brian@avenueinsuranceplanners.com
www.avenueinsuranceplanners.com
 
Patriot Platinum Travel Medical InsuranceSM

Please complete the following form in order to begin your Patriot Platinum Travel Medical InsuranceSM application.

If you would like to save your application and complete it at a later time, simply click on the "Save Application" button at the bottom of any page of the application after selecting a premium amount and before submitting your credit card information. If you have the Authorization Number and Password from a previous application that was not completed, click here to continue with the previous application.

* Denotes a required field.

Primary Insured's Age or Date of Birth is required.

At time of coverage start date
Monthselect
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Dayselect
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Yearselect
Maleselect

At time of coverage start date
Leave blank if spouse is not to be insured.
Monthselect
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Dayselect
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Yearselect
Femaleselect
(Minimum length of coverage is 5 days)
 
 
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Other IMG plans that may be of interest

For a complete list of international medical insurance plans, please click here.

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