Plan Recommendation

CONSULTATION FORM

Please fill out the form prior to your appointment. Forms are individual. If you have a spouse applying you will need to fill out a separate form just for them.

First Name *

Last Name *

Email *

Address

City *

State *

Postal Code *

Do you have a separate mailing address?

Mailing Address (if different from primary address)

Please include full mailing address including city, state, and zip code.

Phone *

Non-US Phone Number

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Gender? *

Date of birth *

Medicare Number (from red, white and blue card) *

On your red, white & blue Medicare card, does it show that you have Part A and Part B? * *

Do you want to make sure any particular doctors are covered by your plan? What are their names?

Think of any primary care doctors, specialist doctors, prior surgeons, or hospitals in the US. We need to look up all your providers to make sure they are in-network with whatever plan we look up for you.

Do you want your insurance to cover any medications? If so, what are (a) names, (b) daily quantities, and (c) dosages?

What non-Medicare coverage do you have?

Do you have any Medicare plan(s) in addition to Part A and Part B?

Frequently Asked Questions

What is emergency care?

Emergency care is healthcare that you need right away due to a serious injury or illness.

What is urgent care?

Urgent care is also when you have an immediate healthcare need, but your condition may not be life threatening. For example, you may need to visit urgent care for antibiotics if you have an infection, sprained your ankle, upset stomach, etc.

Who is this coverage for?

This coverage is for U.S. expats or travelers. It can cover your emergency and urgent care outside of the U.S. while you are abroad.

How does it work?

We will help you best structure and utilize the coverage you already have to cover foreign emergency, or assist you with obtaining a policy you don't yet have.

How much does it cost?

In some cases, it's no additional premium (as we're helping you with the structure and utilization of your existing coverage), but costs will vary depending on a variety of factors.

We offer free educational resources to show how you can get emergency and urgent care coverage when you are traveling abroad.

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