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Contact Information

1066 Bondurant Hall
CB# 9535
Chapel Hill, NC
27599-9535

Phone: 919-962-6195
Fax: 919-966-0730

international@med.unc.edu
Skype: unc_med_international

 
You are here: Home > Forms > Travel Health Insurance Application Form

Travel Health Insurance Application Form

This form helps to sign you up for the University's travel health insurance.

THE FORM IS FOR FULL TIME SCHOOL OF MEDICINE STUDENTS AND FACULTY ONLY!! If you are not in the School of Medicine, please contact the Study Abroad office for more details. IF YOU ARE A UNC PHYSICIAN RESIDENT, click here to access the resident form.

Students are required to purchase travel health insurance through UNC School of Medicine if they are receiving academic credit or funding from UNC, or if they are acting in the role of a medical student.  For example, students are required to purchase travel health insurance through UNC if they are participating in a program like Himalayan Health Exchange, Interhealth South America, International Health Partners , IFMSA or any other program where the student is identified as a medical student – regardless of funding or academic credit. If none of these categories applies to you, you are uneligible for the special UNC rate at HTH, but can call them directly at the information below.

If you would like to have additional coverage beyond the maximum coverage dates stated below, you can contact the insurance provider, Highway to Health, directly. For an overview of what this insurance covers, please see the HTH study abroad brochure and the political and security evacuation pamphlet.

Please note: the cost of Travel Health Insurance has increased.  For the 2011-2012 school year (starting 8/1/2011), the prices will be:

Full Coverage = $1.32 per day
Before/After Coverage = $2.63 per day
Faculty/Staff Coverage = $2.63 per day

For more detailed information on costs, see the HTH rate sheet.

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not your ONYEN password, not your PID number, just your ID, example "shawes"
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This must be a med.unc.edu email address.
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If you are a faculty member that is interested in coverage for your spouse and/or children traveling with you, please include the name and date of birth of each additional person in the comments section at the bottom of this form.



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e.g. 2010, 2013, etc. Please put n/a if you are a resident or faculty member.
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Course Coverage
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Additional Coverage
Note: The maximum number of days of "Before/After" coverage is 7 days for each period. The minimum number of days of "Before/After" coverage is 2 days for each period. They cannot be combined at either end of your trip for the maximum 14 days. DO NOT OVERLAP days between Course Coverage and Additional Coverage.
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Course Information


For instance MEDI 460
Emergency Contact Information
Please enter the name of a person (family member, etc.) to contact in case of emergency.
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Program Contact Information
Please enter the name, phone number, and email address of a contact (supervising physician preferred) located in the country you will be visiting.
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For Example: Himalayan Health Exchange or Proyecto Puentes de Salud. If your experience is not with an established program, you can give the name of a hospital or other description here.
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Funding Sources
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By checking this box, you affirm that the information above is accurate, and that you are EITHER a currently enrolled student in the School of Medicine, OR a member of the School of Medicine faculty. Faculty members should add this additional information to the comments field: Names and birth dates of any family members traveling with you (if applicable).

Next Steps

After submitting this form, you will receive an email (usually within 1-3 days) stating the amount of money you will need to pay for travel insurance.  You will need to pay online or drop off the check and a signed copy of the Travel Waiver Form at the Office of International Affairs in 1066 Bondurant Hall.  You are also required to register with the UNC Global Travel Registry. If you are a student, you will also receive an email giving you access to the GLBE999.MOD.1112 Sakai Site where you will find the two required modules and corresponding quizzes.

Once this form has been processed and you have completed all other requirements, you will be eligible to apply for credit for your overseas course.