Health Insurance Quote

Now get a personalized quote for your reuirement by simply filling in all the information alongside.

We, at liberty general insurance, are committed to providing you the best solution for your requirements.

Name*

Mobile No.*

Email *

PinCode *

Policy Type:*

No. of Adults*

No. of Children*

Annual Income*

Any Pre-Existing Disease(s)*

see list Have any of the proposed insured ever suffered from / currently suffering from any of the following

• Hypertension, Chest Pain or any other cardiac disorder

• Tuberculosis, asthma or any other lung / respiratory disorder

• Kidney stone / failure, urinary tract / prostrate disorder

• Dizziness / stroke / paralysis / epilepsy or any brain / nervous system disorder

• Diabetes / thyroid or any hormonal disorder

• Tumor - benign / malignant, any cyst / ulcer / growth

• Arthritis / spondylosis or any other bone / muscle / joint disorder

• Disease of the nose / throat / ear / eye / dental

• Anaemia / leukemia or any other blood disorder

• HIV / AIDS / any sexually transmitted disorder

• Psychiatric / mental illness or sleep disorders

• DUB, Fibroid, Cyst, Fibroadenoma or any other Gynaecological disorder, menopause & GPAL History

• Been addicted to alcohol / Smoking / Pan Masala / Gutka / narcotics / habit forming drugs or under any detoxication therapy

• Been under any regular medication (self / prescribed including hormones or OC Pills)

• Undertaken any lab tests like blood / urine / stool or any imaging tests like sonography / MRI / CT / X-Rays in the last 5 yrs

• Undertaken any surgery or advised any surgery in the last 10 yrs or is a surgery pending?

• Suffered from any other illness / disease / accident / injury

• Is any of the proposed insured pregnant?

• Any complaint of diabetes, hypertension or any complication during current or earlier pregnancy?

Yes No

Now get a personalized quote for your reuirement by simply filling in all the information alongside.

We, at liberty general insurance, are committed to providing you the best solution for your requirements.

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