Atlas America® Non-U.S. citizens traveling to the U.S.

  • Quote
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  • Applicant Details
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Insureds' Ages

All fields are required unless stated as: (Optional)

Choose method of entry:

Method of entry is required.

Age Group {{numOfTraveler + 1}}
{{numOfTraveler + 1}}

Age Group is required.# of Insureds is required.# of Insureds cannot be 0.

Add Age Group
Add Age Group

Group size must be 5 or more.

Age group already selected.

{{fileName}}Upload insureds' ages spreadsheet

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Download spreadsheet template

Coverage Dates (mm/dd/yyyy)

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Start Date is required. Cannot contain special characters. Cannot contain letters. Please enter the Start Date in the specified date format.

End Date is required. Cannot contain letters. Cannot contain special characters. Please enter the End Date in the specified date format. End Date cannot be before Start Date.

Is your Citizenship or Home Country the U.S. or a U.S. territory?

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Applicants listing Citizenship or Home Country as 'United States of America' are limited to 364 days of coverage per the United States Patient Protection and Affordable Care Act (PPACA). Please adjust the Coverage End Date, choose an alternate plan on this website, or contact us for further assistance.

Insureds' Age(s)

{{numOfTraveler + 1}}
PrimarySpouse Child {{numOfTraveler-1}}{{numOfTraveler}}

Primary Age is required.Insured {{numOfTraveler+1}} Age is required.

Spouse must be at least 18 years old.

Child {{numOfTraveler-1}} Age is required.Spouse Age is required.Insured {{numOfTraveler+1}} Age is required.

Minimum Age must be at least 0.

Child {{numOfTraveler-1}} must be under 18 years old.

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Add ChildAdd Insured
Add ChildAdd Insured

Host Country

Host Country is required.

Please review specific Geographic Restrictions.

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