Plan Ahead, Travel Protected.

Plans are available to non-U.S. residents traveling outside their home country.

Select Plan

Pre-Ex Coverage:

Plan Maximum:

Plan Deductible:

Pre-Ex Maximum:

Visitor Information

Accidental Death and Dismemberment Beneficiary (ADDB)

ADDB Name (?)

ADDB Relation

How did you hear about us?

Dependent Details

Spouse Details

First Name

Last Name

Date of Birth

Passport

Children Details

(Child 1)

First Name

Last Name

Date of Birth

Passport

Children Details

(Child 2)

First Name

Last Name

Date of Birth

Passport

Payment Details

Total Premium :

Disclosures

Terms and Conditions

I understand and agree that refund of plan cost less the enrollment fee and membership fee will be considered only if written cancellation form is received by the INF office before the trip start date. After that trip start date, the plan cost is considered fully earned and non-refundable. I understand that once cancelled, the plan is considered null and void and there will be no benefits or services available.

I have read and agree to the Terms and Conditions and Consent for Electronic Delivery

I confirm that no one covered under this policy is currently seeking or scheduled for emergency medical treatment during the period of coverage, and that this plan is being purchased for unforeseen medical emergencies.

I HEREBY CONFIRM THAT ALL INFORMATION ENTERED IN THE APPLICATION IS ACCURATE. ANY CHANGES TO POLICY MAY INCUR ADDITIONAL PREMIUMS. I HAVE READ THE TERMS, AND HEREBY AUTHORIZE INFPLANS.COM TO CHARGE THE AMOUNT ON THE CARD BELOW.

Credit Card Details

Card Holder

Card Number

Expiry

CVC

Home Address

Street Address

City

State (IF APPLICABLE)

Zipcode/PinCode

Country