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Agent Information
Location Number (if applicable)
This number can be found on the back
of your brochure (e.g.: 33-7777)
Agent Code
Booking Information
Invoice Number
First Trip Payment Date*
RadDatePicker
RadDatePicker
Open the calendar popup.

(mm/dd/yyyy)
Plan Options
 
Travel Select
Underwritten by Berkshire Hathaway Specialty Insurance

 
Trip Information
Prior to departure, your travel documents must indicate your Departure Date and Return Date.
Departure Date*
RadDatePicker
RadDatePicker
Open the calendar popup.

(mm/dd/yyyy)
Return Date*
RadDatePicker
RadDatePicker
Open the calendar popup.

(mm/dd/yyyy)
Destination*
select
Tour Operator
select
Cruise Line
select
Originating Airline
select
Primary Traveler Information
 
First Name*
Last Name*
 
Date of Birth* (mm/dd/yyyy)
 /  / 
Trip Cost* (ex. 1000 or 1000.00)
Additional Traveler Information
Traveler #2
 
First Name*
Last Name*
 
Date of Birth* (mm/dd/yyyy)
 /  / 
Trip Cost* (ex. 1000 or 1000.00)
Traveler #3
 
First Name*
Last Name*
 
Date of Birth* (mm/dd/yyyy)
 /  / 
Trip Cost* (ex. 1000 or 1000.00)
Add Travelers
Only individuals in the same household may be on one policy, up to a maximum of 10.
Additional Primary Traveler Information
Address*
 
City*
State*
select
Zip*
 
Country*
select
Phone*
    
Fax 
    
Beneficiary
(max 256 chars)
 
View Details
Policy Document Delivery Options
 
Delivery Method
 


Primary Traveler*
(Optional) Recipient #2
 
View Details
* Required Field
Plan Details
Travel Select
Benefits
Coverage Per Person
Available to all states except CA & NY
Trip Cancellation
100% of Insured Trip Cost
Trip Interruption
150% of Insured Trip Cost
Trip Delay
$2,000 ($200/day)
Missed Connection
$750
Baggage & Personal Effects
$1,000
Baggage Delay
$200
Emergency Medical Expense
$50,000
($500 dental sublimit)
Sporting Equipment Delay
$200
Emergency Medical Evacuation & Repatriation
$500,000
AD&D
$25,000
Travel Assistance
Included
 
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Customer Service
Phone: 1-800-228-9792
(8:00 a.m. to 7:00 p.m. CST, Monday - Friday)
[email protected]
Technical Difficulties
Phone: (888) 457-4602
(8:00 a.m. to 7:00 p.m. CST, Monday - Friday)
[email protected]
Emergency While Traveling
Click here for emergency phone numbers
while traveling
 

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©2024 Travelex Insurance Services Inc.,
and its licensors. All Rights Reserved.
 
 
 
The product descriptions provided above are only summaries. The full coverage terms and details, including limitations and exclusions, are contained in the insurance policy or Description of Coverage. Coverage and rates may vary by states. If there is any conflict between the contents of this website and the Policy or Description of Coverage, the Policy or Description of Coverage will govern in all cases. Travel Assistance Services are provided by the designated provider listed in the policy or on your Confirmation of Coverage.
Travelex Insurance Services, Inc. 810 North 96th Street, Suite 300, Omaha, NE, 68114. CA Agency License #0D10209.