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Agent Information
Location Number (if applicable)
This number can be found on the back
of your brochure (e.g.: 33-7777)
Agent Code
Booking Information
Invoice Number
First Trip Payment Date*
RadDatePicker
RadDatePicker
Open the calendar popup.

(mm/dd/yyyy)
Plan Options
 
Ultimate
Underwritten by Zurich

 
Trip Information
Prior to departure, your travel documents must indicate your Departure Date and Return Date.
Departure Date*
RadDatePicker
RadDatePicker
Open the calendar popup.

(mm/dd/yyyy)
Return Date*
RadDatePicker
RadDatePicker
Open the calendar popup.

(mm/dd/yyyy)
Destination*
select
Tour Operator
select
Cruise Line
select
Originating Airline
select
Primary Traveler Information
 
First Name*
Last Name*
 
Date of Birth* (mm/dd/yyyy)
 /  / 
Trip Cost* (ex. 1000 or 1000.00)
 
Please Note: $200,000.00 aggregate trip cost for all travelers on the same policy.
Additional Traveler Information
Traveler #2
 
First Name*
Last Name*
 
Date of Birth* (mm/dd/yyyy)
 /  / 
Trip Cost* (ex. 1000 or 1000.00)
Traveler #3
 
First Name*
Last Name*
 
Date of Birth* (mm/dd/yyyy)
 /  / 
Trip Cost* (ex. 1000 or 1000.00)
Add Travelers
Only individuals in the same household may be on one policy, up to a maximum of 10.
Additional Primary Traveler Information
Address*
 
City*
State*
select
Zip*
 
Country*
select
Phone*
    
Fax 
    
Beneficiary
(max 256 chars)
 
View Details
Policy Document Delivery Options
 
Delivery Method
 


Primary Traveler*
(Optional) Recipient #2
 
View Details
* Required Field
Plan Details
Ultimate
Benefits
Coverage Per Person
Trip Cancellation
100% of Insured Trip Cost
Frequent Traveler Awards
$250
Airfare Reissue Fee
$200
Trip Interruption
150% of Insured Trip Cost
Trip Inconvenience
$600
Travel Delay
$2,000 ($250/day)
Airline Club Admission
$50
Missed Connection - Air & Cruise Only
$750
Baggage and Personal Effects
$2,000
Baggage Delay
$500
Emergency Medical Expense
$250,000
Emergency Dental Expense
$500
Emergency Medical Evacuation/Repatriation
$1,000,000
Accidental Death & Dismemberment
$25,000
Exposure & Disappearance
$25,000
Travel Assistance
Included
 
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Contact information
Customer service
Phone: 1-800-228-9792
(8:00 a.m. to 7:00 p.m. CT, Monday - Friday)
[email protected]
Technical difficulties
Phone: (888) 457-4602
(8:00 a.m. to 7:00 p.m. CT, Monday - Friday)
[email protected]
Emergency while traveling
For emergency phone numbers while traveling
 

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©2024 Travelex Insurance Services Inc.,
and its licensors. All Rights Reserved.
 
 
 

The product descriptions provided above are only summaries. The full coverage terms and details, including limitations and exclusions, are contained in the insurance policy. Coverage and rates may vary by states. If there is any conflict between the contents of this website and the Policy, the Policy will govern in all cases. Travel Assistance Services are provided by the designated provider listed in the policy or on your Confirmation of Coverage.

Travelex Insurance Services, Inc. 810 North 96th Street, Suite 300, Omaha, NE, 68114. CA Agency License #0D10209.