Health Insurance Approval Form

Use this form to upload:

1) The completed Insurance Petition Form [doc]

2) Your Proof of Insurance, and

3) Your Insurance Policy Provisions (in English)

Please note that your insurance company must have a U.S. location for billing. Please indicate this address and phone number information on the petition form.  Be sure your proof of insurance includes your name and, the dates of coverage.  Be sure to provide proof of what your insurance covers and the amount of coverage (preferably in U.S. dollars) for each item listed on the petition form.

Upload your completed Insurance Petition Form (link to form in the Instructions section above).
Files must be less than 2 MB.
Allowed file types: gif jpg png pdf doc docx.
Upload proof of insurance coverage here. Must have insured person's name and dates of coverage.
Files must be less than 2 MB.
Allowed file types: gif jpg png html pdf doc docx.
Upload copy of insurance policy provisions (in English only.)
Files must be less than 2 MB.
Allowed file types: gif jpg png html pdf doc docx.

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