.

What is your phone number?

Your phone number

We require your telephone number to provide advice on the policies available to you.

Health insurance can be complicated and we aim to simplify this for you.

What is your email address?

We will never share your email with any third party without your permission.

Your email address

We require your email address to send policy documentation and for your insurer to contact you.

Cover Details

What date would you like your cover to start?

Cover start date

This is the date that your cover will become active from. You can retrieve quotes for up to 3 months in advance.

Do you smoke?

Do you smoke?

Whether you smoke or not may affect the cost of your health insurance policy. Smoking includes all tobacco and nicotine products such as cigarettes, cigars, chewing tobacco, pipes and nicotine replacement products such as e-cigarettes or 'vapes'.

It is important to answer this question accurately as it may affect your cover if you need to make a claim.

Do you currently have a health insurance policy?

Do you currently have a health insurance policy?

If you have an existing health insurance policy we can show you "Switch" quotes, which may allow you to transfer your existing policy underwriting to a new provider, keeping cover for any pre-existing conditions that you have developed since taking out your current policy.

Partner Details

Do you wish to add your partner to your quote?

Add partner

You can add your partner to your policy, as well as your children to ensure that your whole family is protected.

Children

Would you like to add any children to your quote?

Number of children

You can add your children to your policy, as well as your partner, to ensure that your whole family is protected.

To comply with EU data protection regulations, we require the parent's consent to process the data of children under the age of 13.

Terms

Are you happy to receive occasional emails from ActiveQuote?

Email opt in

ActiveQuote would like to contact you from time to time by email in order to send you marketing materials and special offers which may be of interest to you.

If you would prefer not to receive these emails from ActiveQuote, answer 'No' to this question.

Please confirm that you have read and accept the Terms and Conditions?

Terms and conditions

You can read our terms and conditions here

Click the Get Quotes button to see your tailored quotes.

Further Information

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