Visitor Insurance, Visitors Medical Insurance for USA | Medical Insurance for USA visiting parents | Best Rated Health Insurance for Visitors to USA
Claim Forms

Note: Insurance company makes decision on claims. Download appropriate policy claim form.                                                                                                                                                                                                                                                                                                                                                                                           

Tokio Marine HCC Medical Insurance Services GroupDownload Claim FormsEmailFaxMailInsurance Company Phone
Atlas America

Claim Form

Authorization form

Non-US Claim Form

Claimant Appeal Request Form

Lost Checked Luggage

Dental Claimants Statement

Accident Questionnaire

Must submit proof of claim with in 60 days from date of service 

service@hccmis.com

317-262-2140

HCC Medical Insurance Services, LLC

Attention: Claims Department

P.O Box 2005

Farmington Hills, MI 48333-2005

800-605-2282

Or

317-262-2132

Atlas International
Visitor Secure
Student Secure Select - Including USA
Student Secure Select - Excluding USA
Student Secure Budget - Including USA
Student Secure Budget - Excluding USA
Student Secure Smart - Including USA
Student Secure Smart - Excluding USA
Seven CornersDownload Claim FormsEmailFaxMailInsurance Company Phone
Inbound USA

Claim Form

Authorization Form to Disclose Protected Health Information

Must send claim form and payment receipts with in 90 days from date of service

claims@sevencorners.com

317-575-2256

Seven Corners

Attention: Claims Department

303 Congressional Boulevard

Carmel, IN 46032

800-335-0611

Or

317-575-2656

Inbound Guest
Inbound Immigrant
Liaison Continent Plan A
Liaison Continent Plan B
Liaison Continent Plan E
Liaison Continent Plan F
Liaison Majestic - Including USA
Liaison Majestic - Excluding USA
Liaison International
Liaison International Option 1
Liaison International Option 2
Liaison StudentClaim Form
International Medical Group (IMG)Download Claim FormsEmailFaxMailInsurance Company Phone
Visitors Care

Claim Form

Accident Questionnaire

Must submit proof of loss

customercare@imglobal.com

317-655-4505

International Medical Group

Attention: Claims Department

P.O Box 88500

Indianapolis, IN 46208-0500

800-628-4664

or

317-655-4500

Patriot America
Patriot Platinum America
Patriot GoTravel America
Patriot International
Patriot Platinum International
Patriot GoTravel International
Patriot Green America
Patriot Green International
Patriot Exchange Program
Student Health Advantage - Including USA
Student Health Advantage - Excluding USA
USI Affinity Travel Insurance ServicesDownload Claim FormsEmailFaxMailPhone Company Phone
Visit USA

Claimants Statement

Non_US Claim

Dental Claimants

Accident Questionnaire

Authorization Form to Disclose Protected Health Information

Must submit proof of claim with in 60 days from date of service 

service@hccmis.com

317-262-2140

HCC Medical Insurance Services, LLC

Attention: Claims Department

P.O Box 2005

Farminton Hills, MI 48333-2005

800-605-2282

Or

317-262-2132

Inter Medical

Claimants Statement

Non_US Claim

Dental Claimants

Accident Questionnaire

Authorization Form to Disclose Protected Health Information

WorldMed

Claimants Statement

Non_US Claim

Dental Claimants

Accident Questionnaire

Authorization Form to Disclose Protected Health Information

Study USA Healthcare

Claimants Statement

Non-US Claim

Dental Claimants Statement

Accident Questionnaire

Study USA Healthcare Preferred
Trawick InternationalDownload Claim FormsEmailFaxMailInsurance Company Phone
Safe Travels USA

Claim Form

Authorization Form to Disclose Protected Health Information

Must submit proof of loss with in 90 days from date of serviceNA

GBG Administrative Services Inc.

26741 Portola Pkwy 1E # 527

Foothill Ranch CA 92610

Inside USA:

877-916-7920

Outside the U.S. (collect):

949-916-7941

Safe Travels International
Global UnderwritersDownload Claim FormsEmailFaxMailInsurance Company Phone
Diplomat America

Claim Form

Death Claim Form

Dismemberment Claim Form

Baggage Loss, Theft or Damage

Authorization Form to Disclose Protected Health Information

Must submit proof of loss with in 60 days from date of service

claims@globalunderwriters.com

513-533-9416

Global Claims Administration

3195 Linwood Road, Suite 201

Cincinnati, OH 45208

US & Canada

800-513-2981

Outside US & Canada

1-513-533-1330

Diplomat Long Term
Diplomat International
Azimuth Risk SolutionsDownload Claim FormsEmailFaxMailInsurance Company Phone
Beacon America

Claim Form

Authorization For Reimbursement Form

Accident Questionnaire

Trip Delay

Must submit proof of loss

service@azimuthrisk.com

317-423-9620

Azimuth Risk Solutions

Attention: Claims Department

P.O Box 627

Indianapolis, IN 46206

888-201-8850
Beacon International
Petersen International UnderwritersDownload Claim FormsEmailFaxMailInsurance Company Phone
International Major Medical

Claim Form

Authorization-Acknowledgement

Must Inform about claim with in 15 days to insurance company

cmcginnis@irmgroup.com

215-794-1498

International Risk Management Group

3359 Rt 413, Suite 100

Doylestown, Pennsylvania 18902

888-622-4764
USAway International Major Medical
The Bridge Plan

Associated Insurance Companies

Associated Insurance Companies