PATIENT INFORMATION
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YOU MUST FILL OUT THE FORM COMPLETELY IN ORDER TO RECEIVE A QUOTE.
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Email Quote OnlyEmail Quote & Live AgentEmail Quote , Live Agent: I would like more information about other services you offer.
Date of Birth*
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Has 5% Discount for Family group
Restrictions Apply
YesNo
Maximum Insured Amount $25,000. OR If you would like a higher limit, please enter that amount in US dollars?
Beneficiary
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Relationship*
Name of Beneficiary*
[text beneficiary-last-name placeholder "]
Last Name of Beneficiary*
Date of Birth*
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E-mail*
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Additional Traveler
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[group traveler-1]
ADDITIONAL TRAVELER
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THIS INFORMATION IS MANDATORY.
Relationship*
Name of a Additional Traveler*
Middle Name of Traveler
Last Name of Traveler*
Date of Birth*
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Passport# or ID#*
Additional Traveler
[/group]
[group traveler-2]
ADDITIONAL 2nd TRAVELER
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Relationship*
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Middle Name of Traveler
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Date of Birth*
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Additional Traveler
[/group]
[group traveler-3]
ADDITIONAL 3rd TRAVELER
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Relationship*
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Middle Name of Traveler
Last Name of Traveler*
Date of Birth*
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Passport# or ID#*
Additional Traveler
[/group]
[group traveler-4]
ADDITIONAL 4th TRAVELER
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Relationship*
Name of a Additional Traveler*
Middle Name of Traveler
Last Name of Traveler*
Date of Birth*
Gender*
Nationality*
Passport# or ID#*
Additional Traveler
[/group]
[group traveler-5]
ADDITIONAL 5th TRAVELER
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Relationship*
Name of a Additional Traveler*
Middle Name of Traveler
Last Name of Traveler*
Date of Birth*
Gender*
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Passport# or ID#*
Additional Traveler
[/group]
[group traveler-6]
ADDITIONAL 6th TRAVELER
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THIS INFORMATION IS MANDATORY.
Relationship*
Name of a Additional Traveler*
Middle Name of Traveler
Last Name of Traveler*
Date of Birth*
Gender*
Nationality*
Passport# or ID#*
Additional Traveler
[/group]
[group traveler-7]
ADDITIONAL 7th TRAVELER
Please enter the details of additional travelers.
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Relationship*
Name of a Additional Traveler*
Middle Name of Traveler
Last Name of Traveler*
Date of Birth*
Gender*
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Passport# or ID#*
Additional Traveler
[/group]
[group traveler-8]
ADDITIONAL 8th TRAVELER
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THIS INFORMATION IS MANDATORY.
Relationship*
Name of a Additional Traveler*
Middle Name of Traveler
Last Name of Traveler*
Date of Birth*
Gender*
Nationality*
Passport# or ID#*
Additional Traveler
[/group]
[group traveler-9]
ADDITIONAL 9th TRAVELER
Please enter the details of additional travelers.
THIS INFORMATION IS MANDATORY.
Relationship*
Name of a Additional Traveler*
Middle Name of Traveler
Last Name of Traveler*
Date of Birth*
Gender*
Nationality*
Passport# or ID#*
Additional Traveler
[/group]
[group traveler-10]
ADDITIONAL 10th TRAVELER
Please enter the details of additional travelers.
THIS INFORMATION IS MANDATORY.
Relationship*
Name of a Additional Traveler*
Middle Name of Traveler
Last Name of Traveler*
Date of Birth*
Gender*
Nationality*
Passport# or ID#*
[/group]
Government Requirements for entry into Costa Rica
using a Costa Rican Insurance Company
1. Tourists must purchase travel insurance that covers accommodation in case of quarantine and medical expenses due to COVID-19.
This policy can be international or purchased from Costa Rican insurers.
- The policy limits apply for Costa Rica carriers like INS for travelers visiting Costa Rica, covering medical expenses by government mandate basic : $20,000 (twenty thousand U.S. dollars) and isolation (hosting) expenses for at least $2,000 (two thousand U.S. dollars).
Using your own foreign travel insurance policy
Costa Rica also accepts foreign travel insurance policies, as long as they meet a set of requirements.
The tourist must have certification from the policy issuer (in English or Spanish) confirming the following:
1. Validity of the policy during the visit to Costa Rica.
2. Guarantee that it covers medical expenses in cases of COVID-19 in Costa Rica, for at least $50,000 (fifty thousand United States dollars).
3. That it includes a minimum coverage of $2,000 for expenses of extended lodging due to the pandemic.
The Costa Rica Tourism Board (ICT) is responsible for verifying that visitors’ foreign policies comply with the requirements. This verification process will eventually be digital; however, until the digital process is implemented, ICT staff will conduct this verification step upon arrival at the airport.
A travel insurance policy is one of several requirements Costa Rica has established for arriving tourists.
The others include:
1. Anyone entering Costa Rica must complete the online “Health Pass” epidemiological form: This is known as the “Health Pass” or “Pase de Salud.”
- Please make sure to Fill out the digital health form (Pase de Salud) fill out 48 hours before you arrive so you don’t have to do in line . Click here for a link- https://salud.go.cr
When you agree with price & policy coverage agents will start processing your policy.
Keep in mind official policy will be generated in Spanish .
The Spanish version is the official policy you use upon entry.
This policy is written by an official INS Agent not by Green Healthcare Costa Rica. Your policy will have coverages and an explanation of what is being covered so everything your agreeing to is clear and concise.
Insurance Agents :
- José Ricardo Bejarano Sáenz Código 110003 Licencia SUGESE 08-1075
- Brayan José Bejarano Bogantes Código 110005 Licencia SUGESE 08-1750
Contact InfoUSA (786) 345-7689
Costa rica (506) 2460-3333
Email
Name of the company:Instituto Nacional De Seguros
Office NameSeguros Bejarano
Address Costa Rica, Alajuela, San Carlos, Quesada, Seguros Bejarano>
INS Travelers Insurance meets the basic requirements to enter the country established by the Ministry of Health of Costa Rica
INS Summary of Coverages
- Accidental Death
- Permanent Total or Partial Disability due to accident
- Medical Expenses for accident or acute illness:
- Accommodations expenses due to Sanitary Isolation.
- Sanitary/Funerary repatriation. Of your love ones remains
- Keep in mind official policy will be generated in Spanish
- Original will include official policy number # and expiration date
- Agent phone number will be on policy if you should need assistance.
- You will be issued an electronic version of this policy. It is advised to print a paper copy for your convenience.
Immediately after the purchase you will receive your policy number to be able to include it in the 'Health Pass' (Pase de Salud) https://salud.go.cr
The Spanish version is the official policy which you will use upon entry.
Check to agree to Terms and Conditions* Yes
If you need further assistance, the Green Healthcare Team will also be available to answer questions
www.greenhealthcarecr.com
