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APPLICANT DETAILS
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Liaison Travel Choice Insurance Application

Please note that :

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), Cuba (CUB), Gambia (GMB), Ghana (GHA), Iran (IRN), Kosovo (XKX), Nigeria (NGA), Sierra Leone (SLE), Switzerland (CHE) & Syria (SYR).
Not available for Citizens of: Kosovo (XKX).
Not Available for the following Destination Countries: Antarctica (ATA), Cuba (CUB), Iran (IRN), Kosovo (XKX) & Syria (SYR).

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

Coverage Area

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.

LCH

Liaison Travel Choice

Administrative Company

Seven Corners

Carrier / Underwriter

Lloyd's of London and Tramont Insurance Company

Eligibility

For international travelers traveling outside their home country.
Coverage for minimum 5 days to maximum up to 364 days in a policy period.

Comprehensive Coverage Plan

The comprehensive plan provides percentage of eligible expenses, up to the policy maximum. After the deductible,

in the USA

within the PPO Network,

Liaison Travel Choice plan pays 90% of first $5,000; then 100% up to chosen medical maximum.

Outside the PPO Network

:the plan pays 80% for the first $5,000 and then 100% up to the policy maximum

Outside the USA

: After the deductible is met, the plan pays 100% up to the policy maximum. 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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