Travel Month Insurance Payment Form

If you wish to purchase health insurance for your travel month through Envisage Global Insurance, please calculate the number of days you need coverage for (program end date until the day you are flying out) and multiply the number of days times $2.76 (e.g. 14 days of coverage would be $37.52, 30 days of coverage would be $80.40).

Please submit your payment by filling out the payment form. Please make sure to use your full name so we know who you are and can make sure to enroll the correct person in the insurance. Once your payment has been submitted, we will enroll you in the insurance for the number of days that you have paid for and we will email you your insurance card.

Please make sure to submit payment before your program end date.

We process our transactions through Authorize.net to ensure that credit card payments are safely and securely collected for our customers.

Your personal information is never shared or sold by by Agent Au Pair.