1 (800) 694-4311 ext.48

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FlightPlus Single Trip Protection
Underwritten by Old Republic Insurance Company. (* indicates required)
Secure Order Form

If you have not entered a Quote, please go to the HOME PAGE and submit a Quote there.

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To purchase this plan please provide the following information and click the 'Next >>' button to continue to the next page where you will be provided your real-time quote. Click here to view the details of this plan (benefits, pricing, and description of coverage) and it's underwriter.

Please note that only one person per policy is allowed.

Eligibility:All Travelers must be USA or Canadian Residents.
(Oregon residents are not eligible)

Returning / Old Customer?
Please click here to automatically populate this order form with your previous contact and traveler information.

TRIP OVERVIEW

Selected Plan :
Pick either the Package Plan or the Flight Accident Only Plan. Then select the desired Flight Accident Coverage Level.

Package Plan with Flight Accident Insurance:

PLAN BENEFITS
Flight Accident:
Accidental Medical Expense:	$10,000
Sickness Medical Expense:	$10,000
Medical Evacuation/Repatriation:	$50,000
Baggage:	$1,000
Baggage Delay:	$500 ($100/day)
24-hour AD&D:	$25,000
Travel Assistance Services:	Included

Flight Accident Insurance Only:

PLAN BENEFITS
Flight Accident:
Travel Assistance Services:	Included

Coverage Start Date :

* (mm/dd/yyyy)

Coverage End Date :

* (mm/dd/yyyy) Maximum 180 days

Destination :

PRIMARY TRAVELER INFORMATION
First Name :	*
Last Name :	* Returning Customer? Click here...
Address 1 :	*
Address 2 :
City :	*
State / Province :	*
Country :	*
Postal Code (zip-code) :	*
Phone :	*
E-mail :	* Required for e-mail confirmation / policy fulfillment

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1 (800) 694-4311 ext.48