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Step 1/4 - Trip Details
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TRIP DETAILS
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COVERAGE
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APPLICANT DETAILS
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PAYMENT

Patriot Exchange Insurance Application

Please note that :

  • If initially purchased for a minimum of one month or more, coverage may be renewed.
  • Not Available for Addresses from the Following US States: Maryland (MD).
  • Not available for Citizens of: Botswana (BWA), Gambia (GMB), Ghana (GHA), Niger (NER), Nigeria (NGA) & Sierra Leone (SLE).
All fields are required fields unless stated as optional
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.

(Begins at 12:00 AM EST)

(Ends at 12:00 AM EST)

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

Administrative Company

IMG

Carrier / Underwriter

Sirius International
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