Amcan Travel Insurance Service

Travel Accident and Optional Sickness Plan
(Optional Sickness only available with travel accident)
Principal Sum $20,000 $50,000 $100,000 $150,000 Optional Sickness
Medical Expenses
Accident Medical $1,500 $2,000 $3,000 $5,000
Homeward Carriage $2,000 $5,000 $10,000 $15,000 $2,000
Term (days) Premium
(each family member)
Additional Premium
per person
1-5 $5.00 $10.00 $12.00 $15.00 $25.00
6-10 10.00 15.00 25.00 35.00 30.00
11-18 20.00 25.00 35.00 50.00 35.00
19-35 25.00 35.00 50.00 65.00 45.00
36-60 35.00 55.00 75.00 100.00 60.00
61-180 75.00 90.00 125.00 175.00 70.00

Note $5.00 service fee per policy applies.

Coverage begins on either the future departure date and hour shown on the application or when passenger actually departs on the trip, whichever occurs last. Coverage ends on the last day of the term shown on the application or when the traveler returns home, whichever occurs first.

To receive an insurance policy, send mail to Ms. Barbara Hua Ye at amcan@goAmcan.com, or just provide us with your name and contact information in the form entries below.


Name:
Street Address:
City, ST, ZIP:
E-mail:
Phone/FAX:

Destination: Airline, Cruiseline,
or Tour Operator:
Departure Date: Return Date:
Passport Number: Birthdate:
Credit Card: Expiration Date: