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Cigna DIY Health Insurance Plan
IndividualFamily

Basic Information

Smoking Habit

Do you smoke, or have you smoked in last 12 months ?

Contact Information

By submitting this form, I understand the provision of above information means I agree to Cigna Healthcare's use and/or transfer of my personal data for direct marketing of its related insurance products and services. I have read and accepted the Personal Information Collection Statement and Privacy Statement of Cigna Healthcare.

*Please ensure that you complete all required fields. Incomplete information may result in delays or an inability to provide you with a quote.
#The premiums above are for your reference only. Your final premium may differ from this quote. This quote excludes any levy imposed by the Insurance Authority. The final premium will be calculated based on factors including, but not limited to: your selected plan, age, health status, smoking habits, and other relevant factors. A more accurate premium calculation will be provided upon completion of your application.

Basic Information

Myself

Smoking Habit

Do you smoke, or have you smoked in last 12 months ?
Spouse

Smoking Habit

Do you smoke, or have you smoked in last 12 months ?
Child

Smoking Habit

Do you smoke, or have you smoked in last 12 months ?
Child 2
Child 3

Contact Information

By submitting this form, I understand the provision of above information means I agree to Cigna Healthcare's use and/or transfer of my personal data for direct marketing of its related insurance products and services. I have read and accepted the Personal Information Collection Statement and Privacy Statement of Cigna Healthcare.

*Please ensure that you complete all required fields. Incomplete information may result in delays or an inability to provide you with a quote.
#The premiums above are for your reference only. Your final premium may differ from this quote. This quote excludes any levy imposed by the Insurance Authority. The final premium will be calculated based on factors including, but not limited to: your selected plan, age, health status, smoking habits, and other relevant factors. A more accurate premium calculation will be provided upon completion of your application.

Cigna Worldwide General Insurance Company Limited has been authorized and regulated by the Insurance Authority to carry out general insurance business in or from the Hong Kong SAR. Cigna Worldwide General Insurance Company Limited ("Cigna Healthcare"), © 2025 Cigna Healthcare. All rights reserved

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