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Travel Medical
Travel Medical Insurance Quote
Getting Started
NAME*
ADDRESS*
PHONE NUMBER*
EMAIL*
BIRTHDATES
Rating Information
WHERE ARE YOU TRAVELLING?
USA
Non USA
WHAT ARE YOUR TRAVEL DATES?
DO YOU HAVE PROVINCIAL HEALTH CARE?
Y
N
ARE YOU A VISITOR TO CANADA?
Y
N
Current Health
ARE YOU IN GOOD HEALTH?
Yes
No
DO YOU HAVE ANY REASON TO EXPECT A MEDICAL PROBLEM WHILE ON YOUR TRIP?
Yes
No
DO YOU HAVE ANY PRE-EXISTING MEDICAL CONDITIONS?
Yes
No
If SO, WHAT ARE THEY? Please Explain:
HOW MANY MEDICATIONS PERTAINING TO YOUR MEDICAL CONDITION ARE YOU TAKING?
Trip
IS THIS A SINGLE TRIP?
Y
N
OR ARE YOU LOOKING FOR AN ANNUAL TRAVEL POLICY?
ANNUAL POLICY, WHAT IS THE MAX NUMBER OF DAYS WILL YOUR LONGEST TRIP BE?
IF VISITORS TO CANADA:
ARRIVAL DATE TO CANADA
DEPARTURE DATE FROM CANADA
COUNTRY OF RESIDENCE
Persons Insured
IS THERE MORE THAN JUST YOU THAT NEEDS TO BE COVERED UNDER THE POLICY?
Yes
No
If yes, NAME(S) AND BIRTHDATES OF ADDITIONAL TRAVELLERS
Coverage for Travel Medical
IN EXCESS TO THE $5,000,000 EMERGENCY MEDICAL COVERAGE, ARE YOU INTERESTED IN ANY OF THE OFFERED ADD-ONS?
Y
N
BAGGAGE
Y
N
ACCIDENTAL DEATH & DISMEMBERMENT
Y
N
FLIGHT ACCIDENT
Y
N
TRIP INTERRUPTION
Y
N
Coverage for Visitors to Canada
SELECT COVERAGE LIMIT
$25,000
$50,000
$100,000
$150,000
$200,000
Final