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THIS FORM IS FOR UNC RESIDENTS AND FELLOWS (for ACGME-accredited fellowships) ONLY.

Residents are required to purchase GeoBlue International Travel and Emergency Health Insurance through UNC School of Medicine if their travel is related in any way to their medical training.

If you are traveling for leisure in a non-UNC/H 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:

Resident Full Coverage = $1.50 per day

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

  • Date Format: MM slash DD slash YYYY
  • example "slifko@unchealth.unc.edu"
  • For this field and the following four address fields, enter the address, city, province, zip code equivalent, and country of your destination. If you don't know the street address of your destination, enter your current home address for this field and the following four fields.
  • Date Format: MM slash DD slash YYYY
  • e.g. PGY1, PGY2, PGY3
  • e.g. Internal Medicine, Family Medicine, General Surgery...
  • please enter month and year (06/2014 or 12/2015...)
    Date Format: MM slash DD slash YYYY
  • Enter the country of your destination, not your home country
  • Enter the city or region of your destination, not your home city.
  • 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.
  • For Example: UNC Project Malawi or Honduran Health Alliance. If your experience is not with an established program, you can give the name of a hospital or other description here.
  • make sure to include the full address (including http:)
  • Course Coverage

  • "Elective" means the official organized experience (including direct travel to and from the elective). These dates should encompass everything that is not personal or extra tourist travel.
    Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Emergency Contact Information

    Please enter the name of a person (family member, etc.) to contact in case of emergency.
  • Funding Sources

  • not your ONYEN password, not your PID number, just your ID, example "shawes"
  • By checking this box, you affirm that the information above is accurate, and that you are UNC resident or fellow. For the comments field: Please add the names and birth dates of any family members traveling with you (if applicable).

After submitting this form, you will receive an email within 5-10 days stating the amount of money you will need to pay for GeoBlue travel health insurance and the link to do so. You will need to pay online. You will also need to complete all pre-travel requirements set forth by the Office of Global Health Education and GME. Both lists are available here.