Register for an extended Health and Travel insurance in Israel - Application form and method of payment

We would like to congratulate you for joining to an adventure in Israel, Part of preparation to your trip is to make sure you have health insurance.

Please see below the summary of medical insurance:

Summery of coverage

• Initial medical care 24 hours a day at the client’s home or at local clinics.
• Specialist medical care and laboratory testing, x-ray, ultra-sound etc. services
• Medicines upon physician prescription up to the sum of 500 USD for a period.
• Emergency dental treatments at participating clinics up to the sum of 500 USD for period.
• Evacuation by ambulance due to an emergency event and medical expenses of the treatment in the emergency room.
• All hospitalization expenses and treatments up to the sum of 50,000 USD for a period.
• Coverage for personal luggage up to 200$ for a period- 50$ deductible.
• In a case of cancellation of a flight, up to 200$ compensation.
• Alcohol injuries up to 5000$ for a period.
• Personal pre-existing condition in a case of emergency up to 10,000$

Summary of exclusions
The insurance policy shall not cover any event related to and/or emanating from pregnancy and childbirth, use of drugs, work accident, road accidents. The insurance is valid only in the state of Israel.

Extensions/ Renewal - in a case of renewing the insurance to extend the period of the 10-day trip (from arrival date to Israel), choose renewal and choose the name of the - in a case of renewing the insurance to extend the period of the 10-day trip (from arrival date to Israel), choose renewal and choose the name of the group, than choose the date that you want the insurance to end, this will give you the calculation of the days. All renewal must be asked 4 days befor the last day of insurance.You need to call 0732632024 or send an email with your personal details and phone number to tourism@hilit-ins.com to get an approval for your requast.
Note: the insurance will be valid only after the insurance company will get an approval for the credit card. If the insurance company will received wrong card details or the card will denied by the credit card company, you will received an email.
The registration will be valid two weeks before the arrival of the group to Israel.

In any medical event please call 24h 1800 36 36 22

New Renewal

Group ------ SA-22-124 SA-22-125 SA-22-131 SA-22-132 SA-22-133 SA-22-134 SA-22-135 SA-22-136 SA-22-137 SA-22-178 SA-22-220 SA-22-225 SA-22-240 SA-22-243 SA-22-271 SA-22-283 SA-22-352 SA-22-353 SA-22-377 SA-22-378 SA-22-422 SA-22-425 SA-22-459 SA-22-460 SA-22-462 SA-22-463 SA-22-464 SA-22-554 SA-22-555 SA-22-556 SA-22-572 HB-22-13 HB-22-233 HB-22-263 HB-22-355 HB-22-361 HB-22-490 HB-22-525 HB 22-652

From Date:  To Date:

Last Name	First Name	Passport Number	Date of Birth MM/DD/YY	Email address
Male  Female

Card Type

------ Visa Diners American Exress Master Card Other

Card Number

Expiry Date MM/YYYY

Name		Passport Number
Address		City		Email address