InsureMyTrip - Policy Change Request Form

The following form helps us gather the required information to assist you with your change request. Please provide as much of the requested information as possible in order to avoid delays in processing, and/or additional follow-up communications from our team.

If you have any questions about the form or are unable to complete it as requested, please use our chat function (icon at lower right of our Contact Us page) for the most immediate assistance. We will be happy to assist you.

1. Policy Number *This question is required.

Your Policy Number is located in your confirmation email, which was sent at the time of purchase. On this email, find the field labeled Policy Number in the Order Information section.

2. Primary Traveler's Name
The Primary Traveler is the first person listed on your policy under Insured(s) *This question is required.

3. Primary Traveler's Phone Number *This question is required.

4. Email Used to Purchase the Plan *This question is required. This question requires a valid email address.

5. What Type of Change Do You Need to Make? *This question is required.

What is your new departure date?
This question requires a valid date format of MM/DD/YYYY.

calendar

What is your new return date?
This question requires a valid date format of MM/DD/YYYY.

calendar

Please be advised some plans use travel dates to determine premium rates. If your change will result in additional premium we will contact you by phone or email to make you aware of the premium difference, and to request consent for payment.

Also, please note: Most providers require that requests for date changes are received prior to the original trip departure date. Requests received after that date may not be considered.

What is your new departure date? This question requires a valid date format of MM/DD/YYYY.

calendar

What is your new return date? This question requires a valid date format of MM/DD/YYYY.

calendar

Please Enter Your New Total Trip Cost
This is the new cost of your entire trip, not just the amount your trip increased or decreased by.
For example, if your original trip cost was $5,000 and increased by $500, you would enter $5,500

Please be advised most plans use total trip cost to determine premium rates. If your request will result in a change in premium we will contact you by phone or email to make you aware of the premium difference, and to request consent for payment.

Please Enter Your New Destination (Country)
Note: if you are traveling to a different destination in the same country this does not require an update.
If traveling outside the United States, enter the country where travelers will be spending the most time. If spending equal time in multiple countries, choose your first international destination.

Some providers do not allow coverage to be transferred to a new trip; however, you can provide additional documentation as outlined below, and your request will be sent to the provider for consideration. Please be advised that these requests are not guaranteed, and are reviewed on a case by case basis.

Also, please note: Most providers require that any requests for date changes are received prior to the original trip departure date. Requests received after that date may not be considered

Additional Documentation:

Proof of Cancelled/Transferred Trip:
Generally this can be a final invoice or other contact from your travel supplier that includes your name, trip information, and an indication that the trip was cancelled. This may be required from multiple suppliers depending on the details of your trip.

You can attach up to 10 files. Each file must be under 2MB. If you have files that are larger than these requirements, you can send them to customercare@insuremytrip.com.

File: {{filename}} delete

Proof of Refund/Transfer of Funds:

Generally this is a copy of a credit card statement or similar financial document that outlines the refund you received. The name and the dates of refund should be visible, but other information can be redacted.

You can attach up to 10 files. Each file must be under 2MB. If you have files that are larger than these requirements, you can send them to customercare@insuremytrip.com.

File: {{filename}} delete

Please Enter Your New Total Trip Cost
This is the new cost of your entire trip, not just the amount your trip increased or decreased by.
For example, if your original trip cost was $5,000 and increased by $500, you would enter $5,500

Please be advised most plans use total trip cost to determine premium rates. If your request will result in a change in premium we will contact you by phone or email to make you aware of the premium difference, and to request consent for payment.
This question requires a valid number format.

Please Enter Your New Destination (Country)
Note: if you are traveling to a different destination in the same country this does not require an update.
If traveling outside the United States, enter the country where travelers will be spending the most time. If spending equal time in multiple countries, choose your first international destination.

Please be advised some plans use destination to determine premium rates. If your new destination will result in a change in premium we will contact you by phone or email to make you aware of the premium difference, and to request consent for payment.

Also, please note: Most providers require that any requests for destination changes are received prior to the original trip departure date. Requests received after that date may not be considered.

Additional Documentation:

Some providers require additional documentation to update the destination. You can provide additional documentation as outlined below, and your request will be sent to the provider for consideration. Please be advised that these requests are not guaranteed and are reviewed on a case-by-case basis.

Proof of Cancelled/Transferred Trip:
Generally this can be a final invoice or other contact from your travel supplier that includes your name, trip information, and an indication that the trip was cancelled. This may be required from multiple suppliers depending on the details of your trip

File: {{filename}} delete

Proof of Refund/Transfer of Funds:
Generally this is a copy of a credit card statement or similar financial document that outlines the refund you received. The name and the dates of refund should be visible, but other information can be redacted.

File: {{filename}} delete

For changes other than those listed, or if you need to change more than one element of the policy, please outline your request in the field below.

After we receive your request, we will follow up by phone or email with any additional steps or documentation required to process your request, or to inform you in the event a change isn't possible.

Please provide as much detail as possible.

Additional Documentation:

Many changes not listed previously, will require additional documentation to be sent to the provider. To speed up processing, you are welcome to provide the following documentation in advance. Please note: if you do not submit documentation at this time, we will include instructions for what you will need to provide in our response

Proof of Cancelled/Transferred Trip:
Generally this can be a final invoice or other contact from your travel supplier that includes your name, trip information, and an indication that the trip was cancelled. This may be required from multiple suppliers depending on the details of your trip.

You can attach up to 10 files. Each file must be under 2MB. If you have files that are larger than these requirements, you can send them to customercare@insuremytrip.com.

File: {{filename}} delete

Proof of Refund/Transfer of Funds
Generally this is a copy of a credit card statement or similar financial document that outlines the refund you received. The name and the dates of refund should be visible, but other information can be redacted.

You can attach up to 10 files. Each file must be under 2MB. If you have files that are larger than these requirements, you can send them to customercare@insuremytrip.com.

File: {{filename}} delete

Confirmation of No Claims:
By adding your digital signature below, you are acknowledging that you have not submitted a claim under this policy and at the time your submission of the requested change you have not incurred a loss for which you intend to file a claim under this policy.

*This question is required.

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