Secure Server Online Forms for Visitors Insurance

  • Step 1

    Complete India Network Membership Form

    After Completing the membership form, proceed to STEP 2 to complete insurance form

  • Step 2

    Complete one of the following Insurance Enrollment Forms.

  • How to Renew ACE/AXIS Health Insurance Plans - Renewal Instructions

  • ACE Claim Forms:

    Insured must complete the first page of claim form (according to policy number) and file with Administrative Concepts, Inc. (ACI) directly or along with provider office. A notarized affidavit duly signed by visitor to authorize US person to discuss claim status/questions with Administrative Concepts, Inc. (ACI).

    India Network Printable PDF Forms

    Insurance Applications for Print and Faxing

    Membership Forms

    Membership (pdf) -  Membership (doc)

    Insurance Enrollment Form

    Insurance (pdf) -  Insurance (doc)

    Insurance ReEnrollment Form

    Reenrollment (pdf)  - Reenrollment (doc)

    Print the required form(s) and mail the completed documents to:
    India Network Services
    7065 Westpointe Blvd, Suite 209
    Orlando, FL 32835-8758

    Include (2) checks. One for Insurance Premium to India Network Services and one for
    $10 membership fee payable to 'India Network Foundation' or Fax Completed Forms to 407-479-3289

    Applicable only if cancellation occurs before start date of coverage.

    Cancellation Form (pdf)

    Insurance Enrollment Essentials

    No cancellation or refund is available on or after effective date of insurance.

    India Network Foundation membership must be active in order to enroll. The $10 membership fee is not cancellable or refundable and is good for one year

    Rates based on total days times Daily Rate. Daily Rate based on monthly premium divided by 30 days.

    Couple rates are calculated based on the individual rate multiplied times 2 individuals.

    The member’s date of birth and passport are requested entries during enrollment process. Medical records are not required.

    Accident and Sickness coverage applies while visiting the US.

    Call (407)243-8760 if you have questions regarding enrollment.