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


School:

School:

School:

School:

BLANK


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.

Middle Initial


* 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 Student (or legal guardian if student is under 18)


This address will be used for TSS Member Portal creation!


One of the most important services you have is TSS 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


Middle Initial


* 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


Middle Initial


* 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


Middle Initial


* 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. You consent to the use and disclosure of your personally identifiable information, including sensitive health information, and other information in accordance with the Privacy Policies of both the Global Benefits Group, Inc., including SHIP LTD and its other affiliates and Crum & Forster, SPC. 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 https://www.gbg.com/privacy-policy and cfins.com/terms.
  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. Privacy Statement. We know that privacy is important to you and we strive to protect the confidentiality of non-public personal information. We do not disclose any non-public personal information about insureds or former insureds to anyone, except as permitted or required by law. We maintain appropriate physical, electronic and procedural safeguards to ensure the security of non-public personal information. You may obtain a detailed copy of our privacy policy by visiting us at https://www.gbg.com/privacy-policy.
  5. Data Protection. Please note that sensitive health and other information that is provided to us may be used by us, our representatives, the insurers and industry governing bodies and regulators to process the insurance, handle claims and prevent fraud. This may involve transferring information to other countries (some of which may have limited, or no data protection laws). We have taken steps to ensure the information is held securely. Where sensitive personal information relates to anyone other than you, you must obtain the explicit consent of the person to whom the information relates, both to the disclosure of such information to us and its use as set out above. Information we hold will not be shared with third parties for marketing purposes. You have the right to access your personal records.
  6. 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.

I declare that all the information provided by me is true and correct to the best of my knowledge. I understand that giving false information may affect my ability to receive services. I also understand that I may only cancel my insurance in the event the student waiver option is not accepted as a substitute for a school sponsored plan at my school of choice and/or my program is terminated.

I consent and agree to the above Terms and Conditions and acknowledge receipt of the subscription agreement.

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

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Thank You For Your Purchase!

Click to view printer friendly receipt
Order Number:
The payment transaction details for your purchase are below. Please make sure to keep a copy, for your records.
Amount Paid (USD):
Payment Method:
Authorization #:
Policy purchase is non-refundable
ID Card:
Please wait until you have received an email confirmation that your enrollment has been processed, then proceed with the instructions below.
To obtain your Member Identification Card and policy documents, please visit https://memberlogin.tssadminsolutions.com Member Login page and register your new account for the Member Portal. You can also use the MyTSS app to access your electronic Member ID card.

Download MyTSS now from the App Store or Google Play.