Note: If you are a citizen of multiple countries, and one of them is United States, you must answer yes to the question above.
US Citizens are ineligible to purchase this coverage.
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    1. You consent to the use and disclosure of your personally identifiable information, including sensitive health information, and other information in accordance with our Privacy Policy. If you do not consent to the disclosure of your personal information, we will not be able to evaluate your request and will not be able to provide you with the medical program, including the insurance product offered by Crum & Forster, SPC. For information regarding the use and disclosure of your personal information, please visit our privacy policy page.
    2. By purchasing this coverage, you agree to subscribe and become a participant in the Fairmont Specialty Trust and understand that participation in the Trust is a prerequisite to procuring the insurance coverage. Click here for a copy of the subscription agreement.
    3. This insurance coverage is not subject to and does not provide certain insurance benefits required by the United States’ Patient Protection and Affordable Care Act (“PPACA”). PPACA requires certain US citizens or US residents to obtain PPACA compliant health insurance, or “minimum essential coverage.” In some cases, certain individuals may be deemed to have minimum essential coverage under PPACA even if their insurance coverage does not provide all of the benefits required by PPACA. Please consult an attorney or tax professional to determine whether this insurance coverage meets any obligations you may have under PPACA.
    4. This plan contains both insurance and non-insurance benefits. Insurance benefits are provided by Crum & Forster SPC through ITI SP pursuant to a policy issued to the Fairmont Specialty Trust.
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