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Travelance · International students

Student medical insurance application

Complete this form and a licensed Ehcover broker will review your eligibility, finalize your Travelance policy, and send your documents.

Basic eligibility

At the time of purchase, does the purchaser reside in Canada?

Travel information

Insured persons

Insured person #1

Eligibility

1. Do you have a medical condition for which a physician advised you not to travel?
2. Were you diagnosed with a terminal illness before travelling to Canada?
3. Has an insurer terminated your coverage under another policy?
4. Are you enrolled as a student at a Canadian school, the accompanying spouse of that student residing in Canada, or the student's dependent residing in Canada?

Declaration

Please review the following declaration:

I declare that the information I have provided is accurate. For any question I did not know how to answer, I consulted my physician.

I understand that if I provided inaccurate or fraudulent information, or concealed, misrepresented, or omitted an important fact in my application, any applicable questionnaire, or when making a claim—or if I am not eligible for the plan I purchased—my insurance coverage may be voided, any claim may not be paid, and my policy may be cancelled.

I understand that if my eligibility changes before my policy's effective date, I must contact my broker to update my answers to the eligibility questions.

Canadian address

Contact details

Fields marked with * are required.

This form is an application request, not an insurance policy. Coverage begins only after acceptance and payment. View benefits and rates.

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