Kowrry Health System

Monthly Premium:	₦249.99
Annual Deductible:	₦4500
Plan Type:	individual
Category:	silver

Personal Information

First Name

Last Name

Date of Birth

Gender

Email Address

Phone Number

Home Address

Street Address

City

State

ZIP Code

Height (in feet and inches)

Weight (in pounds)

Smoking Status

Medical History

Do you have any of the following medical conditions?

Heart Disease

Diabetes

Cancer

Hypertension

Asthma

Stroke

Mental Health Condition

Arthritis

List any current medications

List any allergies

Previous surgeries or hospitalizations

Family medical history

Coverage & Payment Details

When would you like your coverage to start?

Coverage typically begins on the 1st of the month. The earliest start date is usually the 1st of next month.

Payment Information

Preferred Payment Method

Payment Frequency

Payment details will be collected after your application is approved. You will not be charged until your coverage begins.

Review Your Application

Please review your application information carefully before submitting. You can go back to any section to make changes if needed.

Personal Information

Name:

Date of Birth:

Gender:

Email:

Phone:

Address:

Height:

Weight: lbs

Smoking Status:

Medical History

Medical Conditions: None selected

Medications: None listed

Allergies: None listed

Coverage & Payment

Plan: FlexiCare (Individual)

Coverage Start Date:

Payment Method:

Payment Frequency:

Estimated Premium: ₦249.99 per month

I confirm that all the information provided is accurate and complete to the best of my knowledge. I understand that any misrepresentation may result in the denial of claims or cancellation of coverage.

I have read and agree to the Terms and Conditions and Privacy Policy.

Apply for FlexiCare

Plan Summary

Individual Plan

Personal Information

Home Address

Medical History

Coverage & Payment Details

Payment Information

Review Your Application

Personal Information

Medical History

Coverage & Payment