Student Health Advantage

Applicant Information

US DestinationUS Destination

If your trip includes the US or any US territory, select Yes

Date of Birth

Applicant Date of Birth

Coverage Dates

Start Date

Coverage Start Date

Date that coverage should begin. This date cannot be more than 6 months from today.

End Date

Coverage End Date

This date cannot be more than 12 months from the date coverage begins.

Yes, I need dependent coverage.

Dependent Coverage - Dates of Birth

SpouseSpouse

Only specify the spouse date of birth if this person is to be covered.

SpouseSpouse

Only specify the spouse date of birth if this person is to be covered.

Child 1Child 1

Only specify the date of birth if this person is to be covered.

Child 1Child 1

Only specify the date of birth if this person is to be covered.

Child 2Child 2

Only specify the date of birth if this person is to be covered.

Child 2Child 2

Only specify the date of birth if this person is to be covered.

Add more dependents

Coverage Options

Adventure SportsAdventure Sports

The Adventure Sports Rider is available for eligible participants. Certain activities designated as adventure sports can be covered up to the maximum determined by age. Certain activities are never covered regardless of whether or not the Adventure Sports Rider is issued. For a list of activities which can be considered to be adventure sports, please contact us.

Need Assistance?

Toll Free: +1 (877) 758-4391

Direct: +1 (904) 758-4391

Fax: +1 (904) 212-0412

Email: Email

Twitter: @intl_insurance