Purchase Your Policy

TRIP DETAILS
COVERAGE
APPLICANT DETAILS
PAYMENT

Diplomat America Insurance Application

Please note that :

Not available if Home Country/Country of Residences are: United States (USA).
Not available for Citizens of: Australia (AUS) & Iran (IRN).

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

Where can we email your policy details?

Email Address

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

Diplomat America

Administrative Company

Global Underwriters

Carrier / Underwriter

Allied World Assurance Company (Europe) dac.

Review & Download

Plan Brochure Description of Coverage

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