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Step 1/4 - Trip Details

ChoiceAmerica Insurance Application

All fields are required fields unless stated as optional
This plan is not available if you are currently residing in United States, Mexico or Canada. Please contact for more infomation.
Where are you traveling to? : If any part of your trip includes the United States, please select United States as your Destination Country.
US green card holder is not eligible for this plan. Here is the list of eligible plans for US green card holder.

(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.
You are not eligible to purchase Choice America due to restriction of plan. You may be eligible to purchase Global Medical Insurance.
You are not eligible to purchase Choice America due to restriction of plan.
Where can we email your policy details?

Administrative Company


Carrier / Underwriter

Sirius International


  • For foreign visitors traveling to the United States, Mexico or Canada.
  • Coverage for minimum 5 days to maximum up to 365 days.

Limited Coverage Plan

Plan provide basic and fixed pre defined dollar amount for covered services, as defined in the policy.

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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