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International Medical Travel Services and Insurance - Enrolment Application

Thank you for your interest in Insurance and Services for your medical tourism travel. GPS provides services and insurance designed to meet the needs of the medical traveller / medical tourist and can include traveling companion(s). Complete the below to get pricing and enrolment instructions for travel accident and medical complication insurance specifically designed for those who are undergoing elective medical or dental procedure(s) outside their country of residence.
Frequently Asked Questions

Medical Traveller Information
Age limits for benefits and services is age 70 or younger
Travel Dates
Travel companion coverage is available at a reasonable additional cost.
Please choose the number of travel companions (same travel dates as enrollee) that require this additional coverage.
Agency / Medical Travel Facilitator

If you have a Case Manager or Facilitator that is assisting in arranging your travel and medical needs, please name the Company in the below space. Otherwise, if you are not using a provider of such services, please type "None" in the below space.
Hospital

HOSPITAL NAME

Is the Hospital / Facility Eligible?

A qualifying medical facility: means a hospital, clinic or place for medical, surgical or dental treatment duly qualified by the jurisdiction where the facility is located, and/or possessing an international accreditation from an ISQua member organization or other recognized international accreditation body.

International Society for Quality in Health Care (ISQua)

Covid Coverage

Covid coverage is available at an additional cost. Click here to see the requirements of coverage.
However, if your destination country requires higher limits, you can increase the limit up to $100,000. Higher limits WILL NOT be applicable unless the host country requires higher limits. Please check the requirements of the country before choosing a higher limit. Otherwise, the limit for COVID will be subject to a maximum of $25,000 no matter which limit you have chosen or what amount has been paid.
Enrollees who elect COVID coverage must obtain a negative COVID test result within 96 hours of their departure to be eligible for COVID benefits. Proof shall be provided in the event of a COVID related claim.

Do not include COVID Coverage.
Standard Coverage: $25,000 - Included for enrolled insured and companion(s)

Choose only if destination country requires higher limits
Increase to $50,000 - for each enrolled insured and companion(s)
Increase to $75,000 - for each enrolled insured and companion(s)
Increase to $100,000 - for each enrolled insured and companion(s)

Procedure Options

If the applicant is having a procedure not listed or is having more than one procedure, please choose "Other/Multiple" from the drop down list and the enrolment will provide you a field to write in the details. You must list ALL of the procedures/treatments that are scheduled and are likely to occur on the specific procedure date entered above.
PLEASE NOTE: FAILURE TO DISCLOSE ALL PROCEDURE/TREATMENT PROTOCOLS MAY RESULT IN A CLAIM BEING INVALID.

Home Country Coverage

Care for covered complications can occur in your home country up to 180 days past the procedure date or if warranted in the original treating country. However, you may elect to remove home country coverage at enrolment. If elected, you will be covered for a complication only whilst outside of your home country and for the period between your departure and return date indicated when you enrolled in benefits.

I decline home country coverage.

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