Good Neighbor Insurance
Omega

Great choice! Let’s get your cover started.

GNI Omega Sign Up (v13) - 29 October 2024
Insured's Details
Family Members (ONLY family members that will be on this policy).
Email Address (In order to ensure your email is reachable, kindly check that you receive a notification email shortly after submission of this form)
Mobile phone number (Please provide the best mobile phone number to reach you)
Country of Nationality
Country of Destination
Time in the USA
Church or Mission
Communication Preferences *

If you are in a country where language relating to Christianity or missions could compromise your ministry, we are able to modify our communication methods and language to remove all references to anything that may be sensitive. Note: Sensitive communications will also remove references to Talent Trust, and may mean that you will not receive all of our communications.

Emergency Contact
Referred By
Program Start
Additional Options (Some options have a waiting period. Please refer to the Options Page for details)

All prices are quoted in US$ per year.

Vision Care:

Dental:

Travel Cover:

Travel costs of insured members to be with a close relative who is at peril of death or who has died:

Personal Accident:

Non Emergency Travel:

Additional Chronic Conditions Cover:

Crisis Assistance Program (CAP):

Payment Details
Credit Card Details


When your policy is set up, we will email you the credit card payment link.
Bank Transfer Details
Bank Account Name: CITIBANK
Account Holder Name: AWP HEALTH & LIFE SA-DUBLIN BRANCH
Account Number: 9889671
IBAN Number: IE40CITI99005109889671
SWIFT Code: CITIIE2X
Bank Address: North Wall Quay Dublin 1
Bank Contact Number:
Account Currency: USD
Account Holder's Corresponding Address: 15 Joyce Way Parkwest Business Campus Dublin 12 Ireland
Organization Details
Medical Questionnaire

 

Note: All the following medical questions are * required

A) Hospital admission

B) Prescribed drugs, medication or treatment

C) Foreseeable treatment

D) Medical history

By clicking the 'Submit' button below, you are declaring that you have read, understood, and agree to the following 5 points:

  • I declare that I have read, understood, and agree to the terms of the Table of Benefits and Benefits Guide.
  • I declare that all the information supplied for all persons on this enrollment form is accurate and complete.
  • I understand that no cover is provided for professional sporting activities.
  • I understand that I may not complete this enrollment until all material facts* connected with this enrollment have been declared in full, without misstatement or misrepresentation, and have been accepted by us in writing. I understand that failure to do so will result in cover being void from inception.
  • I understand that pre-existing conditions are not covered. (A pre-existing condition is any disease, illness or injury, secondary or associated complaint for which you have sought or received advice, treatment, therapy, or been submitted to a special diet - whether or not the condition has been diagnosed).

* A material fact is any information that may affect our assessment or acceptance of your enrollment for insurance. If you are unsure as to whether any piece of information is a material fact, it should be declared.

NEED ASSISTANCE?

If you require assistance,
please email our support team at:

Email: info@talent-trust.com
Skype: ttc.insurance
Phone, WhatsApp: +60 (11) 1051 2677
Working hours:
Monday to Friday 10am – 6pm, GMT +8
Enter you Email/WhatsApp and we'll get back to you:
Request for Assistance filling in a Quote or Signup

Or

If you have questions, please email us, and we will get back to you as soon as we can.

info@talent-trust.com