* = Required fields
Choose which Global Medevac enrollment option is best for you: * Member Preferred Hospital Services Region 2: Individual Monthly • $35/moMember Preferred Hospital Services Region 2: Family Monthly • $55/moMember Preferred Hospital Services Region 2: Individual Yearly • $410/yrMember Preferred Hospital Services Region 2: Family Yearly • $645/yrMember Preferred Hospital Services Region 2: Individual 5-Year • $1850Member Preferred Hospital Services Region 2: Family 5-Year • $2900Member Preferred Hospital Services Region 2: Individual 10-Year • $3275Member Preferred Hospital Services Region 2: Family 10-Year • $5150Member Preferred Hospital Services Region 1: Individual Monthly Preferred Hospital • $28/moMember Preferred Hospital Services Region 1: Family Monthly Preferred Hospital • $42/moMember Preferred Hospital Services Region 1: Individual Yearly Preferred Hospital • $325/yrMember Preferred Hospital Services Region 1: Family Yearly Preferred Hospital • $495/yrMember Preferred Hospital Services Region 1: Individual 5-Year Preferred Hospital • $1450Member Preferred Hospital Services Region 1: Family 5-Year Preferred Hospital • $2225Member Preferred Hospital Services Region 1: Individual 10-Year Preferred Hospital • $2600Member Preferred Hospital Services Region 1: Family 10-Year Preferred Hospital • $3950Member Services – Florida: Individual Monthly • $20/moMember Services – Florida: Family Monthly • $30/moMember Services – Florida: Individual Yearly • $230/yrMember Services – Florida: Family Yearly • $350/yrMember Services – Florida: Individual 5-Year • $1050Member Services – Florida: Family 5-Year • $1575Member Services – Florida: Individual 10-Year • $1850Member Services – Florida: Family 10-Year • $2800
Note: Preexisting conditions are covered after 90-days
First Name *
Middle Name
Last Name *
Birthdate *
Age *
Your Email *
Mobile Phone Number *
First Name
Last Name
Birthdate
Age
Spouse Email
Mobile Phone
Street Address *
City *
State *
Zip *
Street Address
City
State
Zip
Agent Name
Agent Number
Note: a Global Medevac agent will reach out to you to process your payment
Annual Credit/Debit Card PaymentEFT/ACH Payment
(help someone else gain the ultimate peace of mind)
Email
Mobile Phone Number
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Market By: New Indemnity Solutions Corp 787-792-5730 P.O. BOX 270295 San Juan Puerto Rico 00927-0295