Have you decided to travel at the
end of your stay with your host family?
If so, you must have medical insurance coverage for this period.
Insurance is required if you do not select the first available departure
date, if you do not already have upgraded insurance and if you cannot
provide proof of other insurance coverage. Au Pair in America can
provide you with an extension of your current Insurance Plan at
a minimal cost.
The extra month of insurance coverage will extend all your current
benefits: Medical Coverage of $100,000 for each accident or illness;
Team Assist Emergency Medical Coverage; and the Personal Liability
Benefit, which provides $1,000 in personal effects coverage. (Please
note: Some limitations and exclusions apply. Refer to your Plan
of Insurance summary for further information.)
Additional benefits of extending coverage:
- If you have met your $200 deductible, no additional deductible
will be taken.
- Should you have an accident during your travels, your Emergency
Medical Coverage will remain in effect. This coverage will provide
for medical evacuation to the nearest appropriate facility and
medically necessary repatriation to your home country. (See Plan
of Insurance brochure for further details of coverage.)
- If you do not purchase this coverage and suffer an illness or
injury, no coverage will be provided to you. This may prevent you
from receiving medical care from certain hospitals and physicians,
as they may only accept patients with proof of insurance.
- For a minimal cost, you can have the peace of mind that in the
event of an accident or illness, you will be covered.
We will provide this coverage at a cost to you of $85.
.........................................................................................................................................................
Print this page, cut along the dotted line and return to:
Au Pair in America
River Plaza
9 West Broad Street
Stamford, CT 06902-3788
Au pair name _________________________________________________________________________
Original departure date _____/_____/_____ New departure date _____/_____/_____
___ Yes! Please sign me up for an additional month of insurance.
AP membership # _______________
___ No thank you. I decline this coverage as I have other insurance.
I have enclosed a copy of this insurance.
Signature ___________________________________ Date ____________________
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