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Participant:

Name
Birthday/Gender
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Email
Phone
University ID (controller)
Home Country*
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TRAVEL ADDRESS
Street Address
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Dual Citizens, of which one citizenship is the United States, are not eligible. *Required only for F and J University Students. If unknown, write UNK.

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Make your coverage even better...

Virtual Healthcare Services

18 years and over only

Get unlimited accesss to qualified doctors, licensed therapists or board-certified psychiatrists 24/7/365 by phone, video or the Compass Wellness App! Included services are Telemedicine, Teletherapy, 24/7 Assistance and Teledentistry.

N/A / insured

Add Virtual Healthcare

Pharmacy Program

Get access to the most used generic medications for FREE with the ScriptSaver Plus Pharmacy Program. Upfront pricing, immediate access for acute prescriptions at over 64,000 pharmacies nationwide, and free delivery for Chronic Medications.

N/A / insured

Add Pharmacy Program

Please note, all selected upgrades to your plan are automatically added to all enrolled persons, including spouse and children.

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Please Confirm:

By checking this box, you give consent for us to process your data and agree to the following:

You consent to the use and disclosure of your personally identifiable information, including sensitive health information, and other information in accordance with our Privacy Policy. If you do not consent to the disclosure of your personal information, we will not be able to evaluate your request and will not be able to provide you with the medical program, including the insurance product offered by Crum & Forster, SPC. For information regarding the use and disclosure of your personal information, please visit https://www.studenthealthusa.com/privacy-policy.html.
By purchasing this coverage, you agree to subscribe and become a participant in the Fairmont Specialty Trust and understand that participation in the Trust is a prerequisite to procuring the insurance coverage. Click for a copy of the subscription agreement.
This insurance coverage is not subject to and does not provide certain insurance benefits required by the United States’ Patient Protection and Affordable Care Act (“PPACA”). PPACA requires certain US citizens or US residents to obtain PPACA compliant health insurance, or “minimum essential coverage.” In some cases, certain individuals may be deemed to have minimum essential coverage under PPACA even if their insurance coverage does not provide all of the benefits required by PPACA. Please consult an attorney or tax professional to determine whether this insurance coverage meets any obligations you may have under PPACA.
This plan contains both insurance and non-insurance benefits. Insurance benefits are provided by Crum & Forster SPC through ITI SP pursuant to a policy issued to the Fairmont Specialty Trust.

By checking this box, you give consent for us to process your data and agree to the following:

You consent to the use and disclosure of your personally identifiable information, including sensitive health information, and other information in accordance with our Privacy Policy. If you do not consent to the disclosure of your personal information, we will not be able to evaluate your request and will not be able to provide you with the medical program, including the insurance product offered by Crum & Forster, SPC. For information regarding the use and disclosure of your personal information, please visit https://www.studenthealthusa.com/privacy-policy.html.
By purchasing this coverage, you agree to subscribe and become a participant in the Fairmont Specialty Trust and understand that participation in the Trust is a prerequisite to procuring the insurance coverage. Click for a copy of the subscription agreement.
This insurance coverage is not subject to and does not provide certain insurance benefits required by the United States’ Patient Protection and Affordable Care Act (“PPACA”). PPACA requires certain US citizens or US residents to obtain PPACA compliant health insurance, or “minimum essential coverage.” In some cases, certain individuals may be deemed to have minimum essential coverage under PPACA even if their insurance coverage does not provide all of the benefits required by PPACA. Please consult an attorney or tax professional to determine whether this insurance coverage meets any obligations you may have under PPACA.
This plan contains both insurance and non-insurance benefits. Insurance benefits are provided by Crum & Forster SPC through ITI SP pursuant to a policy issued to the Fairmont Specialty Trust.

I understand that I will not be able to use the virtual care services until up to 72 hours after my enrollment in the program.

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