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Step 1/4 - Trip Details

Diplomat Long Term America Insurance Application

Please note that :

  • Not Available for Addresses from the Following US States: Maryland (MD), New York (NY) & South Dakota (SD).
  • Not available if Home Country/Country of Residences are: Australia (AUS) & Iran (IRN).
  • Not available for Citizens of: Australia (AUS) & Iran (IRN).
  • Not Available for the following Destination Countries: Iran (IRN).
All fields are required fields unless stated as optional
Sorry, we don't have an online application for your country at this time. Please contact for more infomation.
Traveling to Multiple Countries? : 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.

(Begins at 12:00 AM EST)

(Ends at 11:59 PM EST)

(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.
Where can we email your policy details?

Administrative Company

Global Underwriters

Carrier / Underwriter

United States Fire Insurance Company


  • For international travelers traveling outside their home country.
  • Coverage is availble for a minimum 3 months to a maximum of 12 months at a time. Can be renewed up to maximum 36 months

Comprehensive Coverage Plan

The comprehensive plan provides a percentage of eligible expenses, up to the policy maximum.

In the USA

After the deductible is met, the plan pays 80% of first $5,000; then 100% up to chosen medical maximum.

Outside the USA

After the deductible the plan pays 100% up to the policy maximum.

Review Policy document (Description of Coverage), for complete policy details including benefits and exclusions. ® is an online operating entity of Maxn Insurance Services, CA, USA License #0F17045
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