Patriot Exchange

Applicant Information

Primary DestinationPrimary Destination

The insurance plan covers you internationally, outside of your home country. The primary destination is for informational purposes only.

Date of Birth

Coverage Dates

Start Date

Date that coverage should begin. This date cannot be more than 6 months from today.

End Date

This date cannot be more than 12 months from the date coverage begins.

Yes, I need dependent coverage.

Coverage Options

Adventure SportsAdventure Sports

The Adventure Sports Rider is available for eligible participants. Certain activities designated as adventure sports can be covered up to the maximum determined by age. Certain activities are never covered regardless of whether or not the Adventure Sports Rider is issued. For a list of activities which can be considered to be adventure sports, please contact us.

Add-OnAdd-On

The add-on offers benefits for baggage protection, legal assistance, personal liability and school sports. If required, you have the option to include collision sports coverage.

Need Assistance?

Toll Free: +1 (877) 758-4391

Direct: +1 (904) 758-4391

Fax: +1 (904) 212-0412

Email: Email

Twitter: @intl_insurance