Back to plan comparison 1Plan & Coverage DatesEdit Insurance planPatriot ExchangeStudent Health Advantage Coverage start date Coverage end date Save & Continue 2Primary ApplicantEdit First name Last name Date of birth GenderMaleFemaleOther / Not specified CitizenshipChinaUnited StatesCanadaUnited KingdomIndiaSouth KoreaJapanTaiwanHong KongAustraliaBrazilMexicoGermanyFranceVietnamThailandSingaporeMalaysiaIndonesiaPhilippinesNepalBangladeshPakistanSaudi ArabiaUnited Arab Emirates Home countryChinaUnited StatesCanadaUnited KingdomIndiaSouth KoreaJapanTaiwanHong KongAustraliaBrazilMexicoGermanyFranceVietnamThailandSingaporeMalaysiaIndonesiaPhilippinesNepalBangladeshPakistanSaudi ArabiaUnited Arab Emirates Save & Continue 3Contact & AddressesEdit Email address Phone number Home / Mailing Address Street address Address line 2 (optional) City State / province code Postal code CountryChinaUnited StatesCanadaUnited KingdomIndiaSouth KoreaJapanTaiwanHong KongAustraliaBrazilMexicoGermanyFranceVietnamThailandSingaporeMalaysiaIndonesiaPhilippinesNepalBangladeshPakistanSaudi ArabiaUnited Arab Emirates U.S. Residence Address Street address Address line 2 (optional) City U.S. stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Postal code CountryUnited States Save & Continue 4Signature & ConfirmationEdit Eligibility Questions Is the student currently residing in the United States?YesNo Has the student resided in the United States for more than six months?YesNo Does the student currently have a health plan?YesNo Signature name Signature date Relationship to applicantSelfParentGuardianOther I confirm that the information is accurate and authorize secure submission of the application and payment to GGS. Get Live GGS Quote 5Order Review & Credit Card PaymentComplete the first four steps and obtain a quote to continue.Edit Live GGS quote— Name on card Credit card number Expiration CVV Billing address is the same as the U.S. residence address Billing Address Street address Address line 2 (optional) City State / province code Postal code CountryChinaUnited StatesCanadaUnited KingdomIndiaSouth KoreaJapanTaiwanHong KongAustraliaBrazilMexicoGermanyFranceVietnamThailandSingaporeMalaysiaIndonesiaPhilippinesNepalBangladeshPakistanSaudi ArabiaUnited Arab Emirates Card number and CVV are used only for this GGS purchase and are never written to the local database or logs. Confirm & Pay
1Plan & Coverage DatesEdit Insurance planPatriot ExchangeStudent Health Advantage Coverage start date Coverage end date Save & Continue
2Primary ApplicantEdit First name Last name Date of birth GenderMaleFemaleOther / Not specified CitizenshipChinaUnited StatesCanadaUnited KingdomIndiaSouth KoreaJapanTaiwanHong KongAustraliaBrazilMexicoGermanyFranceVietnamThailandSingaporeMalaysiaIndonesiaPhilippinesNepalBangladeshPakistanSaudi ArabiaUnited Arab Emirates Home countryChinaUnited StatesCanadaUnited KingdomIndiaSouth KoreaJapanTaiwanHong KongAustraliaBrazilMexicoGermanyFranceVietnamThailandSingaporeMalaysiaIndonesiaPhilippinesNepalBangladeshPakistanSaudi ArabiaUnited Arab Emirates Save & Continue
3Contact & AddressesEdit Email address Phone number Home / Mailing Address Street address Address line 2 (optional) City State / province code Postal code CountryChinaUnited StatesCanadaUnited KingdomIndiaSouth KoreaJapanTaiwanHong KongAustraliaBrazilMexicoGermanyFranceVietnamThailandSingaporeMalaysiaIndonesiaPhilippinesNepalBangladeshPakistanSaudi ArabiaUnited Arab Emirates U.S. Residence Address Street address Address line 2 (optional) City U.S. stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Postal code CountryUnited States Save & Continue
4Signature & ConfirmationEdit Eligibility Questions Is the student currently residing in the United States?YesNo Has the student resided in the United States for more than six months?YesNo Does the student currently have a health plan?YesNo Signature name Signature date Relationship to applicantSelfParentGuardianOther I confirm that the information is accurate and authorize secure submission of the application and payment to GGS. Get Live GGS Quote
5Order Review & Credit Card PaymentComplete the first four steps and obtain a quote to continue.Edit Live GGS quote— Name on card Credit card number Expiration CVV Billing address is the same as the U.S. residence address Billing Address Street address Address line 2 (optional) City State / province code Postal code CountryChinaUnited StatesCanadaUnited KingdomIndiaSouth KoreaJapanTaiwanHong KongAustraliaBrazilMexicoGermanyFranceVietnamThailandSingaporeMalaysiaIndonesiaPhilippinesNepalBangladeshPakistanSaudi ArabiaUnited Arab Emirates Card number and CVV are used only for this GGS purchase and are never written to the local database or logs. Confirm & Pay
