1. Enter the age of the traveler or visitor
2. Select the number of dependant under 18 from the drop down(if required.)
0
1
2
3
4
5
6
3. Coverage limit for medical expenses
$25,000 or less
$26,000 to $50,000
$51,000 to $75,000
$76,000 to $100,000
$101,000 to $499,000
$500,000 to $999,000
$1,000,000 to $1,999,000
$2,000,000 to $7,999,000
$8,000,000 or more
4. Deductible amount
US$ 0
US$ 50 to 100
US$ 101 to 250
US$ 500
US$ 1000
US$ 2500
US$ 5000
5. Choose the dates for insurance coverage
Start Date:
End Date:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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5
6
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12
13
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16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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18
19
20
21
22
23
24
25
26
27
28
29
30
31
months
days
6. Visitor/traveler's country of citizenship
7. Country/countries where coverage is required
8. Mailing address & permanent address
9. If visitor already in USA, how long has the visitor been in USA
Not in US yet or arrived less than 1 year ago
Arrived in the US less than 2 years ago
Arrived in the US more than 2 years ago
