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TRIP DETAILS
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APPLICANT DETAILS
PAYMENT

Inbound USA Insurance Application

Please note that :

Plan has to be purchased within 1 year of arrival in USA.
This plan is also not available to residents of Alberta and Manitoba, Canada
Not Available for Addresses from the Following US States: Colorado (CO), Maryland (MD), New York (NY), South Dakota (SD) & Washington (WA).
Not available if Home Country/Country of Residences are: Australia (AUS), Canada (CAN), Cuba (CUB), Gambia (GMB), Ghana (GHA), Iran (IRN), Nigeria (NGA), Sierra Leone (SLE), Switzerland (CHE), Syria (SYR) & United States (USA).
Not available for Citizens of: Australia (AUS), Canada (CAN), Cuba (CUB), Gambia (GMB), Ghana (GHA), Iran (IRN), Nigeria (NGA), Sierra Leone (SLE), Switzerland (CHE), Syria (SYR) & 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.

Date of Arrival in the US

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
(18 years and under)

Dependent Child: Children 18 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.

Inbound USA

Administrative Company

Seven Corners

Carrier / Underwriter

Lloyd's of London

Eligibility

For Non US citizens and Non US residents traveling to the USA.
Coverage for minimum 5 days to maximum up to 364 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.

Review & Download

Plan Brochure Description of Coverage

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