Complete the information below to finish the enrollment process for your student.

1
Date Of Birth
Date Of Birth
Date Of Birth
Date Of Birth
2
School Info
School Info
School Info
School Info
3
Student Info
Student Info
Student Info
Student Info
4
Select Policy
Select Policy
Select Policy
Select Policy
5
Checkout
Checkout
Checkout
Checkout
1
Date Of Birth
Date Of Birth
Date Of Birth
Date Of Birth
2
Student Info
Student Info
Student Info
Student Info
3
Select Policy
Select Policy
Select Policy
Select Policy
4
Checkout
Checkout
Checkout
Checkout

User Dashboard

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+ ADD NEW STUDENT

Forgot Password

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Please enter your account email address and a new password will be emailed to you.


Email Address


Password Email Sent

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Your password has been successfully changed. Please check your email for your new password.

Change Password

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Please enter your current password and your new password.


Current Password


New Password


Password must meet the following requirements:

  • At least one letter
  • At least one capital letter
  • At least one number
  • Be at least 8 characters

Password Successfully Changed

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Your password has been successfully changed.

Change Email Address

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Please enter your new email address.


New Email Address


Confirmation Email Sent

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An email has been sent to your new email address. Please check your email for the confirmation link. Click on the confirmation link to complete the change.

Step 1:

Initial Information

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* Please enter the student's Date Of Birth

* Please enter the student's Date Of Birth

* Please enter the student's Date Of Birth

* Please enter the student's Date Of Birth


* Is the student a middle or high school student studying on a J1 or F1 Visa?

* Is the student a middle or high school student studying on a J1 or F1 Visa?

* Is the student a middle or high school student studying on a J1 or F1 Visa?

* Is the student a middle or high school student studying on a J1 or F1 Visa?

No Yes
No Yes
No Yes
No Yes


* Please select their country of origin

* Please select their country of origin

* Please select their country of origin

* Please select their country of origin


*
You must provide either the student's passport number or their J1/F1 Visa number

*
You must provide either the student's passport number or their J1/F1 Visa number

*
You must provide either the student's passport number or their J1/F1 Visa number

*
You must provide either the student's passport number or their J1/F1 Visa number


Enter your passport number.

Enter your passport number.

Enter your passport number.

Enter your passport number.

Passport Number

Either your passport number or your visa number are required.

Enter your J1/F1 Visa number.

Enter your J1/F1 Visa number.

Enter your J1/F1 Visa number.

Enter your J1/F1 Visa number.

Visa Number

Either your passport number or your visa number are required.

Step 2:

Student Information

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Student Information

Student Information

Student Information

Student Information



Student date of birth:

Student date of birth:

Student date of birth:

Student date of birth:

BLANK


* First Name

First Name

First Name as it appears on your passport.

* Last Name

Last Name

The student's last name.

* Gender



Student Email



Local Address in the United States


Address Line 1

Local mailing address required for the student. This is the address the Insurance Company will use to contact the insured.

City / Town

The mailing address for the student at the school is required. This is the address the Insurance Company will use to contact the insured.

Zip / Postal Code

The mailing address for the student at the school is required. This is the address the Insurance Company will use to contact the insured.

U.S. Mailing Address for Student

* Email address of Legal Guardian (or student if 18)

This address wil be used for GBG Member Portal creation!


One of the most important services you have is GBG Member Portal, your secure online portal where you can view your plan coverage, download your ID Card, view your claims information, view any messages sent to you, and find many other helpful resources.

* First Name


* Last Name


* Gender



Student Email



Local Address in the United States




School Student ID (This is not required and is assigned by school.)

* First Name


* Last Name


* Gender



Student Email



Local Address in the United States




School Student ID (This is not required and is assigned by school.)

* First Name


* Last Name


* Gender



Student Email



Local Address in the United States




School Student ID (This is not required and is assigned by school.)

Step 3:

Select your Policy

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* Select Your Policy

* Select Your Policy

* Select Your Policy

* Select Your Policy

* Select your quantity



Start Date:
End Date:

* Start Date


End date

End date



 I acknowledge that proceeding with this enrollment will create a gap in coverage for this student

Cart:

Manage Cart

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Step 4:

Your Information

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Create Your CAA Trust Account and Make Payment.

Create Your SHIP Account and Make Payment.

Please enter information for the individual making payment.

Create Your CAA Trust Account and Make Payment.

Create Your SHIP Account and Make Payment.

Please enter information for the individual making payment.

Create Your CAA Trust Account and Make Payment.

Create Your SHIP Account and Make Payment.

Please enter information for the individual making payment.

Create Your CAA Trust Account and Make Payment.

Create Your SHIP Account and Make Payment.

Please enter information for the individual making payment.


* First Name

First Name

First Name of individual responsible for payment for insurance policy.


* Last Name

Last Name

Last Name of individual responsible for payment for insurance policy.


* Email Address



* Password


Password must meet the following requirements:

  • At least one letter
  • At least one capital letter
  • At least one number
  • Be at least 8 characters

* Relation to Student

Parent/Guardian
Student
Relative
School
Hosting Family

Unless otherwise stated in the Master Policy, coverage will be effective (if submitting via Online Services) the start of date of the coverage period. The student/visa holder is responsible for timely renewal payments.

By submitting this application, the student/visa holder or guardian acknowledges the following: 1). He/she has carefully read the brochure and elects to enroll as indicated on the application; 2). He/she declares they meet the eligibility requirements for the plan selected; 3). That if it is later determined that the student is not eligible, or upon entrance into the armed forces, the premium will be refunded. Premium will not be refunded except for ineligibility or entrance into the armed forces.

I have read and agree to the terms state above, I am at least 18 years of age, and I elect to purchase insurance coverage under this insurance plan. Above are the choices I have made.

* You must check the box above to proceed with your payment

Proceed with your payment, powered by Flywire

Order Summary

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Thank You For Your Purchase!

Click to view printer friendly receipt
Order Number:
You recently purchased a comprehensive primary student health insurance policy. Please print this receipt as verification of your purchase and present this to the school to verify purchase.
PLEASE NOTE: This is a Non-Renewable One Year Term Insurance Plan.
Amount Paid (USD):
Payment Method:
Authorization #:
CAA LTD MERCHANT #:
4445053600268
CAA LTD does not offer direct refunds. For refund information contact your school's business office.
Policy purchase is non-refundable
ID Card:
Hard copy ID Card will be mailed to the following address:
The legal guardian (or student if 18 years old) will receive a confirmation email with further details and next steps.
You will receive an email confirmation of this purchase as well as an email from United Healthcare Student Resources (UHCSR) to setup your online account.
In case of a dispute contact customer support:

55 Hospital Center Commons
Hilton Head Island, SC
29926
admin@cliffordallen.com
+1 (888)342-2224

Thank You For Your Purchase!

A confirmation email has been sent.

Click to view printer friendly receipt
Order Number:
You recently purchased a comprehensive primary student health insurance policy.
Primary Insured:
Policy Number:
Effective Date:
(Begins at 12:01 a.m. EST)
Termination Date:
(Ends 11:59 p.m. EST)
PLEASE NOTE: This is a Non-Renewable One Year Term Insurance Plan.
Amount Paid (USD):
Card Type:
Authorization #:
CAA LTD MERCHANT #:
4445053600268
CAA LTD does not offer direct refunds. For refund information contact your school's business office.
Policy purchase is non-refundable
ID Card:
Hard copy ID Card will be mailed to the following address:
Temporary ID Card:
Available at this link within 1 week After Purchase
https://www.uhcsr.com/SelfServiceSupport/Students/myaccount/TieAccountIdentify.aspx
If an ID card is needed prior to school receiving the hard copy, please contact your school's health center.
You will receive a confirmation email with further details and next steps.
In case of a dispute contact customer support:

55 Hospital Center Commons
Hilton Head Island, SC 29926
customerservice@cliffordallen.com
+1(843) 342-3150
In case of a dispute contact customer support:

P.O. Box 1051
George Town, Grand Cayman KY1-1102
CAYMAN ISLANDS
info@shipsignup.com
+1(844) 232-7370

Thank You For Your Purchase!

A confirmation email has been sent.

Click to view printer friendly receipt
Order Number:
You recently purchased a comprehensive primary student health insurance policy.
Primary Insured:
Policy Number:
Effective Date:
(Begins at 12:01 a.m. EST)
Termination Date:
(Ends 11:59 p.m. EST)
PLEASE NOTE: This is a Non-Renewable One Year Term Insurance Plan.
Amount Paid (USD):
Card Type:
Authorization #:
CAA LTD MERCHANT #:
4445053600268
CAA LTD does not offer direct refunds. For refund information contact your school's business office.
Policy purchase is non-refundable
ID Card:
Hard copy ID Card will be mailed to the following address:
Temporary ID Card:
Available at this link within 1 week After Purchase
https://www.uhcsr.com/SelfServiceSupport/Students/myaccount/TieAccountIdentify.aspx
If an ID card is needed prior to school receiving the hard copy, please contact your school's health center.
You will receive a confirmation email with further details and next steps.
In case of a dispute contact customer support:

55 Hospital Center Commons
Hilton Head Island, SC 29926
customerservice@cliffordallen.com
+1(843) 342-3150
In case of a dispute contact customer support:

P.O. Box 1051
George Town, Grand Cayman KY1-1102
CAYMAN ISLANDS
info@shipsignup.com
+1(844) 232-7370

Thank You For Your Purchase!

A confirmation email has been sent.

Click to view printer friendly receipt
Order Number:
You recently purchased a comprehensive primary student health insurance policy.
Primary Insured:
Policy Number:
Effective Date:
(Begins at 12:01 a.m. EST)
Termination Date:
(Ends 11:59 p.m. EST)
PLEASE NOTE: This is a Non-Renewable One Year Term Insurance Plan.
Amount Paid (USD):
Card Type:
Authorization #:
CAA LTD MERCHANT #:
4445053600268
CAA LTD does not offer direct refunds. For refund information contact your school's business office.
Policy purchase is non-refundable
ID Card:
Hard copy ID Card will be mailed to the following address:
Temporary ID Card:
Available at this link within 1 week After Purchase
https://www.uhcsr.com/SelfServiceSupport/Students/myaccount/TieAccountIdentify.aspx
If an ID card is needed prior to school receiving the hard copy, please contact your school's health center.
You will receive a confirmation email with further details and next steps.
In case of a dispute contact customer support:

55 Hospital Center Commons
Hilton Head Island, SC 29926
customerservice@cliffordallen.com
+1(843) 342-3150
In case of a dispute contact customer support:

P.O. Box 1051
George Town, Grand Cayman KY1-1102
CAYMAN ISLANDS
info@shipsignup.com
+1(844) 232-7370