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1. Patriot Travel Medical InsuranceSM
Individual and Group coverage form 15 days to 2 years
2. Global Medical InsuranceSM
Individual and Family coverage from 1 year or more
3. GEOSM+Plus International®
Group employee benefits coverage from 1 year or more

The Forms & Applications Listed below are available for you to download. To do so, click on the file you desire. These Files are in Adobe Acrobat (PDF) format. If you don't already have Acrobat Reader on your computer you may download it for free by clicking the "Download Adobe Acrobat Reader" link below.


Once you have opened the form in your browser you may print it or save it for future use. Download times will vary depending on the speed of your modem. If you have any difficulty retrieving these files or if you have any questions E-Mail IMG.

PATRIOT TRAVEL MEDICAL INSURANCESM
Patriot Travel Medical Brochure and application(121kb)
Patriot Executive Travel Brochure and application (266kb)
Patriot Executive Group brochure and application
Patriot Travel Group Brochure and application (256kb)
Patriot Extreme Travel Medical Insurance and application
Visitors Care brochure and application
Spanish Patriot Travel Medical Insurance brochure and application  

GLOBAL MEDICAL INSURANCESM
Global Basic Insurance brochure
Global Basic Insurance application
Global Medical Insurance brochure
Global Medical Insurance application
Spanish Global Medical Insurance brochure
Spanish Global Medical Insurance application  

Diabetes Questionnaire(24kb)
Global Medical Insurance Affidavit of Eligibility(11kb)
Global Medical Insurance Claim Form(21kb)

GEOSM+PLUS INTERNATIONAL® (group coverage)
GEO+Plus International Request for Proposal(82kb)
GEO+Plus International Application(87kb)
GEO+Plus International Enrollment Form(117kb)

OTHER ENROLLMENT
MP Enrollment Form(19kb)
Special Enrollment Form(19kb)

CLAIM FORMS
IMG Claim Form(20kb)
IMG Interactive Claim Form (123 kb) must have MS Word to use
IMG Dental Claim Form (25kb)
Assignment of Benefit Form (50kb)
Privacy & Confidentiality Release (4kb)
General Accident Questionnaire (6kb)

MISCELLANEOUS FORMS
Cobra Election Form (16kb)
IMG Supply Fax Order Form (25kb)

TRIP CANCELLATION INSURANCE OPTIONS

Patriot T.R.I.P.SM 
Trip Cancellation Insurance

To help protect you from losing the money you've spent to travel, there is Patriot T.R.I.P., Patriot T.R.I.P. provides protection to travelers who are unable to travel or are interrupted during their trips due to circumstances such as illness or injury, jury duty, job layoff, terrorism or the bankruptcy of the tour operator, cruise line or airline.
Patriot T.R.I.P. EliteSM 
Premier Trip Cancellation Insurance

To provide superior protection for a picture perfect vacation, there is Patriot T.R.I.P. Elite, a travel cancellation insurance program. Patriot T.R.I.P. Elite provides coverage for many of those unforseen circumstances that may force the cancellation or interruption of your covered trip. In addition, this program can provide benefits for travel delays, baggage delays, emergency medical treatment and medical evacuation while you are away from home.

Patriot StudentSM T.R.I.P. 
Student Trip Cancellation Insurance

Patriot Student T.R.I.P. is a cost effective travel insurance program designed to provide coverage to students for many of those unforeseen circumstances that may force the cancellation of travel plans or interrupt a covered trip. This program provides coverage for trip cancellation, trip interruption, lost and stolen baggage, emergency medical evacuation and much more.


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