Secutive | Compass Insurance Booking: Golden West College OPT

Welcome to the Booking System for Golden West College OPT

Booking your travel insurance online with the Golden West College OPT Booking System^© is quick and simple:

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Choose your insurance coverage		Enter your personal & travel information		Review your insurance coverage		Process the order

Choose your insurance coverage

Medical Plan - OPT

10104B|O1 | 4929

Details

Enter your Email Address:

(This is where your confirmation and credit card receipt will be sent.)

Enter your Personal & Travel Information:

Person 1:

First Name
Last Name
Date of Birth	/ /
Gender
University ID
Visa Status
Start Date
End Date
Home Country
Travel Destination



Travel Phone

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Review your insurance coverage

Please check your booking details to ensure that all information is correct.

By confirming your booking you also authorize Global Secutive, LLC to charge your credit card in the amount of

Insured(s) Information:

Coverage Information:

Selected insurance coverage	Medical Plan - OPT [10104B\|O1] Rate per person / travel day: 4.7648 USD
Total Cost:

Please Confirm:

I understand that OPT Students on a F-Visa may purchase a maximum of 12 consecutive months of coverage from the OPT effective date. OPT extension coverage beyond 12 months is not allowed. Enrollment must be completed within 30 days of the expiration of prior coverage on the schools’ student health insurance plan. A gap in coverage is not allowed.

I understand a copy of a valid EAD or OPT application or receipt (I-765 or I-797c) is required to enroll. In order to complete my enrollment, I agree to email this document to info@compassstudentinsurance.com.

I have read and made note of the Policy Wording *. I have read and made note of the Withdrawal and the Cancellation Terms *.

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