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HEALTHGROUP GAP COVER COMPLIANCE & NEEDS ANALYSIS FORM

This form collects the information HealthGroup needs to complete your compliance requirements and determine whether you qualify as a transfer or a new entrant under the Genesis underwriting concession. Once submitted, a HealthGroup advisor will review your details and email you the appropriate application pack, including a full explanation of the cover, benefits, waiting periods, pricing, and the onboarding process. We will then guide you step‑by‑step and provide compliant advice tailored to your needs.

  1. Personal Details
2. Genesis Membership Details
Genesis Option
Med-100
Med-200
Med-200 Plus
3. Household & Dependant Information
Are you applying for cover for:
Just yourself
Yourself + dependants
4. Current Gap Cover Status
Do you currently have gap cover with another provider?
Yes, I have existing gap cover
No, I do not have gap cover
  1. Consent for Advice & Communication
  1. Privacy & Data Use Consent
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