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Please
have the following information available to complete the
application process:
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Premium
Rates
All
premium rates are per person. |
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Renewing
Your Policy
If
you are RENEWING, please complete the application form
and mark Yes for RENEWAL. You may also RENEW
over the phone for faster service. |
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Applicant
Name
This is the name of the policy holder. |
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Passport
Number
Please list the passport number of the primary
applicant. |
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Policy
Effective Dates
Effective date of the Policy and the Expiration date
of the policy. This is the start and end
date of insurance coverage you would like for the policy you are
currently purchasing. |
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Primary
Destination
Primary Destination is the USA if you
are applying for the Incoming to the USA
Plans. If you are applying for the
Outbound from the USA Plans, please indicate the name
of the country you will be traveling. |
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Return
Destination
For the Incoming to the USA Plans, please indicate the
country you will be returning to after your stay in
the USA. For the Outbound Plans, your return
destination would be the USA. |
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Emergency
Contact
Please provide the name of an Emergency
Contact & Telephone number. |
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Payment
If
paying by credit card, please have your credit card
information ready. VISIT accepts
MasterCard, VISA and American Express |
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Family
Members
Please list the name, birth date, gender and relationship to applicant
for all Family members to be covered by this policy. Plans are
per person. |
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Beneficiary
Beneficiary
name and address. The Beneficiary is the person
that would receive the monetary benefit in case of an
accidental death of the insurance policy holder. |
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Who
is eligible for the insurance?
Plans
AB and CD
Students - All
student participants age 69 and under who are
traveling to the United States and are currently
enrolled in an accredited institution of higher
learning on a full-time basis with no less than
6 credit hours, unless the institution’s
full-time status requires less credit hours.
Scholars
- Scholars
working with or for an accredited educational
institution are generally exempt from the
minimum (i.e. Student) credit-hour requirement,
and thus are eligible for any VISIT Plan S, AB,
CD, and E. Please note that if maternity
coverage is not desired, students and scholars
are also eligible for Plan E, with an
annual rather than per occurrence deductible,
for approximately the same price as Plan AB.
Eligible
Spouses
-
means the Insured’s legal spouse who is
age 69 and under.
Eligible
Dependent Children -
means the Insured’s unmarried children,
including natural, step, foster or adopted
children from the moment of placement in the
home of the Insured, who are over 30 days old
and under age 18 and primarily dependent on the
Insured for support and maintenance.
Plan
E
VISIT's Plan E is open to any non-US citizen
(Student, Scholar or Visitor) traveling to
the US and their family-members traveling with
them, all under the age of sixty-nine.
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Student
Plan - Plan S
Our
newest VISIT Plan
S is specifically designed for Undergraduate
or Graduate Students holding a J1 or F1 visa, 17 to 26
years of age inclusive, who are traveling to the
United States and currently are enrolled in an
accredited institution of higher learning on a
full-time basis with no less than 6 credit hours,
unless the institution’s full-time status requires
less credit hours.
Scholars
are generally exempt from the minimum credit-hour
requirement (see above).
Click
Here for more details
Premiums
are per person.
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Questions
About Claims?
Click Here
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How
Do I Apply?
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VISIT
Travel & Medical Insurance makes applying easy!
To apply,
please choose one of the following options:
YOU MAY ORDER BY:
Online
Phone
Fax or Mail
A
Special Note to Seniors
* Premium rates
listed on this website are for persons traveling
abroad and their family members traveling with them,
69 years of age and younger. Additional coverage is
available for persons 70-80 years of age. Please call
1-800-247-5575 for premium rates or
Click Here for additional program options.
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IMPORTANT
SPECIAL ANNOUNCEMENT
Plans
A, B, C, D & E RATES
and BENEFITS
are changing effective July 1, 2008. Click
on Links or Call for details. |
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Buy Online Now using a major credit card. (MasterCard, VISA, American Express)
This process will take
approximately 5-7 minutes to complete over our Secure
Server. If
you are RENEWING your application, please
complete the online order form and check
YES to the question- Is this a Renewal?
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Phone orders only take a few minutes to complete and
our representatives will be pleased to answer
any questions you may have. Please have your
credit card (MasterCard, VISA or American Express)
information available as well as the names, birthdates
and passport numbers of all family members to be
covered. Please have the specific dates of
coverage and beneficiary information available when
placing your order.
Please contact us at:
1-800-247-5575 or
1-703-660-9062
VISIT Travel & Medical Insurance representatives are available during
regular business hours:
Monday-Friday, 9:00 a.m. to 6:00
p.m.
USA Eastern Time
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Print
Application
To view and print an application in .pdf format
Click
Here
Download
Acrobat Reader For Free
Once
you have completed the application, please Mail or Fax
it to:
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By
Mail:
VISIT
Travel & Medical Insurance
PO Box 210
Mount Vernon, VA 22121
You may pay by check, money order or major credit
card if mailing your application to VISIT. Your application is
NOT valid until it
is received by VISIT. Consider ordering online for
immediate coverage and confirmation. |
By
Fax:
1-703-991-9164
FAX
You MUST use a major credit card to submit your
application by fax.
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