Secure Server Online Forms for Visitors Insurance
After Completing the membership form, proceed to STEP 2 to complete insurance form
Complete one of the following Insurance Enrollment Forms.
- CHUBB Network Comprehensive 80/20 Plan with or without Pre-ex Coverage-- Click to Enroll in CHUBB Network Plan
- CHUBB Premier Fixed Benefit Plan with Pre-ex Coverage-- Click to Enroll in CHUBB Premier Plan
- AXIS BasicCare Fixed Benefit Plan -- Click to Enroll in AXIS BasicCare Health Insurance Plan
- AXIS Fixed Benefit Plan with Acute Onset Pre-ex Coverage --Click to Enroll in AXIS Health Insurance Plan
- AXIS 80/20 U&C Plan - Click to Enroll in AXIS Network Plan
- CHUBB Standard Fixed Benefit Plan-- Click to Enroll in CHUBB Standard Plan
- IMG VisitorCare Fixed Benefit--Click to Enroll IMG VisitorCare
- IMG Platinum Visitor Health Insurance Plan--Click to Enroll in IMG Platinum Plan
How to Renew CHUBB/BasicCare Health Insurance Plans - Renewal Instructions
India Network Printable PDF Forms
No cancellation or refund is available on or after effective date of insurance.
India Network Foundation membership must be active in order to enroll. The $10 membership fee is not cancellable or refundable and is good for one year
Rates based on total days times Daily Rate. Daily Rate based on monthly premium divided by 30 days.
Couple rates are calculated based on the individual rate multiplied times 2 individuals.
The member’s date of birth and passport are requested entries during enrollment process. Medical records are not required.
Accident and Sickness coverage applies while visiting the US.
Call (408)540-3600 if you have questions regarding enrollment.