Executive Connection Travel Protection Enrollment
- You can enroll yourself and/or a group of employees in this plan using our secure enrollment form.
- Enrolling 10 or more employees? You can complete one enrollment form and attach a roster with details for each applicant. The details required for each applicant are listed on page two of the enrollment form.
Already a customer?
Need to pay your invoice?
If you are re-enrolling (coverage that has not yet lapsed) or if you are making changes to your coverage at re-enrollment time, such as changing to or from a family plan, or upgrading your plan level, please indicate the appropriate changes on your invoice, and mail payment to the address shown on your invoice.
If you are changing dependents on an existing family plan, at re-enrollment time, please complete our
dependent change form.
Looking for coverage for the first time?
Choose this option if you have not had coverage in the past.
Online enrollment form*
Has your coverage lapsed?
Choose this option if your coverage is currently lapsed but you have had coverage in the past.
Online enrollment form*
*Online enrollment – ou'll need a valid credit card to complete this enrollment form. All information will be transmitted over a secure connection, to protect your privacy.