Odyssey Expatriate Benefits Program - Request for Quotation

Quotation Request

FAQ


	Please complete and submit the form below, and we'll be pleased to provide you with a no-obligation quotation as quickly as possible. We respect your privacy. We treat all information submitted as confidential, and will not resell, record or reuse said information.

P E R S O N A L I N F O R M A T I O N :

Full Name:

E-mail:

Telephone:

Gender:

Male

Female

Language:

English

French

Date of Birth:

Marital Status:

Nationality:

E M P L O Y M E N T I N F O R M A T I O N :

Company Name:

Occupation:

Annual Basic Salary & Currency

Number of Dependents accompanying you:

Location of Foreign Assignment:

Nature of work:

Date of Departure:

Anticipated Duration:
(Minimum 90 days)

C H O O S E Y O U R C O V E R A G E O P T I O N S :

Mandatory Coverage

No deductible, 100% reimbursement. Automatically includes Medical Benefits, $25,000 AD&D,and Contingency Benefts.

Long Term Disability

Benefit amount of 60%, 67% or 70% of monthly earnings to a maximum benefit of $10,000 USD per month;

Elimination Period:

Group Life Insurance

Amount:

Add spousal coverage:

Dependent Children:

Dental Insurance

No deductible - 100% reimbursement of basic and 50% of major Restorative Services to a combined Annual Maximum of $2,000 per year

Additional AD&D

Above and beyond the mandatory $25,000 Accidental Death & Dismemberment Insurance

Additional Info or Questions:


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				Odyssey™ Expatriate Form Pack (includes everything below) Odyssey™ 4 page Brochure Odyssey™ Application Form Odyssey™ Health Questionnaire for Applicant Odyssey™ Health Questionnaire for Each Dependent Odyssey™ Beneficiary Designation Form Odyssey™ Medical Claim Form Odyssey™ Dental Claim Form Downloads require Acrobat® Reader software, freely available from Adobe® here