Insurance application

The amount you've paid for your trip is nonrefundable. If you need to cancel your trip before you leave, or interrupt it while traveling, you won't be able to get your money back.

If you purchase trip interruption/cancellation insurance, you'll be able to get your money back if you cancel/interrupt it for a covered reason. The primary reason people cancel is for a medical/death reason, either for themselves or their family. See below for all the covered reasons*.

Complete the application below so that you can be enrolled in trip cancellation/interruption insurance for your trip. Complete one form for each person to be covered by the insurance. Enrollment will insure you for the following coverage:

Trip Cancellation Trip Interruption

Up to Trip Cost* 150% Trip Cost*

Missed Connection Trip Delay

$750 (3 hours) $750 ($200/day/6 hours)

Baggage & Personal Effects Baggage Delay

$1,500 $300 (12 hours)

Pet Care Emergency Accident & Sickness Medical Expense

$300 $50,000 ($50 deductible per occurrence)

Emergency Evacuation & Repatriation of Remains Accidental Death & Dismemberment

$500,000 $25,000

Optional Collision Damage Waiver Optional Accidental Death & Dismemberment Air Only

$50,000 Up To The Amount Purchased

Optional Accident & Sickness Medical Expense Optional Evacuation & Repatriation of Remains

$50,000 (For a total of $100,000) $500,000 (For a total of $1,000,000)

Optional Cancel For Any Reason Optional Cancel For Work Reasons

Up to 75% of Trip Cost Up to Trip Cost*

Optional Sports Coverage

Combined maximum of $1,000 per person

Cost of trip interruption/cancellation insurance*

Age at time of purchase

Amount of prepaid, nonrefundable costs to insure 0-35 36-60 61-70 71-75 76-80 81-85 86+

$3,501-$4,000 $     147 $        161 $     239 $     320 $     386 $     552 $     592

$4,001-$4,500 $     164 $        183 $     301 $     360 $     432 $     580 $     664

$4,501-$5,000 $     184 $        204 $     343 $     397 $     480 $     655 $     730

$5,001-$5,500 $     210 $        243 $     378 $     470 $     527 $     685 $       80

$0** $       20 $         30 $       36 $       45 $       54 $       89 $       97

*there is an $8 processing fee in addition to insurance costs

** policy will not include trip interruption/trip cancellation, but will include everything else

* Required fields
Name *
E-mail Address *
Total prepaid cost of trip you are insuring: *
Billing Address *
City *
State *
Zip code: *
Date of birth; age at time of enrollment *
Gender *
Phone: *
Form of payment *
Credit card number: *
Expiration Date: *
Security ID: *
	I want to purchase the insurance that allows me to cancel for any reason (50% premium surcharge). You are only eligible for this if you purchase the insurance within 13 days of your initial trip deposit.
	I want to purchase the insurance that allows me to cancel for a work reason ($24 premium surcharge). You are only eligible for this if you purchase the insurance within 13 days of your initial trip deposit.
	Additional medical coverage for a total of $100,000
I want to purchase additional accidental death/disability insurance due to air accident.	$100,000 for $8 $250,000 for $18 $500,000 for $39 $1,000,000 for $50
If more than one person is to be enrolled in this policy, indicate names of other persons, age/date of birth, gender, and relationship to you:

I have read and agree to the Privacy Policy *

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You also receive the following services and assistance:

Worldwide Travel and Assistance Services Are Included

Travel Assistance Services Medical or Legal Referral Inoculation information

Hospital Admission Guarantee Translation Service Lost Baggage Retrieval

Passport & Visa Information Emergency Cash Advance Bail Bond

Prescription Drug & Eyeglass Replacement Concierge Services Access to ticket services for events

Directions, Contact information & Reservations Translation, Local guides, Tours Pre-Trip assistance, Destination Profiles

Meet and greet service Shopping assistance Floral Services

Tee Time Reservations Procurement of hard-to-find items ID Theft Recovery Assistance

Cancellation of Lost or Stolen Credit Cards Place Fraud Alert on Customer's Credit Record Cash Advance and Translation Services (up to $500)

Provide a Guide Detailing the Steps Needed to Rest Notify all three major credit-reporting agencies Place a "security freeze" on credit report

Provide weekly status reports until file is closed Follow up with creditors ensuring items are closed Notify local authorities of ID Theft incident

An $8 handling fee is added by the insurance company.

* Reasons why one can cancel/interrupt an insured trip and get your money back:

a) Sickness, Accidental Injury, or death of You, Your Traveling Companion, or a Family Member or Business Partner of You or Your Traveling Companion which results in medically imposed restrictions as certified by a Physician at the time of loss, preventing Your continued participation in the Trip. A Physician must advise cancellation of the Trip on or before the Scheduled Departure Date.

b) Strike that causes complete cessation of services for at least 24 consecutive hours.

c) Weather which causes complete cessation of services of Your Common Carrier for at least 24 consecutive hours.

d) You or Your Traveling Companion are terminated or laid off from employment subject to three years of continuous employment at the place of employment where terminated.

e) You or Your Traveling Companion are hijacked, quarantined, required to serve on a jury, subpoenaed or required to appear as a witness in a legal action, provided You or a Traveling Companion are not a party to the legal action or appearing as a law enforcement officer, the victim of felonious assault within 10 days of departure; or having Your principal place of residence made uninhabitable by fire, flood, or other Natural Disaster; or burglary of Your principal place of residence within 10 days of departure.

f) Bankruptcy or Default of Your Travel Supplier which occurs more than 14 days following Your Effective Date. Coverage is not provided for the Bankruptcy or Default of the travel agent or Travel Supplier that solicited this protection plan and from whom You purchased Your Land/Sea Arrangements. Benefits will be paid due to Bankruptcy or Default of an airline only if no alternate transportation is available. If alternate transportation is available, benefits will be limited to the change fee charged to allow You to transfer to another airline in order to get to Your intended destination. You must purchase Your plan within 14 days of Your initial Trip deposit.

g) If within 30 days of Your departure, a politically motivated Terrorist Attack occurs within the territorial limits of the City listed on Your itinerary. The Terrorist Attack must occur after the Effective Date of Your Trip Cancellation coverage.

h) You or Your Traveling Companion who are military personnel, and are called to emergency duty for a disaster other than war or are called to active military duty, have their leave revoked or are reassigned for reasons other than war.

i) You or Your Traveling Companion being directly involved in a traffic Accident substantiated by a police report, while en route to departure.

j) The death or hospitalization of Your Host at Destination.

k) Natural Disaster at the site of Your destination which renders Your destination accommodations uninhabitable.

l) Your normal pregnancy or attending the childbirth of Your Family Member. The pregnancy must occur after the Plan Effective Date and be verified by medical records.

m) The primary or secondary school where You or Your Dependent Children attend must extend operating session beyond the predefined school year, due to Unforeseen events commencing during Your plan effective period and the travel dates for Your Trip fall within the period of the school year extension. Extensions due to extracurricular or athletic events are not covered.

n) Mandatory evacuation ordered by local authorities at Your destination due to hurricane or other Natural Disaster. You must have 50% or less of Your Trip remaining at the time the mandatory evacuation ends, in order for this benefit to be payable.

The full list of all insurance coverages can be found at this link.