Bridges International Insurance Services A division of KRG Insurance Brokers (Western) Inc. Canada Travel Insurance, Travel Insurance, Visitors to Canada

International Student Medical and Hospital Insurance Plan

You confirm that you meet the eligibility criteria
Maximum application period is 365 or 366 (leap year) days.
Minimum application period is 30 days.
The earliest effective date is the next day of the application date.
The departure date can be chosen as the effective date if you leave your home country and arrive in Canada within 48 hours after departure.
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MEDICAL AND HOSPITAL RATES

Days

30 - 365

Optional Coverage

69 years and
under

$1.88
/daily

$22.00
/policy

International Student Medical Insurance Plan Eligibility Requirements

If applicable, please check the boxes below.

1. You are not traveling against physician's advice and you have not been diagnosed with a terminal condition.

2. You are a student enrolled in a learning institution accredited by the local authorities in Canada, and the insurance coverage period you apply for does not exceed your school registration expiry date.

3. You agree to the exclusion of coverages related to pre-existing conditions that occurred prior to the effective date.

4. You confirm that you are in good health and do not have to seek medical attention, and that currently no circumstance is known for which a claim may be made.

* Please call or e-mail us if you do not meet all of the conditions above.

Fill in the information in the light blue shaded boxes, then click the quotation button below.
It will automatically quote the number of days coverage and the total cost of the insurance.

<= Quotation Button

Optional Coverage Yes No

Effective Date : Y/M/D

Expiry Date : Y/M/D

Arrival Date in Canada Y/M/D :

Number of Days Coverage

Days

* Please make sure you enter the correct day, as the drop down menu has 31 days available
regardless of the month (eg. please do not enter Feb. 30 or 31 or April 31)

Estimated Premium in Canadian Dollars:
: $

First Name:

Last Name:

Mailing Address in Canada:

Suite No.:

City / Province:

Postal Code:

Tel: () -

Email:

Gender:
Male Female

Date of Birth: YYYY / MM DD

Accidental Death Beneficiary :

First Name:

Last Name:

Relationship:

Name of School, Province:

Pay by: VISA MC AMEX

Card Holder Name:

Card Number:

Expiry Date: M/Y: /

CVV:

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Bridges International Insurance Services

International Students Application Form