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TRIP DETAILS
COVERAGE
APPLICANT DETAILS
PAYMENT

CoverAmerica - Gold Insurance Application

Please note that :

The policy must be purchased for a minimum of 30 days to be eligible for COVID-19 benefits and coverage.
Not Available for Addresses from the Following US States: Maryland (MD) & New York (NY).
Not available if Home Country/Country of Residences are: Cuba (CUB), Iran (IRN), North Korea (PRK), Syria (SYR), United States (USA) & Venezuela (VEN).
Not available for Citizens of: Botswana (BWA), Gambia (GMB), Ghana (GHA), Niger (NER), Nigeria (NGA), Sierra Leone (SLE) & United States (USA).

All fields are required fields unless stated as optional

Citizenship

Residence / Home Country

Where are you traveling to?

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

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

You are not eligible to purchase Patriot International due to restriction of plan. You may be eligible to purchase Global Medical Insurance.

You are not eligible to purchase Patriot International due to restriction of plan.

Where can we email your policy details?

Email Address

Will be used for communicating policy related notifications.

CA-G

CoverAmerica - Gold

Administrative Company

IMG

Carrier / Underwriter

Sirius International

Payment Options

Credit cards accepted:
Debit cards with MasterCard or Visa logo are accepted.

Eligibility

For non-U.S. residents and non-U.S. citizens, while traveling to the United States and for incidental trips to Canada, Mexico, Latin America, Bahamas and South America.
For Age 14 days to 79 years of age.
Coverage for minimum of 5 days up to 365 days.
Must purchase a minimum of 30 days of coverage to be eligible for COVID-19 benefits and coverage.

Comprehensive Coverage Plan

The comprehensive plan provides a percentage coverage for eligible medical expenses, up to the policy maximum. After the deductible is satisfied, within the PPO in network, CoverAmerica - Gold plan pays 100% of all eligible medical expenses up to the policy maximum. For coverage outside of the PPO network, the plan will it pay 80% of eligible medical expenses up to $1,000 than 100% thereafter.

Review Policy document (Description of Coverage), for complete policy details including benefits and exclusions.

Review & Download

Plan Brochure Description of Coverage

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