Policy Change Request

Custom Change Type*

Please enter another change type not listed above

The Primary Traveler is the first person listed on your policy under Insured(s) *

Policy Number*

Your Policy Number is located in your confirmation email, which was sent at the time of purchase. On this email, find the field labeled Policy Number in the Order Information section.

Primary Traveler's Phone Number*

Email Used to Purchase the Plan*

Please Enter Your New Total Trip Cost*

This is the new cost of your entire trip, not just the amount your trip increased or decreased by.
For example, if your original trip cost was $5,000 and increased by $500, you would enter $5,500.

Reason for Cancellation*

Please be advised most plans use total trip cost to determine premium rates. If your request will result in a change in premium we will contact you by phone or email to make you aware of the premium difference, and to request consent for payment.

What is your new departure date?*

Please be advised some plans use travel dates to determine premium rates. If your change will result in additional premium we will contact you by phone or email to make you aware of the premium difference, and to request consent for payment.

What is your new return date?*

Also, please note: Most providers require that requests for date changes are received prior to the original trip departure date. Requests received after that date may not be considered.

Please Enter Your New Destination*

Note: If you are traveling to a different destination in the same country this does not require an update.
If traveling outside the United States, enter the country where travelers will be spending the most time. If spending equal time in multiple countries, choose your first international destination.

Please Select Your New Residence State*

Please choose the State of your official residence (drivers license, state you file income tax)

What is your new Initial Trip Payment date?*

What is your new Final Trip Payment date?*

Please enter the name of the traveler as listed in your policy document.

If you would like to remove yourself, you have to cancel this policy and purchase a new one.

Birthdate should be entered in the following format: mm/dd/yyyy.

Some providers do not allow coverage to be transferred to a new trip; however you can provide additional documentation as outlined below, and your request will be sent to the provider for consideration. Please be advised that these requests are not guaranteed, and are reviewed on a case by case basis. Also, please note: Most providers require that any requests for date changes are received prior to the original trip departure date. Requests received after that date may not be considered.

If you are outside of the review period for your policy, please also provide the following documentation as outlined below:

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Proof of Cancelled / Transferred Trip, Refund / Transfer of Funds:

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Upload Document(s)

Generally this can be a final invoice or other contact from your travel supplier that includes your name, trip information, and an indication that the trip was cancelled. This may be required from multiple suppliers depending on the details of your trip.

Drop files here or

Max. file size: 2 MB, Max. files: 10.

You can attach up to 10 files. Each file must be under 2MB. If you have files that are larger than these requirements, you can send them to [email protected].

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Before making any changes to your coverage, please have your current policy in hand as reference

Policy Change Request Form

Proof of Cancelled / Transferred Trip, Refund / Transfer of Funds:

Confirmation of No Claims

Before making any changes to your coverage, please have your current policy in hand as reference

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