Buy Student Health Advantage Platinum

All fields are required fields unless stated as optional

Residence / Home Country

Where are you traveling to?

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

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

Coverage Area

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

Is the applicant present in the USA ?

Has the applicant resided outside the U.S. continuously for the past 6 months?

Do you have a current health plan in force?

International Insurance Provider

Expiration Date of Current Coverage

Where can we email your policy details?

This email address will be used to communicate the policy related information and the status of the policy application.

Administrative Company

IMG

Carrier / Underwriter

Sirius International

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Plan Brochure

Preferred Method to Reach You ^*

We have received your request. One of our licensed insurance agents will get in touch with you.

Purchase Your Policy

Student Health Advantage - Platinum Insurance Application

Please note that :

Student Health Advantage - Platinum

Administrative Company

Carrier / Underwriter

Review & Download