Travel Insurance Assessment

Complete this after your initial travel-insurance request. It helps the broker review trip details and identify items requiring insurer-specific eligibility or medical review.

1. Quick intake complete

2. Detailed assessment

Sensitive information

Health information is collected only for preliminary broker review. Insurer medical questionnaires and stability definitions remain controlling. Do not enter health-card numbers, passport numbers, banking information or credit-card numbers.

Reference number

Email or phone used on your request

Traveller & trip details

Number of travellers

Traveller ages

Destination(s)

Departure date

Return date

Trip type

Purpose

Prepaid / non-refundable trip cost

Valid provincial / territorial health coverage for entire trip?

Coverage requested

Emergency medical / Soins médicaux d’urgenceTrip cancellation / AnnulationTrip interruption / InterruptionBaggage / BagagesAll-inclusive / Tout inclus

Pre-existing conditions & medical review

Any pre-existing medical condition, diagnosis, treatment or ongoing symptoms?

Any recent change in health, symptoms, treatment, medication or dosage?

Any pending investigation, test, referral or specialist follow-up?

Emergency visit, hospitalization or surgery in the last 12 months?

Pregnancy-related coverage review required?

Optional medical context

A “Yes”, “Not sure” or recent change answer is flagged for broker review. The website does not determine whether a condition meets an insurer’s stability period.

Destination, activities & existing coverage

Have you reviewed current Government of Canada travel advisories for the destination?

Cruise?

Adventure / higher-risk activities?

Will any traveller work or perform occupational duties abroad?

Existing travel coverage

Have you confirmed the limits / exclusions of that existing coverage?

Coverage may be affected by destination advisories, insurer exclusions, pre-existing-condition definitions and stability periods. Eligibility and coverage are determined by the insurer’s application and policy wording.

I expressly consent to Frank Insurance collecting and using the health and trip information I provide for insurance-needs assessment and broker review.I expressly consent to Frank Insurance disclosing this assessment to the assigned licensed broker and, if I ask to proceed with insurance options, to insurers, MGAs and underwriting partners where reasonably necessary for quotation, eligibility or underwriting review.I understand this website does not bind coverage and does not replace the insurer’s eligibility or medical questionnaire.

Open client status