Application for Buying Discounted Health Insurance - College of Medicine, Alfaisal University
Discounted Health Insurance through this application is offered to Alfaisal University Medical Students only.

Kindly enter all the fields as given in your passport. Please be careful with the information you enter as the same would appear on your insurance coverage card.

Also, note that all SPIRIT students must have health/travel insurance, the cost of which would be covered by the SPIRIT funding.

Make sure you apply for the insurance only after getting acceptance from your program and visa approval (in the case of B1/B2 visa programs). For J1 visa programs, you would have to apply earlier.

For non-SPIRIT students, the insurance will not be covered; for payment contact asiddique@alfaisal.edu.
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First Name (as given in passport) *
Middle Name (as given in passport)
Last Name (as given in passport) *
Alfaisal ID *
Alfaisal Email Address *
Gender *
Date of Birth *
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US Citizen *
US Destination *
Country of Origin (Nationality) *
Coverage Start Date *
Enter travel dates NOT program dates. For example, if your program is starting on June 1 but you are traveling on May 28, then enter May 28.
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DD
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YYYY
Coverage End Date *
Enter travel dates NOT program dates. For example, if your program is ending on August 21 but you are traveling on August 23, then enter August 23.
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