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APPLICANT DETAILS
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Atlas International Insurance Application

Please note that :

If you are purchasing this plan for Schengen visa purposes, please select a zero dollar ($0) deductible.
Not Available for Addresses from the Following U.S. States/Territories: Maryland (MD), New York (NY) & Washington (WA).
Not available if Home Country/Country of Residences are: Cuba (CUB), Iran (IRN), North Korea (PRK) & Syria (SYR).
Not available for Citizens of: Cuba (CUB), Iran (IRN) & North Korea (PRK).
Not Available for the following Destination Countries: Cuba (CUB), Iran (IRN), North Korea (PRK), Syria (SYR) & United States (USA).

All fields are required fields unless stated as optional

Citizenship

Residence / Home Country

Where are you traveling to?

Where are you traveling to? : If any part of your trip includes the United States, please select United States as your Destination Country. Other countries except Home Country on your trip is automatically covered.

Will your trip include the US or US territories?

Sorry, we don't have an online application for your country at this time. Please contact support@visitorscoverage.com for more infomation.

You are not eligible to purchase Atlas International because your trip include US or US territories. You may be eligible to purchase Atlas America.

Coverage Start Date
(Begins at 12:00 AM EST)

Coverage End Date
(Ends at 11:59 PM EST)

Coverage Area

Please use the date of birth that appears in your travel documents, for e.g passport. A request to correct date of birth after the policy is purchased may result in changes to policy premium and benefits.

Applicant Date of Birth

Spouse Coverage Needed

Spouse Date of Birth

Child Coverage Needed
(17 years and under)

Dependent Child: Children 17 years and under of the primary insured on this policy. Grandchildren, nieces, nephews etc. are not considered as dependent children. Please fill a separate application in such cases or for older children.

+ Add Child

Where can we email your policy details?

Email Address

Will be used for communicating policy related notifications.

Atlas International

Administrative Company

Tokio Marine HCC – MIS Group

Carrier / Underwriter

Lloyd's of London

Payment Options

Credit cards accepted:
Debit cards are not accepted.

Eligibility

For international travelers travelling anywhere outside their home country. No Coverage in USA.
Coverage for minimum 5 days to maximum up to 364 days in a policy period.

Comprehensive Coverage Plan

Review the policy document for complete policy details including benefits and exclusions and an important notice regarding Affordable Care Act requirements.

Review & Download

Plan Brochure Description of Coverage Insurance Product Information Document

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