Get A Quote

International Student Insurance Application

Information About You

First and Last Name*

Title*

Institution Name*

Address*

City*

Zip Code*

Phone Number*

Email Address*

Student Information

How many students need coverage?*

Tell us how old they are (age range of students travelling to the U.S.).*

How long will your students need coverage? It's okay if some students will be travelling longer than others, just give us as many details you can. Your premium will be based on total insured days.*

What is your current international health insurance policy?*

How much did you pay for the premium?*

Altering insurance documents is against the law per U.S. Code, Title 18, Section 1347. If it is determined a document has been altered, we will notify your school and revoke your request.

If you have it readily available, please attach your travel claims data from the past 1-3 years. The acceptable file types are pdf, jpg, gif, png, jpeg