Patriot Platinum Group Travel Medical InsuranceSM
View Plan Details

Please complete the following form in order to begin your Patriot Platinum Group 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.

(Minimum length of coverage is 5 days)
Age # of Primary Insureds # of Spouses # of Dependent Children

Select United States if any of your destinations include the U.S.
--- Select a Country ---select
Optional File Upload

You have the option to upload a comma-separated value (CSV) file containing the group insureds. Select your file by clicking on the "Browse" button. Then, click on the "Upload" button.