Global Protective Solutions

International Medical Travel Services and Benefits - Enrollment Application

Thank you for your interest in Soter World Services (Guernsey) Trust (SWS), providing services and benefits designed to meet the needs of the medical traveler / medical tourist to include their traveling companions. Complete the below to get pricing and enrollment instructions for travel accident and medical complication benefits specifically designed for those who are undergoing elective medical or dental procedure(s) outside of their country of residence.
Frequently Asked Questions

Medical Traveler Information

First / Given Name

Last Name / Surname

Birthdate

Age limits for benefits and services is age 70 or younger

Re-Enter Your Email

Applicant's COUNTRY of Citizenship

Applicant's COUNTRY of Residence

Primary COUNTRY of Destination Cannot be Applicant’s country of Citizenship or Residency

Travel Dates

Depart Date

Procedure Date

Return Date

How many travel companions do you need coverage for?

0 1 2 3 4 5

Case Manager / Medical Travel Facilitator - Agent

If you are using the services of a Case Manager, Medical Travel Facilitator - Agent 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.

Medical Facility

Name of Facility

City of Facility’s Location

Country of Facility’s Location

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)

Is the Hospital / Facility Eligible?

Yes No ( Please define )

Procedure Options

If the applicant is to receive more than a single procedure/treatment please choose "OTHER / MULTIPLE" from the drop down listing. You must then list ALL of the procedures/treatments that are scheduled and are likely to occur.
PLEASE NOTE: FAILURE TO DISCLOSE ALL PROCEDURE/TREATMENT PROTOCOLS MAY RESULT IN A CLAIM BEING INVALID.

Type of Procedure