Are you signing up for a Birthright trip? Ask your tour operator for the direct signup link!

Get a quote for the policy here

Primary Policy Holder Details
Last Name *
First Name *
Date of Birth * / /
Age  *
Passport Number *
Gender * Male Female
Are you suffering from or have you ever suffered from,  or have you been diagnosed with any of the following *
 *
 

Details (please add date of event):
What is the pre-existing condition for which you require cover?
Name of Yeshiva \ School \ Sem  *
Address of Program in Israel:
Home Address *
City *
ZIP
State
Country *
Phone in the US *
Fax
Email *
Name of the owner of the credit card you will be using  *
Travel Details
Start Date *
End Date *
Health Details
Have you ever been insured by Harel? * No Yes
Has Harel or another insurer refused to insure you ? If yes, specify which company and for what reason ? * No Yes
Details:
Are you pregnant? * No Yes
Are you sick now? * No Yes
Details:
How did you hear about us?

Renunciation of Medical Secrecy
I, hereby give my permission to all the doctors and other medical institutions and hospitals and/or to all insurance companies and/or to every institution and other body or individual, to provide Harel Insurance Company Ltd.  with all the details, without exception and in the matter that shall be demanded by Harel, as regards my state of health and/or any disease that I have suffered from in the past and/or that I am currently suffering from, and I hereby release you from the obligation to safeguard medical secrets and hereby renounce this secrecy towards Harel. This declaration of renunciation binds me, my estate and my legal delegates and everyone who will come in my stead. This declaration of renunciation shall also apply to the minors in this policy.


IMPORTANT: Pre-existing illness information

 

Pre-existing conditions (not included in the basic policy)
Details of Coverage

Sudden Deterioration of pre-existing illnesses/medical conditions Where, In the 6 months preceding the arrival to Israel:

  1. The condition has been stable.
  2. No hospitalization.
  3. No change in the dosage of medication being taken.

Coverage: Up to $10,000
Exclusions:

  1. Any condition for which the treatment was expected / for which a doctor in the applicant’s home country recommended the applicant not travel to Israel / for which the applicant was on a waiting list for an operation or treatment.
  2. AIDS, transplants, M.S., dialysis, C.F., sexual diseases, heart disease, malignant diseases (such as cancer).
  3. No cover for refills of medications related to the pre-existing condition.
  4. Applicants over 49 years of age.
  5. Applicants who do not have basic Tour and Care insurance or where the premium for the basic policy has not been paid.

Contact our office for more details