Travel Health Insurance Application Form

Complete this form to register for the mandatory health insurance requirement for your outbound international travels in a UNC role.


If you are not in the School of Medicine, please contact the Study Abroad office for more details.

Medical 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, Child Family Health International , UNC Project Malawi, 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, such as going to France for vacation, you are ineligible for the special UNC rate at GeoBlue, but can call them directly at the information below.

If you are traveling for leisure in a non-UNC role, you are NOT eligible for the GeoBlue UNC group plan. However, you can contact the insurance provider, GeoBlue, directly to inquire further.

Policy rates for GeoBlue are as follows:

Student Full Coverage = $1.42 per day
Faculty/Staff Coverage = $2.95 per day

All questions regarding Claims will go directly to GeoBlue’ s Customer Service:

Today's Date  
/ /  
Status   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.

Course Coverage
Beginning of Course Period   "Course" means the official organized experience (including direct travel to and from the course), regardless of whether you're getting academic credit for the experience. These dates should encompass everything that is not personal or extra tourist travel.
/ /  
End of Course Period  
/ /  
Course Information
Are you going to register for elective credit?

Program Contact Information
Please enter the name, phone number, and email address of a contact (supervising physician or program contact preferred) located in the country you will be visiting. DO NOT, again, DO NOT LIST the student leader or the faculty advisor for your UNC student group (HHA, PPS, S2S). You may only list a UNC contact here if you are going to Malawi or another UNC site with full-time, in-country UNC faculty/staff. Otherwise, a host-site contact is required such as the in-country preceptor (clinical site), the principal investigator (research elective), or host-site administrator.
Official UNC Site Is your medical student experience taking place at an official UNC site? Only options include: UNC Malawi; UNC Zambia; UNC Nicaragua; UNC China; UNC Vietnam (National Hospital for Tropical Diseases and Bach Mai Hospital). If your host-site is not listed, select NO.

Emergency Contact Information
Please enter the name of a person (family member, etc.) to contact in case of emergency.
Funding Sources
Were you funded for this experience?  

Date of Birth  
/ /  

Type of International Experience

Next Steps

After submitting this form, you will receive an email (within 5-10 days) stating the amount of money you will need to pay for travel insurance.  You will need to pay online.  You are also required to complete the remaining UNC School of Medicine's Pre-Travel Requirements before your travel is approved. If you are a student, you will also receive an email- within moments of receiving the email from the OIA- granting you access to the Sakai Course Site where you will find the two required travel 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.