We are confident we can offer you comparative cover at cost effective premiums. It will take just a few minutes for you to input some details and calculate an indicative premium.

This assessment form is intended to give you an indicative appraisal of your health insurance needs. This is for comparative purposes only. It is based on the data you supply and data publicly available from Health Funds. Please note that if you currently have no Private Health Insurance, and are over 30 years of age, Lifetime loadings will apply. Our calculations are based on the Government 30% rebate having been applied. Older Australians will benefit from increased rebates depending on their age.

It is really easy to see how Health Insurance Advocates will assist you obtain an answer. Just follow these steps.

1. COMPLETE your relevant details in the boxes below
2. COMPREHEND our recommendations which are assessed on your input data
3. SUBMIT your form and one of our Health Insurance Advocates will contact you to ensure your individual needs are adequately addressed and provide you with quality, affordable cover.

Personal Details: denotes mandatory field

Title:
First name:
Surname:
Address:
Suburb:
Post code:
State:	VIC NSW ACT TAS QLD SA NT WA
NB. Please note all rates are based on Victorian charts. For other states please contact us for information as rates vary in all states..
Phone:(1 phone contact number is mandatory and 1 email address)
Home phone:
Work phone:
Mobile:
Fax:
Email:
Suitable time of day/evening to contact you: Anytime Morning Noon Afternoon Evening
I agree to allow Health Insurance Advocates to contact me via any of the media selected above.
Health Cover Details (hospital):
Make your selection: None Gold hospital cover (nil excess) Top hospital cover (with excess) Hospital Saver - $408 (single) yearly Hospital Saver - $815 (family/couple/sole parent) yearly Phone 1300 858 162 for information on Hospital Saver Cover. Choose below if you will consider an excess: (to reduce your premiums) nil 250 500 NB. Hospital covers displayed are top cover (with/without an excess) at Direct Debit rates. We have not included any policies with exclusions or co-payments herein.
Health Cover Details (extras):
Do you require extras cover? If so, complete boxes below Acupuncture Chiropractic Dental (general) Dental (major) Myotherapy Naturopathy Occup. Therapy Optical Pharmacy Physiotherapy Speech Therapy Psychology Podiatry NB. Extras: There are numerous extras benefits. If you have specific needs or queries in relation to extras cover, please contact us or telephone 1300 858 162.
Type:	FAMILY OR COUPLE SINGLE
Your Age Group:	UNDER 65 YEARS 65-69 YEARS OVER 70 YEARS
Date of birth:	DD/MM/YYYY
Partner’s Date of birth (If you and/or your partner are over 65 years a higher Govt. rebate applies, so be sure to complete this box)	DD/MM/YYYY
Partner’s Age Group:	UNDER 65 YEARS 65-69 YEARS OVER 70 YEARS
Your current health insurance details: No Health Fund at present Currently insured with
THANK YOU for completing your details and selections. Please press for your estimate