Please complete the Insurance Roster and email it to firstname.lastname@example.org.
In the email, also include the account number you want the insurance premium charged to and a copy of the trip itinerary.
- All orange-highlighted columns are required fields.
- Visa Type is required if a Visa is required to enter the foreign country.
- Coverage From is the date the participant leaves the US. If part of the trip is inside the US, list the date the participant actually leaves the US for the Host Country.
- Coverage To is the date the participant returns to the US from the Host Country.
- Educational Qualification (drop-down menu) is required if the participant is anyone other than a student.
- Home Country is the participant's country of citizenship. If the participant is a citizen of the Host Country, coverage WILL NOT be available for that participant, and they should not be included on the roster unless the group is traveling to other countries where that participant is not a citizen.
- Host Country if traveling to more than one country, it is the country in which the majority of the time will be spent. The participant will have coverage in all foreign countries visited while on the tour, not just the host country.
- Insured Status (drop-down menu) designates if the coverage is just for the participant or if there will be a spouse and/or dependents. If the spouse or dependents will be acting as chaperons, assisting on the tour in any way, or are students of BYU-Idaho, list them separately and mark as PO (Participant Only). If the spouse or dependent is not assisting on the tour or is not a student, mark as PS (Participant and Spouse), PF (Participant and Family), or PC (Participant and Children).
For questions regarding the INSURANCE ROSTER, please contact Leesa Allen at extension 1974.