9am - 8am EST (Mon - Fri)
12pm - 5pm EST (Sat - Sun)
Plan Name Forms
Visitors Care
Patriot America
Patriot Go Travel America
Patriot International
Patriot Go Travel International
Patriot Exchange
Patriot Exchange Group
Patriot Group Travel
Claim form
Assignment of Benefits form
Baggage Claim Form
Baggage Delay Claim Form
Common Carrier AD&D Claim Form
Emergency Medical / Evacuation or Repatriation Claim Form
General Accident Questionnaire
GEO Group claim form
IMG claim form
IMG Dental claim form
Life Benefit Claim Form
Overseas Benefit Request Form
Privacy & ConfidentialityRelease
Spanish Claim Form
Travel Delay Claim Form
Trip Cancellation /Interruption Claim Form
Vision Reimbursement Form
Liaison International
Liaison Continent
Liaison Worldwide
Liaison Majestic
Inbound USA
Inbound Immigrant
Inbound Hospital
Liaison Student
Medical Claim Form/Proof Of Loss Form / Medical Claim Form/Proof Of Loss Form – Nationwide
Baggage Proof Of Loss Form / Baggage Proof Of Loss Form – Nationwide
Trip Cancellation Claim Form /
Trip Cancellation Form – Nationwide
RoundTrip Accident Sickness Claim Form /
RoundTrip Accident/Sickness Claim Form – Nationwide
RoundTrip Trip Cancellation Claim Form /
RoundTrip Trip Cancellation Claim Form – Nationwide
Collision Damage Waiver Form
Diplomat America
Diplomat Long Term
Diplomat International
Accident and sickness Claim form
Death Claim form
Dismemberment Claim form
Atlas America
Atlas International
Atlas Group Travel
Claims Form
Visit USA
Visit USA (for enrollments prior to February 1, 2011)
Visit USA (for enrollments on or after February 1, 2011)
Trip Delay Claim Form
Baggage Claim Form
Peterson International International Major Medical