Have each member of your team fill out and sign this form, regardless of whether your team is traveling inside or outside the U.S.
Use this one if your team will be traveling outside the United States. Please type directly into the spreadsheet. It will automatically calculate your fees. Please submit this spreadsheet even if you are a 1 person team. Submit a separate spreadsheet for team members with alternate travel dates or varying levels of coverage.
UMVIM Group Insurance Application Spreadsheet for Teams Serving in the U.S. Use this form if your team is based in the U.S. and will be serving domestically. Domestic teams must purchase coverage for at least 3 days and be traveling at least 100 miles from point of origin. Please type directly into the spreadsheet. It will automatically calculate your fees. Please submit this spreadsheet even if you are a 1 person team. Submit a separate spreadsheet for team members with alternate travel dates or varying levels of coverage.
$10,000 $25,000 and $50,000 are the basic insurance plans.
For travel outside of the U.S. where you may be engaging in riskier activities such as travel by motorcycle or using zip lines, we also offer Sports insurance at coverage levels of $10,000 and $25,000.
For U.S. Teams serving within the U.S.:
$10K costs $3.10 per person per day.
$25K costs $3.60 per person per day.
$50K costs $4.10 per person per day.
For teams serving outside the U.S.:
$10K costs $2.00 per person per day.
$25K is $2.25 per person per day.
$50K is $2.50 per person per day.
$10K Sports costs $2.50 per person per day.
$25K Sports is $2.75 per person per day.
(Persons 80+ years of age are only eligible for $10K coverage)
Additionally there is a $15/person origination fee for each team member.
Each team member must complete the Individual Insurance Application form using Microsoft Word. The completed form is printed and signed by the team member and a witness. It is suggested a team member keep a copy of their application before providing the original to the team leader.
Use the information from the Individual Applications to fill in the spreadsheet using Excel. Excel performs the payment calculations based on your dates of trip and insurance rate chosen. If members of your group are traveling on different dates or are applying for different rates of coverage, please submit a separate spreadsheet for each set of travel dates and/or level of coverage.
Send the Group Application spreadsheet in Excel format (.xls or .xlsx) and scans of all the Individual Applications (.pdf) to firstname.lastname@example.org.
Pay for your insurance with a credit card through PaymentSpring, our secured payment application. Applications will not be processed until payment is made.
Email your questions to email@example.com or call us at (919) 428-0461.