Patriot Exchange Program Medical Insurance for Individuals and Groups Involved in Educational or Cultural Exchange

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  • Applicant Details
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  • Review
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  • Payment
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Insureds' Age(s)

Primary

Primary Age is required.

Minimum Age must be at least 0.

Spouse

Spouse Age is required.

Minimum Age must be at least 0.

Child {{form.travelerInfos[1] && form.travelerInfos[1].travelerType === 'spouse' ? index-1 : index}}

Child {{index-1}} Age is required.

Minimum Age must be at least 0.

Child {{index-1}} must be under 18 years old.Child {{index-1}} must be under 19 years old.

Age is required for each proposed insured.

Add Child

Please enter the age(s) of child(ren).

Eligibility

Country of Citizenship is required.

Country of Residence is required.

Primary Destination Country is required.

Residence Country and Primary Destination Country cannot be the same.

Destination Country cannot be US or US territory if Country of Residence is US or US territory.

Please review specific Geographic Restrictions.

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