Request for Travel Coverage Quote
STATUS:
New
Processing
Complete
Today's Date:
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Month
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Day
Year
Name:
*
Email:
*
Are you interested in:
travel medical insurance (short term)
travel insurance (covers trip cancellation, travel delays, and other losses incurred while traveling)
international health insurance (long term)
Type of traveler:
vacation/holiday
visitors/immigrant
student/scholar
employer/business travel
expat/global citizen (digital nomad)
mission/social good
marine captain/crew
Are you interested in the following riders?
Add Device Protection Rider: Provides coverage for repair or replacement of your cell phone if it is lost, stolen, or accidentally damaged during your trip (so you can continue your trip uninterrupted and stay digitally connected wherever you are in the world).
Add Adventure Sports Rider: Provides coverage for any illness or injury sustained while taking part in activities designated as Adventure Sports, which are limited to the following: abseiling, BMX, bobsledding, bungie jumping, canyoning, caving, hot air ballooning, jungle zip lining, parachuting, paragliding, parascending, rappelling, skydiving, spelunking, whitewater kayaking, wildlife safaris, and windsurfing.
Add Telehealth, Travel Intelligence, & Higher Limits: Provides 24/7 access to telehealth providers, IMG Travel Intelligence alerts about your destination, a $2,000,000 maximum limit, emergency medical evacuation up to the maximum limit, and up to $25,000 coverage for sudden, non-life-threatening medical evacuations.
Add Enhanced Accidental Death & Dismemberment: Provides coverage in the event the insured has an accident (not listed in the exclusions) resulting in death during the Period of Insurance, an Enhanced Personal Death benefit in the amount of the Principal Sum as shown on the Certificate of Insurance is paid.
Traveler #1
Gender:
Male
Female
Date of Birth:
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Month
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Day
Year
Date
Age:
Coverage Start Date:
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Month
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Day
Year
Coverage End Date:
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Month
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Day
Year
Primary Destination, Country:
If more than 1 country, where will you spend the most time?
Country of Citizenship:
Country of Residency:
What country do you pay taxes in?
State of Residency:
If you live in the US.
Zip Code:
Spouse's Gender:
Male
Female
Spouse's Date of Birth:
-
Month
-
Day
Year
Date
Spouse's Age:
If either traveler is 65 or older and resides in the US, do they have Medicare:
Yes
No
Traveler #2
Gender:
Male
Female
Date of Birth:
-
Month
-
Day
Year
Date
Age:
Coverage Start Date:
-
Month
-
Day
Year
Coverage End Date:
-
Month
-
Day
Year
Primary Destination, Country:
If more than 1 country, where will you spend the most time?
Country of Citizenship:
Country of Residency:
What country do you pay taxes in?
State of Residency:
If you live in the US.
Zip Code:
Spouse's Gender:
Male
Female
Spouse's Date of Birth:
-
Month
-
Day
Year
Date
Spouse's Age:
If either traveler is 65 or older and resides in the US, do they have Medicare:
Yes
No
Provide any additional details below.
Submit
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