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Atlas America® Non-U.S. citizens traveling to the U.S.

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  • Applicant Details
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Quote

Retrieve Application
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Coverage Dates (mm/dd/yyyy)

Start Date is required. Cannot contain special characters. Cannot contain letters. Please enter the Start Date in the specified date format.

End Date is required. Cannot contain letters. Cannot contain special characters. Please enter the End Date in the specified date format. End Date cannot be before Start Date.

Is your Citizenship or Home Country the U.S. or a U.S. territory?

      

Please select an option to move forward.

Applicants listing Citizenship or Home Country as 'United States of America' are limited to 364 days of coverage per the United States Patient Protection and Affordable Care Act (PPACA). Please adjust the Coverage End Date, choose an alternate plan on this website, or contact us for further assistance.

Insureds' Age(s)

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Primary Age is required.Insured {{numOfTraveler+1}} Age is required.

Spouse must be at least 18 years old.

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Please enter the age(s) of other(s).

Host Country

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