What kind of traveller are you?
—Please choose an option—Canadian citizen or residentVisitor to Canada or a new immigrantStudent studying out of province, internationally, or as a newcomer to CanadaCanadian looking to top up an existing plan

Are you applying for the Super Visa?
YesNo

When are you arriving in Canada?

Coverage Start Date

Coverage End Date

Emergency Medical Coverage Amount
—Please choose an option—$15,000$24,000$50,000$100,000$150,000

Primary Province of Stay
—Please choose an option—AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Date of Birth

Number of Travellers to Cover

Full Name

Phone Number

Contact Email