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CONTACT US:

Azimuth Risk Solutions ^sm , LLC
8520 Allison Pointe Blvd, Suite 220, Indianapolis, IN 46250 USA

service@azimuthrisk.com

P: 888-201-8850 or 317-644-6291
F: 888-201-8851 or 317-423-9620

US Short Term Medical

Trip Protection Plan

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Important Information

The Meridian Series offers two options: worldwide coverage or worldwide coverage excluding the U.S. and Canada. Both options provide coverage 24 hours a day, 7 days a week allowing you to have the freedom to choose any doctor or hospital for treatment. The plan versions are these :

Meridian Enhanced - the perfect plan for those seeking top-tier benefits at a premium point that is extremely attractive for those seeking the best value in the international insurance market.

Meridian Essential - a great option for those who need significant coverage and are comfortable having a benefit schedule which provides defined levels of coverage for various medical services.

Please note: these plans require the completion of a medical questionnaire which details your health history. Please allow time to complete the application, however you do have the option to save the application and return to it and complete it at a later time if necessary. Be sure to record the application number provided to log back into your application.

Requested Effective Date(mm/dd/yyyy) :

Number of Applicants

Enter DOB (mm/dd/yyyy) :

Select Gender (A) :

Destination Country 1 :
If you have additional Destinations, please click + to add

Destination Country 2 :

Destination Country3 :

Destination Country 4 :

Is your expected length of residence outside the U.S. at least 6 of the next 12 months? Yes No

Citizenship Country :

Eligibility Requirements:

U.S. Citizens: If you or any family member applying for coverage is located in the U.S. on the date of this application, the effective date of this insurance, if issued, will be the later of: (i) The effective date requested on the application; or (ii) The date the insured person departs the U.S.; or (iii) The date the application is accepted by Azimuth and an Evidence of Insurance issued.

Non-U.S. Citizens: If you or any family member applying for coverage is located in the U.S. on the date of this application and do not plan to depart the U.S., an affidavit of eligibility must be completed. Your insurance agent/broker can assist you with this form and its completion. A new affidavit of eligibility will be required at each renewal.