Request a Quote

Please complete the below information to request a Group Private Medical Insurance quotation for a company. This form should only be used for companies with less than 10 members to be covered who do not currently have insurance in place. For any other quotation requests please email us at or give us a call on 0800 783 3311 and we will be happy to assist.

Policyholder/company Name:

Policyholder/ Company Address:


Telephone Number:


Mobile Number:

Business Description:

Number of Principal members (employees) on policy:

Cover Region:
Hospital Network required (uk only):
Cover extension required:

Excess Required:

Please enter below details of employees to be covered:

Name Gender Cover Required
(single, couple, family)
Date of Birth


"I would like to take this opportunity to thank you and your team for your advice and support in arranging both our Death in Service and Private Medical Insurance cover. Premier Healthcare clearly have a great deal of knowledge and expertise in the healthcare field and it was re-assuring to know that we were in capable hands. My numerous requests for advice and information were dealt with promptly and efficiently and we are very grateful that you were able to obtain very competitive prices for both our schemes."
C Froude, Bristol