Application for a national health insurance card-EHIC

Are you traveling abroad? Do you have valid health insurance in Dovera? You do not have a valid insurance card. Just fill in the following application. We will issue you the insurance card within 7 working days and then deliver it by post.

Warning: From 01.07.2018, health insurance companies do not issue new insurance cards to insured persons who have an identification document with a chip. These insured persons are only entitled to get a European Insurance Card (hereinafter EHIC). An identification document or EHIC is sufficient for identification at a health care provider or pharmacy.

Title

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Name

Firstname is required field

Surname

Surname is required field

Identification number (without slash)

Identification number is required field, allowed numbers

Date of birth

Date of birth required field, date in format dd.mm.yyyy

{Vybraný dátum je víkend / sviatok.}

{Zadajte dátum vo formáte DD.MM.YYYY}

Street and descriptive number

Address is required field

Town

Town is required field

ZIP Code

ZIP is required field

Phone number

Phone is required field

Email address

Email is required field

I apply for an insurance card for a reason:

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I am applying for an EHIC Replacement Certificate due to travelling abroad within 30 days

Yes

I will pick up the card at branch of the Dôvera, zdravotná poisťovňa, a.s.:

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For more information, please, contact our Customer service.

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Application for a national health insurance card-EHIC

DÔVERA

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