www.imglobal.com Open in urlscan Pro
3.219.40.176  Public Scan

Submitted URL: http://www.imglobal.com/
Effective URL: https://www.imglobal.com/
Submission: On December 07 via api from US — Scanned from DE

Form analysis 5 forms found in the DOM

Name: coverageDurationForm

<form class="quote_dropdown ng-pristine ng-valid" name="coverageDurationForm" ng-submit="changeStep(3)" novalidate="">
  <div class="quote_dropdown__inner cf">
    <div class="calendar_box">
      <div uib-datepicker-popup-wrap="" ng-model="date" ng-change="dateSelection(date)" template-url="uib/template/datepickerPopup/popup.html" class="ng-pristine ng-untouched ng-valid ng-scope ng-empty" aria-invalid="false"><!-- ngIf: isOpen -->
      </div>
      <div uib-datepicker-popup-wrap="" ng-model="date" ng-change="dateSelection(date)" template-url="uib/template/datepickerPopup/popup.html" class="ng-pristine ng-untouched ng-valid ng-scope ng-empty" aria-invalid="false"><!-- ngIf: isOpen -->
      </div>
    </div>
    <div class="quote_dropdown__footer cf"><!-- ngIf: $parent.quoteForm.coverageDuration.$valid && duration > 1 -->
      <div class="quote_dropdown__footer_right">
        <a href="/travel-medical-insurance/patriot-multi-trip/" class="display__block"><div class="title ng-binding">Taking Multiple Trips Throughout The Year?</div><div class="sub_title ng-binding">View our Multi-Trip Coverage Options</div></a>
      </div>
    </div>
  </div>
  <div class="quote_item_submit btn_submit_footer mobile_quote_submit ng-hide" ng-class="{'active' : $parent.quoteForm.$valid}" ng-show="$parent.quoteForm.$valid" aria-hidden="true">
    <div class="quote_item__inner">
      <div class="button_padding_box_bottom"><button class="btn_raised btn_orange btn_block_ui_loader md-button md-ink-ripple" type="button" ng-transclude="" ng-click="$parent.seePrices($parent.quoteForm)"><span class="text ng-binding ng-scope">Get
            Quote</span></button></div>
    </div>
  </div>
</form>

Name: coverageAreaForm

<form name="coverageAreaForm" ng-submit="vm.changeStep(3)" novalidate="" class="ng-pristine ng-invalid ng-invalid-required">
  <div class="quote_dropdown" ng-class="{'where_365' : vm.duration > 364, 'where_1-364' : vm.duration <= 364 &amp;&amp; vm.duration >= 1}"><!-- ngIf: vm.showUsaQuestion -->
    <div class="inner_box inner_box_top ng-scope" ng-if="vm.showUsaQuestion"><label class="question_label"><!-- ngIf: vm.isTravelPlan --><!-- ngIf: !vm.plan --><span ng-if="!vm.plan" class="ng-binding ng-scope">Do you need coverage in the
          USA?</span><!-- end ngIf: !vm.plan -->
        <help name="DoYouNeedCoverageInUSA" fullscreen="true" tooltip="true" class="ng-isolate-scope">
          <!-- ngIf: tooltip --><a ng-if="tooltip" class="helper_tooltip zmdi zmdi-help-outline ng-scope" ng-click="openHelpModal($event)"><ng-transclude></ng-transclude></a><!-- end ngIf: tooltip --><!-- ngIf: modal --><!-- ngIf: texthelp --></help>
      </label>
      <div class="form_item no_padding__all">
        <div class="radio_group horizontal no_padding__all"><md-radio-group name="coverageInUS" ng-model="vm.quote.coverageInUS" ng-required="true" ng-change="vm.selectUSCoverage(vm.quote)"
            class="ng-pristine ng-untouched _md ng-empty ng-invalid ng-invalid-required" role="radiogroup" tabindex="0" aria-required="true" required="required" aria-invalid="true">
            <div class="row_box cf"><!-- ngRepeat: opt in vm.coverageInUsOpts --><md-radio-button ng-repeat="opt in vm.coverageInUsOpts" md-no-ink="" ng-value="opt.value" aria-label="Yes" class="ng-scope" id="radio_1" role="radio"
                aria-checked="false" value="yes" style="">
                <div class="md-container" md-ink-ripple="" md-ink-ripple-checkbox="">
                  <div class="md-off"></div>
                  <div class="md-on"></div>
                </div>
                <div ng-transclude="" class="md-label">Yes</div>
              </md-radio-button><!-- end ngRepeat: opt in vm.coverageInUsOpts --><md-radio-button ng-repeat="opt in vm.coverageInUsOpts" md-no-ink="" ng-value="opt.value" aria-label="No" class="ng-scope" id="radio_2" role="radio" aria-checked="false"
                value="no">
                <div class="md-container" md-ink-ripple="" md-ink-ripple-checkbox="">
                  <div class="md-off"></div>
                  <div class="md-on"></div>
                </div>
                <div ng-transclude="" class="md-label">No</div>
              </md-radio-button><!-- end ngRepeat: opt in vm.coverageInUsOpts --></div>
            <p ng-show="vm.quoteForm.coverageInUS.$error.required" class="alert-danger ng-binding ng-hide" aria-hidden="true">You must select if you need coverage in the USA</p>
          </md-radio-group></div>
      </div>
    </div><!-- end ngIf: vm.showUsaQuestion -->
    <div class="perfect_scrollbar__parent" style="height: 100%; width: 100%;">
      <div class="perfect_scrollbar__wrapper ps-container ps-theme-default" update="update" data-ps-id="b8b2eb15-5752-c5b7-d58c-aad8c103bbc7">
        <div ng-transclude="">
          <div class="perfect_scrollbar__content_wrapper_box moved_for_desktop"><!-- ngIf: !vm.showUsaQuestion || vm.quote.coverageInUS == 'no' --></div>
        </div>
        <div class="ps-scrollbar-x-rail" style="left: 0px; bottom: 3px;">
          <div class="ps-scrollbar-x" tabindex="0" style="left: 0px; width: 0px;"></div>
        </div>
        <div class="ps-scrollbar-y-rail" style="top: 0px; right: 3px;">
          <div class="ps-scrollbar-y" tabindex="0" style="top: 0px; height: 0px;"></div>
        </div>
      </div>
      <div class="perfect_scrollbar__no_scroll_box">
        <div class="perfect_scrollbar__no_scroll_box__inner_box"></div>
      </div>
    </div>
    <div class="inner_box control_box__main no_padding__top cf">
      <help name="MultipleCountriesOrCruise" fullscreen="true" tooltip="true" class="helper_text ng-isolate-scope">
        <!-- ngIf: tooltip --><a ng-if="tooltip" class="helper_tooltip zmdi zmdi-help-outline ng-scope" ng-click="openHelpModal($event)"><ng-transclude>What if I need coverage in multiple countries or on a cruise?</ng-transclude></a><!-- end ngIf: tooltip --><!-- ngIf: modal --><!-- ngIf: texthelp -->
      </help>
    </div>
    <div class="quote_item_submit btn_submit_footer mobile_quote_submit ng-hide" ng-class="{'active' : vm.quoteForm.$valid}" ng-show="vm.quoteForm.$valid" aria-hidden="true">
      <div class="quote_item__inner">
        <div class="button_padding_box_bottom"><button class="btn_raised btn_orange btn_block_ui_loader md-button md-ink-ripple" type="button" ng-transclude="" ng-click="vm.seePrices(vm.quoteForm)"><span class="text ng-binding ng-scope">Get
              Quote</span></button></div>
      </div>
    </div>
  </div>
</form>

Name: coverageAmountForm

<form class="quote_dropdown ng-pristine ng-valid-max ng-invalid ng-invalid-required" name="coverageAmountForm" ng-init="parent = $parent" ng-submit="changeStep(4)" novalidate="">
  <div class="form_item no_padding__all">
    <div class="perfect_scrollbar__parent" style="height: 100%; width: 100%;">
      <div class="perfect_scrollbar__wrapper ps-container ps-theme-default" update="update" data-ps-id="299c1325-f29e-8bb3-1735-afc72a2b8374">
        <div ng-transclude="">
          <div class="perfect_scrollbar__content_wrapper_box moved_for_desktop">
            <div class="inner_box inner_box_bottom scroll_box ng-scope">
              <div class="family_box_set">
                <family class="tag_reset global ng-isolate-scope" countries="countries" coverage-amount-form="coverageAmountForm" genders="genders" plan="plan" provinces="provinces" quote="quote" states="states">
                  <!-- ngRepeat: family in vm.quote.families -->
                  <div class="family_box ng-scope" ng-repeat="family in vm.quote.families"><!-- ngRepeat: traveler in family.travelers -->
                    <div class="family_box_item cf ng-scope" ng-repeat="traveler in family.travelers">
                      <div ng-class="{'family_include_box' : (family.hasChildren || family.hasSpouse) &amp;&amp; traveler.travelerType > 1}"><span class="bg_small top"></span> <span class="bg_large middle"></span> <span
                          class="bg_small bottom"></span>
                        <div class="family_item family_item_primary" ng-class="{'family_item_primary': traveler.travelerType === 1}">
                          <div class="family_item_inner">
                            <div class="header" ng-switch="traveler.travelerType"><!-- ngSwitchWhen: 1 -->
                              <div ng-switch-when="1" class="ng-binding ng-scope">Primary Insured <!-- ngIf: vm.quote.families.length > 1 --><button
                                  class="btn_fab__remove_btn md-fab btn_fab__outline btn_icon__red btn_fab md-button md-ink-ripple ng-hide" type="button" ng-transclude="" ng-show="vm.showRemoveFamily(traveler, vm.quote, family)"
                                  ng-click="vm.removeFamily(vm.quote.families.indexOf(family), vm.quote.families)" aria-label="Remove" md-labeled-by-tooltip="md-tooltip-0" aria-hidden="true"><span
                                    class="icon zmdi zmdi-delete ng-scope"></span></button></div><!-- end ngSwitchWhen: --><!-- ngSwitchWhen: 2 --><!-- ngSwitchWhen: 3 -->
                            </div>
                            <traveler traveler="traveler" quote="vm.quote" plan="vm.plan" coverage-amount-form="vm.coverageAmountForm" countries="vm.countries" genders="vm.genders" states="vm.states" provinces="vm.provinces" class="ng-isolate-scope">
                              <div class="form_row_box">
                                <div class="form_row cf">
                                  <div class="input_item_box col-lg-2 col-xs-12" ng-class="{
                'col-lg-3': vm.isGlobalPlan || vm.isTripPlan,
                'error error_tooltip_open submitted' : vm.coverageAmountForm.age_452476.$invalid &amp;&amp; vm.quote.submitted,
                'error error_tooltip_open' : vm.coverageAmountForm.age_452476.$invalid &amp;&amp; vm.coverageAmountForm.age_452476.$dirty,
                'complete' : vm.coverageAmountForm.age_452476.$valid }">
                                    <div class="input_label"><span class="text ng-binding">Age</span></div>
                                    <div class="input_item"><md-input-container md-no-float="" class="md-block md-input-has-placeholder md-input-invalid"><input id="age_452476" type="number" inputmode="decimal" name="age_452476" placeholder="--"
                                          ng-model="vm.traveler.age" ng-model-options="{debounce: 250}" ng-required="true" oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');"
                                          onkeydown="if(this.value.length==3 &amp;&amp; event.keyCode!=8) return false;" ng-max="120" class="ng-pristine md-input ng-empty ng-valid-max ng-invalid ng-invalid-required placeholder ng-touched"
                                          required="required" aria-invalid="true" style="">
                                        <div class="md-errors-spacer"></div> <span class="validation_icon"></span>
                                      </md-input-container></div>
                                  </div><!-- ngIf: !vm.isTripPlan -->
                                  <div class="input_item_box col-lg-2 col-xs-12 ng-scope" ng-if="!vm.isTripPlan" ng-class="{
                'col-lg-3': vm.isGlobalPlan,
                'error error_tooltip_open submitted' : vm.coverageAmountForm.gender_452476.$invalid &amp;&amp; vm.quote.submitted,
                'error error_tooltip_open' : vm.coverageAmountForm.gender_452476.$invalid &amp;&amp; vm.coverageAmountForm.gender_452476.$dirty,
                'complete' : vm.coverageAmountForm.gender_452476.$valid  }">
                                    <div class="input_label"><span class="text ng-binding">Gender</span></div>
                                    <div class="input_item"><select ui-select2="{ placeholder: '--', minimumResultsForSearch: 20}" ng-model="vm.traveler.gender" id="gender_452476" name="gender_452476" ng-required="true"
                                        ng-options="gender as gender.text for gender in vm.genders track by gender.value" class="ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required select2-hidden-accessible" required="required"
                                        aria-invalid="true" tabindex="-1" aria-hidden="true" style="">
                                        <option value="" class="" selected="selected">--</option>
                                        <option label="Male" value="2">Male</option>
                                        <option label="Female" value="1">Female</option>
                                      </select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: auto;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
                                            aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-gender_452476-container"><span class="select2-selection__rendered" id="select2-gender_452476-container"><span
                                                class="select2-selection__placeholder">--</span></span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper"
                                          aria-hidden="true"></span></span><span class="validation_icon"></span></div>
                                  </div><!-- end ngIf: !vm.isTripPlan -->
                                  <div class="input_item_box col-xs-12 col-lg-4" ng-class="{
                    'col-lg-3': vm.traveler.residence.value == 'USA' || vm.traveler.residence.value == 'CAN', 
                    'col-lg-4': vm.traveler.residence.value != 'USA' &amp;&amp; vm.traveler.residence.value != 'CAN',
                    'col-lg-6': vm.isGlobalPlan,
                    'error error_tooltip_open submitted': vm.coverageAmountForm.citizenship_452476.$invalid &amp;&amp; vm.quote.submitted,
                    'error error_tooltip_open': vm.coverageAmountForm.citizenship_452476.$invalid &amp;&amp; vm.coverageAmountForm.citizenship_452476.$dirty,
                    'complete' : vm.coverageAmountForm.citizenship_452476.$valid }">
                                    <div class="input_label"><span class="text ng-binding">Citizenship<help name="Citizenship" fullscreen="true" tooltip="true" class="ng-isolate-scope">
                                          <!-- ngIf: tooltip --><a ng-if="tooltip" class="helper_tooltip zmdi zmdi-help-outline ng-scope" ng-click="openHelpModal($event)"><ng-transclude></ng-transclude></a><!-- end ngIf: tooltip --><!-- ngIf: modal --><!-- ngIf: texthelp -->
                                        </help></span></div>
                                    <div class="input_item"><select ui-select2="{ placeholder: '--'}" ng-model="vm.traveler.citizenship" id="citizenship_452476" name="citizenship_452476"
                                        ng-options="citizenship as citizenship.text for citizenship in vm.countries | filterCitizenshipCountries track by citizenship.value" ng-required="true"
                                        class="ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required select2-hidden-accessible" required="required" aria-invalid="true" tabindex="-1" aria-hidden="true" style="">
                                        <option value="" class="" selected="selected">--</option>
                                        <option label="United States" value="USA">United States</option>
                                        <option label="United Kingdom of Great Britain and Northern Ireland" value="GBR">United Kingdom of Great Britain and Northern Ireland</option>
                                        <option label="Canada" value="CAN">Canada</option>
                                        <option label="Afghanistan" value="AFG">Afghanistan</option>
                                        <option label="Aland Islands" value="ALA">Aland Islands</option>
                                        <option label="Albania" value="ALB">Albania</option>
                                        <option label="Algeria" value="DZA">Algeria</option>
                                        <option label="Andorra" value="AND">Andorra</option>
                                        <option label="Angola" value="AGO">Angola</option>
                                        <option label="Anguilla" value="AIA">Anguilla</option>
                                        <option label="Antarctica" value="ATA">Antarctica</option>
                                        <option label="Antigua And Barbuda" value="ATG">Antigua And Barbuda</option>
                                        <option label="Argentina" value="ARG">Argentina</option>
                                        <option label="Armenia" value="ARM">Armenia</option>
                                        <option label="Aruba" value="ABW">Aruba</option>
                                        <option label="Australia" value="AUS">Australia</option>
                                        <option label="Austria" value="AUT">Austria</option>
                                        <option label="Azerbaijan" value="AZE">Azerbaijan</option>
                                        <option label="Bahamas" value="BHS">Bahamas</option>
                                        <option label="Bahrain" value="BHR">Bahrain</option>
                                        <option label="Bangladesh" value="BGD">Bangladesh</option>
                                        <option label="Barbados" value="BRB">Barbados</option>
                                        <option label="Belarus" value="BLR">Belarus</option>
                                        <option label="Belgium" value="BEL">Belgium</option>
                                        <option label="Belize" value="BLZ">Belize</option>
                                        <option label="Benin" value="BEN">Benin</option>
                                        <option label="Bermuda" value="BMU">Bermuda</option>
                                        <option label="Bhutan" value="BTN">Bhutan</option>
                                        <option label="Bolivia" value="BOL">Bolivia</option>
                                        <option label="Bonaire, Sint Eustatius And Saba" value="BES">Bonaire, Sint Eustatius And Saba</option>
                                        <option label="Bosnia And Herzegovina" value="BIH">Bosnia And Herzegovina</option>
                                        <option label="Botswana" value="BWA">Botswana</option>
                                        <option label="Bouvet Island" value="BVT">Bouvet Island</option>
                                        <option label="Brazil" value="BRA">Brazil</option>
                                        <option label="British Indian Ocean Territory" value="IOT">British Indian Ocean Territory</option>
                                        <option label="Brunei Darussalam" value="BRN">Brunei Darussalam</option>
                                        <option label="Bulgaria" value="BGR">Bulgaria</option>
                                        <option label="Burkina Faso" value="BFA">Burkina Faso</option>
                                        <option label="Burundi" value="BDI">Burundi</option>
                                        <option label="Cambodia" value="KHM">Cambodia</option>
                                        <option label="Cameroon" value="CMR">Cameroon</option>
                                        <option label="Cape Verde" value="CPV">Cape Verde</option>
                                        <option label="Cayman Islands" value="CYM">Cayman Islands</option>
                                        <option label="Central African Republic" value="CAF">Central African Republic</option>
                                        <option label="Chile" value="CHL">Chile</option>
                                        <option label="China" value="CHN">China</option>
                                        <option label="Christmas Island" value="CXR">Christmas Island</option>
                                        <option label="Cocos (Keeling) Islands" value="CCK">Cocos (Keeling) Islands</option>
                                        <option label="Colombia" value="COL">Colombia</option>
                                        <option label="Comoros" value="COM">Comoros</option>
                                        <option label="Congo" value="COG">Congo</option>
                                        <option label="Congo, The Democratic Republic Of The" value="COD">Congo, The Democratic Republic Of The</option>
                                        <option label="Cook Islands" value="COK">Cook Islands</option>
                                        <option label="Costa Rica" value="CRI">Costa Rica</option>
                                        <option label="Cote D'Ivoire" value="CIV">Cote D'Ivoire</option>
                                        <option label="Croatia" value="HRV">Croatia</option>
                                        <option label="Cuba" value="CUB">Cuba</option>
                                        <option label="Curacao" value="CUW">Curacao</option>
                                        <option label="Cyprus" value="CYP">Cyprus</option>
                                        <option label="Czechia" value="CZE">Czechia</option>
                                        <option label="Denmark" value="DNK">Denmark</option>
                                        <option label="Djibouti" value="DJI">Djibouti</option>
                                        <option label="Dominica" value="DMA">Dominica</option>
                                        <option label="Dominican Republic" value="DOM">Dominican Republic</option>
                                        <option label="Ecuador" value="ECU">Ecuador</option>
                                        <option label="Egypt" value="EGY">Egypt</option>
                                        <option label="El Salvador" value="SLV">El Salvador</option>
                                        <option label="Equatorial Guinea" value="GNQ">Equatorial Guinea</option>
                                        <option label="Eritrea" value="ERI">Eritrea</option>
                                        <option label="Estonia" value="EST">Estonia</option>
                                        <option label="Eswatini" value="SWZ">Eswatini</option>
                                        <option label="Ethiopia" value="ETH">Ethiopia</option>
                                        <option label="Falkland Islands (Malvinas)" value="FLK">Falkland Islands (Malvinas)</option>
                                        <option label="Faroe Islands" value="FRO">Faroe Islands</option>
                                        <option label="Fiji" value="FJI">Fiji</option>
                                        <option label="Finland" value="FIN">Finland</option>
                                        <option label="France" value="FRA">France</option>
                                        <option label="French Guiana" value="GUF">French Guiana</option>
                                        <option label="French Polynesia" value="PYF">French Polynesia</option>
                                        <option label="French Southern Territories" value="ATF">French Southern Territories</option>
                                        <option label="Gabon" value="GAB">Gabon</option>
                                        <option label="Gambia" value="GMB">Gambia</option>
                                        <option label="Georgia" value="GEO">Georgia</option>
                                        <option label="Germany" value="DEU">Germany</option>
                                        <option label="Ghana" value="GHA">Ghana</option>
                                        <option label="Gibraltar" value="GIB">Gibraltar</option>
                                        <option label="Greece" value="GRC">Greece</option>
                                        <option label="Greenland" value="GRL">Greenland</option>
                                        <option label="Grenada" value="GRD">Grenada</option>
                                        <option label="Guadeloupe" value="GLP">Guadeloupe</option>
                                        <option label="Guatemala" value="GTM">Guatemala</option>
                                        <option label="Guernsey" value="GGY">Guernsey</option>
                                        <option label="Guinea" value="GIN">Guinea</option>
                                        <option label="Guinea-Bissau" value="GNB">Guinea-Bissau</option>
                                        <option label="Guyana" value="GUY">Guyana</option>
                                        <option label="Haiti" value="HTI">Haiti</option>
                                        <option label="Heard And Mcdonald Islands" value="HMD">Heard And Mcdonald Islands</option>
                                        <option label="Holy See (Vatican City State)" value="VAT">Holy See (Vatican City State)</option>
                                        <option label="Honduras" value="HND">Honduras</option>
                                        <option label="Hong Kong" value="HKG">Hong Kong</option>
                                        <option label="Hungary" value="HUN">Hungary</option>
                                        <option label="Iceland" value="ISL">Iceland</option>
                                        <option label="India" value="IND">India</option>
                                        <option label="Indonesia" value="IDN">Indonesia</option>
                                        <option label="Iran (Islamic Republic Of)" value="IRN">Iran (Islamic Republic Of)</option>
                                        <option label="Iraq" value="IRQ">Iraq</option>
                                        <option label="Ireland" value="IRL">Ireland</option>
                                        <option label="Isle Of Man" value="IMN">Isle Of Man</option>
                                        <option label="Israel" value="ISR">Israel</option>
                                        <option label="Italy" value="ITA">Italy</option>
                                        <option label="Jamaica" value="JAM">Jamaica</option>
                                        <option label="Japan" value="JPN">Japan</option>
                                        <option label="Jersey" value="JEY">Jersey</option>
                                        <option label="Jordan" value="JOR">Jordan</option>
                                        <option label="Kazakhstan" value="KAZ">Kazakhstan</option>
                                        <option label="Kenya" value="KEN">Kenya</option>
                                        <option label="Kiribati" value="KIR">Kiribati</option>
                                        <option label="Korea, Democratic People's Republic Of" value="PRK">Korea, Democratic People's Republic Of</option>
                                        <option label="Korea, Republic Of" value="KOR">Korea, Republic Of</option>
                                        <option label="Kuwait" value="KWT">Kuwait</option>
                                        <option label="Kyrgyzstan" value="KGZ">Kyrgyzstan</option>
                                        <option label="Lao People's Democratic Republic" value="LAO">Lao People's Democratic Republic</option>
                                        <option label="Latvia" value="LVA">Latvia</option>
                                        <option label="Lebanon" value="LBN">Lebanon</option>
                                        <option label="Lesotho" value="LSO">Lesotho</option>
                                        <option label="Liberia" value="LBR">Liberia</option>
                                        <option label="Libya" value="LBY">Libya</option>
                                        <option label="Liechtenstein" value="LIE">Liechtenstein</option>
                                        <option label="Lithuania" value="LTU">Lithuania</option>
                                        <option label="Luxembourg" value="LUX">Luxembourg</option>
                                        <option label="Macau" value="MAC">Macau</option>
                                        <option label="Madagascar" value="MDG">Madagascar</option>
                                        <option label="Malawi" value="MWI">Malawi</option>
                                        <option label="Malaysia" value="MYS">Malaysia</option>
                                        <option label="Maldives" value="MDV">Maldives</option>
                                        <option label="Mali" value="MLI">Mali</option>
                                        <option label="Malta" value="MLT">Malta</option>
                                        <option label="Marshall Islands" value="MHL">Marshall Islands</option>
                                        <option label="Martinique" value="MTQ">Martinique</option>
                                        <option label="Mauritania" value="MRT">Mauritania</option>
                                        <option label="Mauritius" value="MUS">Mauritius</option>
                                        <option label="Mayotte" value="MYT">Mayotte</option>
                                        <option label="Mexico" value="MEX">Mexico</option>
                                        <option label="Micronesia, Federated States Of" value="FSM">Micronesia, Federated States Of</option>
                                        <option label="Moldova, Republic Of" value="MDA">Moldova, Republic Of</option>
                                        <option label="Monaco" value="MCO">Monaco</option>
                                        <option label="Mongolia" value="MNG">Mongolia</option>
                                        <option label="Montenegro" value="MNE">Montenegro</option>
                                        <option label="Montserrat" value="MSR">Montserrat</option>
                                        <option label="Morocco" value="MAR">Morocco</option>
                                        <option label="Mozambique" value="MOZ">Mozambique</option>
                                        <option label="Myanmar" value="MMR">Myanmar</option>
                                        <option label="Namibia" value="NAM">Namibia</option>
                                        <option label="Nauru" value="NRU">Nauru</option>
                                        <option label="Nepal" value="NPL">Nepal</option>
                                        <option label="Netherlands, The" value="NLD">Netherlands, The</option>
                                        <option label="New Caledonia" value="NCL">New Caledonia</option>
                                        <option label="New Zealand" value="NZL">New Zealand</option>
                                        <option label="Nicaragua" value="NIC">Nicaragua</option>
                                        <option label="Niger" value="NER">Niger</option>
                                        <option label="Nigeria" value="NGA">Nigeria</option>
                                        <option label="Niue" value="NIU">Niue</option>
                                        <option label="Norfolk Island" value="NFK">Norfolk Island</option>
                                        <option label="North Macedonia" value="MKD">North Macedonia</option>
                                        <option label="Norway" value="NOR">Norway</option>
                                        <option label="Oman" value="OMN">Oman</option>
                                        <option label="Pakistan" value="PAK">Pakistan</option>
                                        <option label="Palau" value="PLW">Palau</option>
                                        <option label="Palestine" value="PSE">Palestine</option>
                                        <option label="Panama" value="PAN">Panama</option>
                                        <option label="Papua New Guinea" value="PNG">Papua New Guinea</option>
                                        <option label="Paraguay" value="PRY">Paraguay</option>
                                        <option label="Peru" value="PER">Peru</option>
                                        <option label="Philippines" value="PHL">Philippines</option>
                                        <option label="Pitcairn" value="PCN">Pitcairn</option>
                                        <option label="Poland" value="POL">Poland</option>
                                        <option label="Portugal" value="PRT">Portugal</option>
                                        <option label="Qatar" value="QAT">Qatar</option>
                                        <option label="Reunion" value="REU">Reunion</option>
                                        <option label="Romania" value="ROU">Romania</option>
                                        <option label="Russia" value="RUS">Russia</option>
                                        <option label="Rwanda" value="RWA">Rwanda</option>
                                        <option label="Saint Barthélemy" value="BLM">Saint Barthélemy</option>
                                        <option label="Saint Helena, Ascension And Tristan Da Cunha" value="SHN">Saint Helena, Ascension And Tristan Da Cunha</option>
                                        <option label="Saint Kitts And Nevis" value="KNA">Saint Kitts And Nevis</option>
                                        <option label="Saint Lucia" value="LCA">Saint Lucia</option>
                                        <option label="Saint Martin" value="MAF">Saint Martin</option>
                                        <option label="Saint Vincent And The Grenadines" value="VCT">Saint Vincent And The Grenadines</option>
                                        <option label="Samoa" value="WSM">Samoa</option>
                                        <option label="San Marino" value="SMR">San Marino</option>
                                        <option label="Sao Tome And Príncipe" value="STP">Sao Tome And Príncipe</option>
                                        <option label="Saudi Arabia" value="SAU">Saudi Arabia</option>
                                        <option label="Senegal" value="SEN">Senegal</option>
                                        <option label="Serbia" value="SRB">Serbia</option>
                                        <option label="Seychelles" value="SYC">Seychelles</option>
                                        <option label="Sierra Leone" value="SLE">Sierra Leone</option>
                                        <option label="Singapore" value="SGP">Singapore</option>
                                        <option label="Sint Maarten (Dutch Part)" value="SXM">Sint Maarten (Dutch Part)</option>
                                        <option label="Slovakia" value="SVK">Slovakia</option>
                                        <option label="Slovenia" value="SVN">Slovenia</option>
                                        <option label="Solomon Islands" value="SLB">Solomon Islands</option>
                                        <option label="Somalia" value="SOM">Somalia</option>
                                        <option label="South Africa" value="ZAF">South Africa</option>
                                        <option label="South Georgia And The South Sandwich Islands" value="SGS">South Georgia And The South Sandwich Islands</option>
                                        <option label="South Sudan" value="SSD">South Sudan</option>
                                        <option label="Spain" value="ESP">Spain</option>
                                        <option label="Sri Lanka" value="LKA">Sri Lanka</option>
                                        <option label="St. Pierre And Miquelon" value="SPM">St. Pierre And Miquelon</option>
                                        <option label="Sudan" value="SDN">Sudan</option>
                                        <option label="Suriname" value="SUR">Suriname</option>
                                        <option label="Svalbard And Jan Mayen Islands" value="SJM">Svalbard And Jan Mayen Islands</option>
                                        <option label="Sweden" value="SWE">Sweden</option>
                                        <option label="Switzerland" value="CHE">Switzerland</option>
                                        <option label="Syrian Arab Republic" value="SYR">Syrian Arab Republic</option>
                                        <option label="Taiwan" value="TWN">Taiwan</option>
                                        <option label="Tajikistan" value="TJK">Tajikistan</option>
                                        <option label="Tanzania, United Republic Of" value="TZA">Tanzania, United Republic Of</option>
                                        <option label="Thailand" value="THA">Thailand</option>
                                        <option label="Timor-Leste" value="TLS">Timor-Leste</option>
                                        <option label="Togo" value="TGO">Togo</option>
                                        <option label="Tokelau" value="TKL">Tokelau</option>
                                        <option label="Tonga" value="TON">Tonga</option>
                                        <option label="Trinidad And Tobago" value="TTO">Trinidad And Tobago</option>
                                        <option label="Tunisia" value="TUN">Tunisia</option>
                                        <option label="Turkey" value="TUR">Turkey</option>
                                        <option label="Turkmenistan" value="TKM">Turkmenistan</option>
                                        <option label="Turks And Caicos Islands" value="TCA">Turks And Caicos Islands</option>
                                        <option label="Tuvalu" value="TUV">Tuvalu</option>
                                        <option label="Uganda" value="UGA">Uganda</option>
                                        <option label="Ukraine" value="UKR">Ukraine</option>
                                        <option label="United Arab Emirates" value="ARE">United Arab Emirates</option>
                                        <option label="Uruguay" value="URY">Uruguay</option>
                                        <option label="Uzbekistan" value="UZB">Uzbekistan</option>
                                        <option label="Vanuatu" value="VUT">Vanuatu</option>
                                        <option label="Venezuela" value="VEN">Venezuela</option>
                                        <option label="Vietnam" value="VNM">Vietnam</option>
                                        <option label="Virgin Islands (British)" value="VGB">Virgin Islands (British)</option>
                                        <option label="Wallis And Futuna Islands" value="WLF">Wallis And Futuna Islands</option>
                                        <option label="Western Sahara" value="ESH">Western Sahara</option>
                                        <option label="Yemen" value="YEM">Yemen</option>
                                        <option label="Zambia" value="ZMB">Zambia</option>
                                        <option label="Zimbabwe" value="ZWE">Zimbabwe</option>
                                      </select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: auto;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
                                            aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-citizenship_452476-container"><span class="select2-selection__rendered" id="select2-citizenship_452476-container"><span
                                                class="select2-selection__placeholder">--</span></span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper"
                                          aria-hidden="true"></span></span><span class="validation_icon"></span></div>
                                  </div><!-- ngIf: !vm.isGlobalPlan -->
                                  <div class="input_item_box col-xs-12 ng-scope col-lg-4" ng-class="{
                    'col-lg-3': vm.traveler.residence.value == 'USA' || vm.traveler.residence.value == 'CAN',
                    'col-lg-4': vm.traveler.residence.value != 'USA' &amp;&amp; vm.traveler.residence.value != 'CAN',
                    'error error_tooltip_open submitted': vm.coverageAmountForm.residence_452476.$invalid &amp;&amp; vm.quote.submitted,
                    'error error_tooltip_open': vm.coverageAmountForm.residence_452476.$invalid &amp;&amp; vm.coverageAmountForm.residence_452476.$dirty,
                    'complete' : vm.coverageAmountForm.residence_452476.$valid }" ng-if="!vm.isGlobalPlan">
                                    <div class="input_label"><span class="text ng-binding">Residence<help name="Residence" fullscreen="true" tooltip="true" class="ng-isolate-scope">
                                          <!-- ngIf: tooltip --><a ng-if="tooltip" class="helper_tooltip zmdi zmdi-help-outline ng-scope" ng-click="openHelpModal($event)"><ng-transclude></ng-transclude></a><!-- end ngIf: tooltip --><!-- ngIf: modal --><!-- ngIf: texthelp -->
                                        </help></span></div>
                                    <div class="input_item"><select ui-select2="{ placeholder: '--'}" ng-model="vm.traveler.residence" id="residence_452476" name="residence_452476" ng-required="true"
                                        ng-options="residence.text for residence in vm.countries | filterResidenceCountries track by residence.value" ng-change="vm.clearState(vm.traveler)"
                                        class="ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required select2-hidden-accessible" required="required" aria-invalid="true" tabindex="-1" aria-hidden="true" style="">
                                        <option value="" class="" selected="selected">--</option>
                                        <option label="United States" value="USA">United States</option>
                                        <option label="United Kingdom of Great Britain and Northern Ireland" value="GBR">United Kingdom of Great Britain and Northern Ireland</option>
                                        <option label="Canada" value="CAN">Canada</option>
                                        <option label="Afghanistan" value="AFG">Afghanistan</option>
                                        <option label="Aland Islands" value="ALA">Aland Islands</option>
                                        <option label="Albania" value="ALB">Albania</option>
                                        <option label="Algeria" value="DZA">Algeria</option>
                                        <option label="American Samoa" value="ASM">American Samoa</option>
                                        <option label="Andorra" value="AND">Andorra</option>
                                        <option label="Angola" value="AGO">Angola</option>
                                        <option label="Anguilla" value="AIA">Anguilla</option>
                                        <option label="Antarctica" value="ATA">Antarctica</option>
                                        <option label="Antigua And Barbuda" value="ATG">Antigua And Barbuda</option>
                                        <option label="Argentina" value="ARG">Argentina</option>
                                        <option label="Armenia" value="ARM">Armenia</option>
                                        <option label="Aruba" value="ABW">Aruba</option>
                                        <option label="Australia" value="AUS">Australia</option>
                                        <option label="Austria" value="AUT">Austria</option>
                                        <option label="Azerbaijan" value="AZE">Azerbaijan</option>
                                        <option label="Bahamas" value="BHS">Bahamas</option>
                                        <option label="Bahrain" value="BHR">Bahrain</option>
                                        <option label="Bangladesh" value="BGD">Bangladesh</option>
                                        <option label="Barbados" value="BRB">Barbados</option>
                                        <option label="Belarus" value="BLR">Belarus</option>
                                        <option label="Belgium" value="BEL">Belgium</option>
                                        <option label="Belize" value="BLZ">Belize</option>
                                        <option label="Benin" value="BEN">Benin</option>
                                        <option label="Bermuda" value="BMU">Bermuda</option>
                                        <option label="Bhutan" value="BTN">Bhutan</option>
                                        <option label="Bolivia" value="BOL">Bolivia</option>
                                        <option label="Bonaire, Sint Eustatius And Saba" value="BES">Bonaire, Sint Eustatius And Saba</option>
                                        <option label="Bosnia And Herzegovina" value="BIH">Bosnia And Herzegovina</option>
                                        <option label="Botswana" value="BWA">Botswana</option>
                                        <option label="Bouvet Island" value="BVT">Bouvet Island</option>
                                        <option label="Brazil" value="BRA">Brazil</option>
                                        <option label="British Indian Ocean Territory" value="IOT">British Indian Ocean Territory</option>
                                        <option label="Brunei Darussalam" value="BRN">Brunei Darussalam</option>
                                        <option label="Bulgaria" value="BGR">Bulgaria</option>
                                        <option label="Burkina Faso" value="BFA">Burkina Faso</option>
                                        <option label="Burundi" value="BDI">Burundi</option>
                                        <option label="Cambodia" value="KHM">Cambodia</option>
                                        <option label="Cameroon" value="CMR">Cameroon</option>
                                        <option label="Cape Verde" value="CPV">Cape Verde</option>
                                        <option label="Cayman Islands" value="CYM">Cayman Islands</option>
                                        <option label="Central African Republic" value="CAF">Central African Republic</option>
                                        <option label="Chile" value="CHL">Chile</option>
                                        <option label="China" value="CHN">China</option>
                                        <option label="Christmas Island" value="CXR">Christmas Island</option>
                                        <option label="Cocos (Keeling) Islands" value="CCK">Cocos (Keeling) Islands</option>
                                        <option label="Colombia" value="COL">Colombia</option>
                                        <option label="Comoros" value="COM">Comoros</option>
                                        <option label="Congo" value="COG">Congo</option>
                                        <option label="Congo, The Democratic Republic Of The" value="COD">Congo, The Democratic Republic Of The</option>
                                        <option label="Cook Islands" value="COK">Cook Islands</option>
                                        <option label="Costa Rica" value="CRI">Costa Rica</option>
                                        <option label="Cote D'Ivoire" value="CIV">Cote D'Ivoire</option>
                                        <option label="Croatia" value="HRV">Croatia</option>
                                        <option label="Curacao" value="CUW">Curacao</option>
                                        <option label="Cyprus" value="CYP">Cyprus</option>
                                        <option label="Czechia" value="CZE">Czechia</option>
                                        <option label="Denmark" value="DNK">Denmark</option>
                                        <option label="Djibouti" value="DJI">Djibouti</option>
                                        <option label="Dominica" value="DMA">Dominica</option>
                                        <option label="Dominican Republic" value="DOM">Dominican Republic</option>
                                        <option label="Ecuador" value="ECU">Ecuador</option>
                                        <option label="Egypt" value="EGY">Egypt</option>
                                        <option label="El Salvador" value="SLV">El Salvador</option>
                                        <option label="Equatorial Guinea" value="GNQ">Equatorial Guinea</option>
                                        <option label="Eritrea" value="ERI">Eritrea</option>
                                        <option label="Estonia" value="EST">Estonia</option>
                                        <option label="Eswatini" value="SWZ">Eswatini</option>
                                        <option label="Ethiopia" value="ETH">Ethiopia</option>
                                        <option label="Falkland Islands (Malvinas)" value="FLK">Falkland Islands (Malvinas)</option>
                                        <option label="Faroe Islands" value="FRO">Faroe Islands</option>
                                        <option label="Fiji" value="FJI">Fiji</option>
                                        <option label="Finland" value="FIN">Finland</option>
                                        <option label="France" value="FRA">France</option>
                                        <option label="French Guiana" value="GUF">French Guiana</option>
                                        <option label="French Polynesia" value="PYF">French Polynesia</option>
                                        <option label="French Southern Territories" value="ATF">French Southern Territories</option>
                                        <option label="Gabon" value="GAB">Gabon</option>
                                        <option label="Gambia" value="GMB">Gambia</option>
                                        <option label="Georgia" value="GEO">Georgia</option>
                                        <option label="Germany" value="DEU">Germany</option>
                                        <option label="Ghana" value="GHA">Ghana</option>
                                        <option label="Gibraltar" value="GIB">Gibraltar</option>
                                        <option label="Greece" value="GRC">Greece</option>
                                        <option label="Greenland" value="GRL">Greenland</option>
                                        <option label="Grenada" value="GRD">Grenada</option>
                                        <option label="Guadeloupe" value="GLP">Guadeloupe</option>
                                        <option label="Guam" value="GUM">Guam</option>
                                        <option label="Guatemala" value="GTM">Guatemala</option>
                                        <option label="Guernsey" value="GGY">Guernsey</option>
                                        <option label="Guinea" value="GIN">Guinea</option>
                                        <option label="Guinea-Bissau" value="GNB">Guinea-Bissau</option>
                                        <option label="Guyana" value="GUY">Guyana</option>
                                        <option label="Haiti" value="HTI">Haiti</option>
                                        <option label="Heard And Mcdonald Islands" value="HMD">Heard And Mcdonald Islands</option>
                                        <option label="Holy See (Vatican City State)" value="VAT">Holy See (Vatican City State)</option>
                                        <option label="Honduras" value="HND">Honduras</option>
                                        <option label="Hong Kong" value="HKG">Hong Kong</option>
                                        <option label="Hungary" value="HUN">Hungary</option>
                                        <option label="Iceland" value="ISL">Iceland</option>
                                        <option label="India" value="IND">India</option>
                                        <option label="Indonesia" value="IDN">Indonesia</option>
                                        <option label="Iraq" value="IRQ">Iraq</option>
                                        <option label="Ireland" value="IRL">Ireland</option>
                                        <option label="Isle Of Man" value="IMN">Isle Of Man</option>
                                        <option label="Israel" value="ISR">Israel</option>
                                        <option label="Italy" value="ITA">Italy</option>
                                        <option label="Jamaica" value="JAM">Jamaica</option>
                                        <option label="Japan" value="JPN">Japan</option>
                                        <option label="Jersey" value="JEY">Jersey</option>
                                        <option label="Jordan" value="JOR">Jordan</option>
                                        <option label="Kazakhstan" value="KAZ">Kazakhstan</option>
                                        <option label="Kenya" value="KEN">Kenya</option>
                                        <option label="Kiribati" value="KIR">Kiribati</option>
                                        <option label="Korea, Republic Of" value="KOR">Korea, Republic Of</option>
                                        <option label="Kuwait" value="KWT">Kuwait</option>
                                        <option label="Kyrgyzstan" value="KGZ">Kyrgyzstan</option>
                                        <option label="Lao People's Democratic Republic" value="LAO">Lao People's Democratic Republic</option>
                                        <option label="Latvia" value="LVA">Latvia</option>
                                        <option label="Lebanon" value="LBN">Lebanon</option>
                                        <option label="Lesotho" value="LSO">Lesotho</option>
                                        <option label="Liberia" value="LBR">Liberia</option>
                                        <option label="Libya" value="LBY">Libya</option>
                                        <option label="Liechtenstein" value="LIE">Liechtenstein</option>
                                        <option label="Lithuania" value="LTU">Lithuania</option>
                                        <option label="Luxembourg" value="LUX">Luxembourg</option>
                                        <option label="Macau" value="MAC">Macau</option>
                                        <option label="Madagascar" value="MDG">Madagascar</option>
                                        <option label="Malawi" value="MWI">Malawi</option>
                                        <option label="Malaysia" value="MYS">Malaysia</option>
                                        <option label="Maldives" value="MDV">Maldives</option>
                                        <option label="Mali" value="MLI">Mali</option>
                                        <option label="Malta" value="MLT">Malta</option>
                                        <option label="Marshall Islands" value="MHL">Marshall Islands</option>
                                        <option label="Martinique" value="MTQ">Martinique</option>
                                        <option label="Mauritania" value="MRT">Mauritania</option>
                                        <option label="Mauritius" value="MUS">Mauritius</option>
                                        <option label="Mayotte" value="MYT">Mayotte</option>
                                        <option label="Mexico" value="MEX">Mexico</option>
                                        <option label="Micronesia, Federated States Of" value="FSM">Micronesia, Federated States Of</option>
                                        <option label="Moldova, Republic Of" value="MDA">Moldova, Republic Of</option>
                                        <option label="Monaco" value="MCO">Monaco</option>
                                        <option label="Mongolia" value="MNG">Mongolia</option>
                                        <option label="Montenegro" value="MNE">Montenegro</option>
                                        <option label="Montserrat" value="MSR">Montserrat</option>
                                        <option label="Morocco" value="MAR">Morocco</option>
                                        <option label="Mozambique" value="MOZ">Mozambique</option>
                                        <option label="Myanmar" value="MMR">Myanmar</option>
                                        <option label="Namibia" value="NAM">Namibia</option>
                                        <option label="Nauru" value="NRU">Nauru</option>
                                        <option label="Nepal" value="NPL">Nepal</option>
                                        <option label="Netherlands, The" value="NLD">Netherlands, The</option>
                                        <option label="New Caledonia" value="NCL">New Caledonia</option>
                                        <option label="New Zealand" value="NZL">New Zealand</option>
                                        <option label="Nicaragua" value="NIC">Nicaragua</option>
                                        <option label="Niger" value="NER">Niger</option>
                                        <option label="Nigeria" value="NGA">Nigeria</option>
                                        <option label="Niue" value="NIU">Niue</option>
                                        <option label="Norfolk Island" value="NFK">Norfolk Island</option>
                                        <option label="North Macedonia" value="MKD">North Macedonia</option>
                                        <option label="Northern Mariana Islands" value="MNP">Northern Mariana Islands</option>
                                        <option label="Norway" value="NOR">Norway</option>
                                        <option label="Oman" value="OMN">Oman</option>
                                        <option label="Pakistan" value="PAK">Pakistan</option>
                                        <option label="Palau" value="PLW">Palau</option>
                                        <option label="Palestine" value="PSE">Palestine</option>
                                        <option label="Panama" value="PAN">Panama</option>
                                        <option label="Papua New Guinea" value="PNG">Papua New Guinea</option>
                                        <option label="Paraguay" value="PRY">Paraguay</option>
                                        <option label="Peru" value="PER">Peru</option>
                                        <option label="Philippines" value="PHL">Philippines</option>
                                        <option label="Pitcairn" value="PCN">Pitcairn</option>
                                        <option label="Poland" value="POL">Poland</option>
                                        <option label="Portugal" value="PRT">Portugal</option>
                                        <option label="Puerto Rico" value="PRI">Puerto Rico</option>
                                        <option label="Qatar" value="QAT">Qatar</option>
                                        <option label="Reunion" value="REU">Reunion</option>
                                        <option label="Romania" value="ROU">Romania</option>
                                        <option label="Russia" value="RUS">Russia</option>
                                        <option label="Rwanda" value="RWA">Rwanda</option>
                                        <option label="Saint Barthélemy" value="BLM">Saint Barthélemy</option>
                                        <option label="Saint Helena, Ascension And Tristan Da Cunha" value="SHN">Saint Helena, Ascension And Tristan Da Cunha</option>
                                        <option label="Saint Kitts And Nevis" value="KNA">Saint Kitts And Nevis</option>
                                        <option label="Saint Lucia" value="LCA">Saint Lucia</option>
                                        <option label="Saint Martin" value="MAF">Saint Martin</option>
                                        <option label="Saint Vincent And The Grenadines" value="VCT">Saint Vincent And The Grenadines</option>
                                        <option label="Samoa" value="WSM">Samoa</option>
                                        <option label="San Marino" value="SMR">San Marino</option>
                                        <option label="Sao Tome And Príncipe" value="STP">Sao Tome And Príncipe</option>
                                        <option label="Saudi Arabia" value="SAU">Saudi Arabia</option>
                                        <option label="Senegal" value="SEN">Senegal</option>
                                        <option label="Serbia" value="SRB">Serbia</option>
                                        <option label="Seychelles" value="SYC">Seychelles</option>
                                        <option label="Sierra Leone" value="SLE">Sierra Leone</option>
                                        <option label="Singapore" value="SGP">Singapore</option>
                                        <option label="Sint Maarten (Dutch Part)" value="SXM">Sint Maarten (Dutch Part)</option>
                                        <option label="Slovakia" value="SVK">Slovakia</option>
                                        <option label="Slovenia" value="SVN">Slovenia</option>
                                        <option label="Solomon Islands" value="SLB">Solomon Islands</option>
                                        <option label="Somalia" value="SOM">Somalia</option>
                                        <option label="South Africa" value="ZAF">South Africa</option>
                                        <option label="South Georgia And The South Sandwich Islands" value="SGS">South Georgia And The South Sandwich Islands</option>
                                        <option label="South Sudan" value="SSD">South Sudan</option>
                                        <option label="Spain" value="ESP">Spain</option>
                                        <option label="Sri Lanka" value="LKA">Sri Lanka</option>
                                        <option label="St. Pierre And Miquelon" value="SPM">St. Pierre And Miquelon</option>
                                        <option label="Sudan" value="SDN">Sudan</option>
                                        <option label="Suriname" value="SUR">Suriname</option>
                                        <option label="Svalbard And Jan Mayen Islands" value="SJM">Svalbard And Jan Mayen Islands</option>
                                        <option label="Sweden" value="SWE">Sweden</option>
                                        <option label="Switzerland" value="CHE">Switzerland</option>
                                        <option label="Taiwan" value="TWN">Taiwan</option>
                                        <option label="Tajikistan" value="TJK">Tajikistan</option>
                                        <option label="Tanzania, United Republic Of" value="TZA">Tanzania, United Republic Of</option>
                                        <option label="Thailand" value="THA">Thailand</option>
                                        <option label="Timor-Leste" value="TLS">Timor-Leste</option>
                                        <option label="Togo" value="TGO">Togo</option>
                                        <option label="Tokelau" value="TKL">Tokelau</option>
                                        <option label="Tonga" value="TON">Tonga</option>
                                        <option label="Trinidad And Tobago" value="TTO">Trinidad And Tobago</option>
                                        <option label="Tunisia" value="TUN">Tunisia</option>
                                        <option label="Turkey" value="TUR">Turkey</option>
                                        <option label="Turkmenistan" value="TKM">Turkmenistan</option>
                                        <option label="Turks And Caicos Islands" value="TCA">Turks And Caicos Islands</option>
                                        <option label="Tuvalu" value="TUV">Tuvalu</option>
                                        <option label="Uganda" value="UGA">Uganda</option>
                                        <option label="Ukraine" value="UKR">Ukraine</option>
                                        <option label="United Arab Emirates" value="ARE">United Arab Emirates</option>
                                        <option label="United States Minor Outlying Islands" value="UMI">United States Minor Outlying Islands</option>
                                        <option label="Uruguay" value="URY">Uruguay</option>
                                        <option label="Uzbekistan" value="UZB">Uzbekistan</option>
                                        <option label="Vanuatu" value="VUT">Vanuatu</option>
                                        <option label="Vietnam" value="VNM">Vietnam</option>
                                        <option label="Virgin Islands (British)" value="VGB">Virgin Islands (British)</option>
                                        <option label="Virgin Islands (U.S.)" value="VIR">Virgin Islands (U.S.)</option>
                                        <option label="Wallis And Futuna Islands" value="WLF">Wallis And Futuna Islands</option>
                                        <option label="Western Sahara" value="ESH">Western Sahara</option>
                                        <option label="Yemen" value="YEM">Yemen</option>
                                        <option label="Zambia" value="ZMB">Zambia</option>
                                        <option label="Zimbabwe" value="ZWE">Zimbabwe</option>
                                      </select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: auto;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
                                            aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-residence_452476-container"><span class="select2-selection__rendered" id="select2-residence_452476-container"><span
                                                class="select2-selection__placeholder">--</span></span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper"
                                          aria-hidden="true"></span></span><span class="validation_icon"></span></div>
                                  </div><!-- end ngIf: !vm.isGlobalPlan --><!-- ngIf: !vm.isGlobalPlan && vm.traveler.residence.value == 'USA' --><!-- ngIf: vm.traveler.residence.value == 'CAN' -->
                                </div>
                              </div>
                            </traveler>
                            <div class="checkbox_group_horizontal" ng-show="traveler.travelerType === 1" aria-hidden="false"><!-- ngIf: vm.isSpouseAllowed() --><md-checkbox ng-change="vm.addSpouse(vm.quote, family)" ng-if="vm.isSpouseAllowed()"
                                ng-model="family.hasSpouse" tabindex="0" type="checkbox" role="checkbox" class="ng-pristine ng-untouched ng-valid ng-scope ng-empty" aria-checked="false" aria-invalid="false" aria-label="QUOTE.AMOUNT.ADD_SPOUSE">
                                <div class="md-container md-ink-ripple" md-ink-ripple="" md-ink-ripple-checkbox="">
                                  <div class="md-icon"></div>
                                </div>
                                <div ng-transclude="" class="md-label">Add Spouse</div>
                              </md-checkbox><!-- end ngIf: vm.isSpouseAllowed() --><!-- ngIf: vm.isChildrenAllowed() --><md-checkbox ng-change="vm.addChildren(vm.quote, family)" ng-if="vm.isChildrenAllowed()" ng-model="family.hasChildren"
                                tabindex="0" type="checkbox" role="checkbox" class="ng-pristine ng-untouched ng-valid ng-scope ng-empty" aria-checked="false" aria-invalid="false" aria-label="QUOTE.AMOUNT.ADD_CHILDREN">
                                <div class="md-container md-ink-ripple" md-ink-ripple="" md-ink-ripple-checkbox="">
                                  <div class="md-icon"></div>
                                </div>
                                <div ng-transclude="" class="md-label">Add Children</div>
                              </md-checkbox><!-- end ngIf: vm.isChildrenAllowed() --></div>
                          </div>
                        </div><!-- ngIf: family.hasChildren && traveler.travelerType === 3 && $index === family.travelers.length - 1 -->
                      </div>
                    </div><!-- end ngRepeat: traveler in family.travelers -->
                  </div><!-- end ngRepeat: family in vm.quote.families -->
                  <div class="inner_box inner_box_top"><!-- ngIf: vm.plan.productType !== 'GLOBAL' --><!-- end ngIf: vm.plan.productType !== 'GLOBAL' --></div>
                </family>
              </div>
            </div>
          </div>
        </div>
        <div class="ps-scrollbar-x-rail" style="left: 0px; bottom: 3px;">
          <div class="ps-scrollbar-x" tabindex="0" style="left: 0px; width: 0px;"></div>
        </div>
        <div class="ps-scrollbar-y-rail" style="top: 0px; right: 3px;">
          <div class="ps-scrollbar-y" tabindex="0" style="top: 0px; height: 0px;"></div>
        </div>
      </div>
      <div class="perfect_scrollbar__no_scroll_box">
        <div class="perfect_scrollbar__no_scroll_box__inner_box"></div>
      </div>
    </div>
    <div id="scroll_to_me"></div>
    <div class="inner_box inner_box_top control_new_home">
      <div ng-if="vm.plan.productType !== 'GLOBAL'" class="control_box__main control_box_coverage_amount padding__top__small cf ng-scope">
        <div class="btn_box halves left">
          <div ng-click="vm.newFamily(vm.quote)" class="btn_fab__inline_block btn_fab__text_btn btn_fab__blue btn_fab__text_btn__large btn_add_primary left cf" role="button" tabindex="0">
            <div class="md-button md-fab btn_fab"><span class="icon zmdi zmdi-account-add"></span></div>
            <div class="text text_color__blue">Add Another Insured</div>
          </div>
        </div>
        <div class="btn_box halves right" ng-class="{'left': vm.isTravelPlan, 'right': !vm.isTravelPlan}">
          <div ng-click="vm.showUploadModal(vm.quote)" class="hidden-sm right btn_fab__text_btn btn_fab__text_btn__large btn_fab__blue btn_group_upload cf btn_fab__inline_block" ng-class="{'right': !vm.isTravelPlan}" role="button" tabindex="0">
            <div class="md-button md-fab btn_fab btn_fab__outline"><span class="icon zmdi zmdi-upload"></span></div>
            <div class="text text_color__blue">CSV Group Upload</div>
          </div>
        </div>
      </div>
    </div>
    <div class="quote_item_submit btn_submit_footer mobile_quote_submit ng-hide" ng-class="{'active' : parent.quoteForm.$valid}" ng-show="parent.quoteForm.$valid" aria-hidden="true">
      <div class="quote_item__inner">
        <div class="button_padding_box_bottom"><button class="btn_raised btn_orange btn_block_ui_loader md-button md-ink-ripple" type="button" ng-transclude="" ng-click="parent.seePrices(parent.quoteForm)"><span class="text ng-binding ng-scope">Get
              Quote</span></button></div>
      </div>
    </div>
  </div>
</form>

<form id="contactForm_1">
  <div data-sf-role="form-container" class="formBox" id="IMGForm">
    <input type="hidden" data-sf-role="form-id" value="da44c237-a856-6fd5-8d0a-ff1a00eef763" name="FormId" autocomplete="off">
    <div data-sf-role="fields-container">
      <div id="C001_Col00" class="sf_colsIn formBox contactForm" data-sf-element="Container">
        <p style="font-size:14px;color:#697a8a;padding-bottom:15px;">If you need to send personal information such as medical records, payment information, etc., please use our <a href="/secure-message-center">Secure Message Center</a>.</p>
        <script data-sf-role="start_field_C036" data-sf-role-field-name="TextFieldController_4"></script>
        <!-- InputCssClass class variable -->
        <div class="form-group" data-sf-role="text-field-container">
          <input data-sf-role="violation-restrictions" type="hidden" value="{&quot;maxLength&quot;:&quot;255&quot;, &quot;minLength&quot;: &quot;0&quot;}" autocomplete="off">
          <input data-sf-role="violation-messages" type="hidden"
            value="{&quot;maxLength&quot;:&quot;First Name field must be less than 255 characters&quot;, &quot;required&quot;: &quot;First Name is required&quot;, &quot;invalid&quot;: &quot;Entry is not valid!&quot;, &quot;regularExpression&quot;: &quot;First Name field input is invalid&quot;}"
            autocomplete="off">
          <div class="formBox">
            <div class="form-group no_margin__bottom">
              <label class="" for="Textbox-1">First Name</label>
            </div>
          </div>
          <div class="formBox">
            <div class="form_item">
              <input id="Textbox-1" type="text" class="form-control" name="TextFieldController_4" value="" aria-required="true" data-sf-role="text-field-input" required="required" pattern=".{0,255}" aria-describedby="TextboxErrorMessage-1">
              <p id="TextboxErrorMessage-1" data-sf-role="error-message" role="alert" aria-live="assertive" class="error_message"></p>
            </div>
          </div>
        </div>
        <script data-sf-role="end_field_C036"></script>
        <script data-sf-role="start_field_C042" data-sf-role-field-name="TextFieldController_1"></script>
        <!-- InputCssClass class variable -->
        <div class="form-group" data-sf-role="text-field-container">
          <input data-sf-role="violation-restrictions" type="hidden" value="{&quot;maxLength&quot;:&quot;255&quot;, &quot;minLength&quot;: &quot;0&quot;}" autocomplete="off">
          <input data-sf-role="violation-messages" type="hidden"
            value="{&quot;maxLength&quot;:&quot;Last Name field must be less than 255 characters&quot;, &quot;required&quot;: &quot;Last Name is required&quot;, &quot;invalid&quot;: &quot;Entry is not valid!&quot;, &quot;regularExpression&quot;: &quot;Last Name field input is invalid&quot;}"
            autocomplete="off">
          <div class="formBox">
            <div class="form-group no_margin__bottom">
              <label class="" for="Textbox-2">Last Name</label>
            </div>
          </div>
          <div class="formBox">
            <div class="form_item">
              <input id="Textbox-2" type="text" class="form-control" name="TextFieldController_1" value="" aria-required="true" data-sf-role="text-field-input" required="required" pattern=".{0,255}" aria-describedby="TextboxErrorMessage-2">
              <p id="TextboxErrorMessage-2" data-sf-role="error-message" role="alert" aria-live="assertive" class="error_message"></p>
            </div>
          </div>
        </div>
        <script data-sf-role="end_field_C042"></script>
        <script data-sf-role="start_field_C040" data-sf-role-field-name="EmailTextFieldController"></script>
        <div class="form-group" data-sf-role="email-text-field-container">
          <input data-sf-role="violation-restrictions" type="hidden" value="{&quot;maxLength&quot;:&quot;255&quot;, &quot;minLength&quot;: &quot;0&quot;}" autocomplete="off">
          <input data-sf-role="violation-messages" type="hidden"
            value="{&quot;maxLength&quot;:&quot;Email field must be less than 255 characters&quot;, &quot;required&quot;: &quot;Email is required&quot;, &quot;invalid&quot;: &quot;Entry is not valid!&quot;, &quot;regularExpression&quot;: &quot;Email address is invalid&quot;}"
            autocomplete="off">
          <div class="formBox">
            <div class="form-group no_margin__bottom">
              <label for="Email-1">Email</label>
            </div>
          </div>
          <div class="formBox">
            <div class="form_item">
              <input id="Email-1" data-sf-role="email-text-field-input" type="email" class="form-control" name="EmailTextFieldController" value="" aria-required="true" required="required"
                pattern="^[a-zA-Z0-9.!#$%&amp;'*\+\-/=?^_`{|}~]+@(?:[a-zA-Z0-9-]+\.)+[a-zA-Z]{2,63}$" aria-describedby="TextboxErrorMessage-3">
              <p id="EmailErrorMessage-1" data-sf-role="error-message" role="alert" aria-live="assertive" class="error_message"></p>
            </div>
          </div>
        </div>
        <script data-sf-role="end_field_C040"></script>
        <script data-sf-role="start_field_C019" data-sf-role-field-name="TextFieldController_0"></script>
        <!-- InputCssClass class variable -->
        <div class="form-group" data-sf-role="text-field-container">
          <input data-sf-role="violation-restrictions" type="hidden" value="{&quot;maxLength&quot;:&quot;255&quot;, &quot;minLength&quot;: &quot;0&quot;}" autocomplete="off">
          <input data-sf-role="violation-messages" type="hidden"
            value="{&quot;maxLength&quot;:&quot;Phone is too long&quot;, &quot;required&quot;: &quot;Phone is required&quot;, &quot;invalid&quot;: &quot;Entry is not valid!&quot;, &quot;regularExpression&quot;: &quot;Phone is invalid&quot;}"
            autocomplete="off">
          <div class="formBox">
            <div class="form-group no_margin__bottom">
              <label class="" for="Textbox-3">Phone</label>
              <span class="optional"> (Optional) </span>
            </div>
          </div>
          <div class="formBox">
            <div class="form_item">
              <input id="Textbox-3" type="tel" class="form-control" name="TextFieldController_0" value="" aria-required="false" data-sf-role="text-field-input" pattern="(?=^.{0,255}$)^\+?(\d[\d\-\.\s]+)?(\([\d\-\.\s]+\))?[\d\-\.\s]+\d$"
                aria-describedby="TextboxErrorMessage-4">
              <p id="TextboxErrorMessage-4" data-sf-role="error-message" role="alert" aria-live="assertive" class="error_message"></p>
            </div>
          </div>
        </div>
        <script data-sf-role="end_field_C019"></script>
        <script data-sf-role="start_field_C007" data-sf-role-field-name="DropdownListFieldController"></script>
        <div class="form-group" data-sf-role="dropdown-list-field-container">
          <input type="hidden" data-sf-role="violation-messages" value="{ &quot;required&quot;: &quot;Please select an option above&quot;}" autocomplete="off">
          <div class="formBox">
            <div class="form-group no_margin__bottom">
              <label for="Dropdown-1"> I'm a </label>
              <span id="DropdownInfo-1" uib-tooltip="In order to properly route your message to the appropriate team, please select from the following options. If none of the options relate to you or you're unsure, please select 'Other.'"
                class="text-tooltip-help margin-left-5 helper_tooltip zmdi zmdi-help-outline" tooltip-append-to-body="true">
              </span>
            </div>
          </div>
          <div class="formBox form_item">
            <div class="selectpicker form-group">
              <select id="Dropdown-1" data-sf-role="dropdown-list-field-select" name="DropdownListFieldController" required="required" class="form-control" aria-required="true" aria-describedby="DropdownInfo-1 DropdownErrorMessage-1">
                <option value="">--</option>
                <option value="Job Applicant">Job Applicant</option>
                <option value="Medical Provider">Medical Provider</option>
                <option value="New / Potential Customer">New / Potential Customer</option>
                <option value="Policy Holder">Policy Holder</option>
                <option value="Producer / Agency / Broker">Producer / Agency / Broker</option>
                <option value="Other">Other</option>
              </select>
              <p id="DropdownErrorMessage-1" data-sf-role="error-message" role="alert" aria-live="assertive" class="error_message"></p>
            </div>
          </div>
        </div>
        <script data-sf-role="end_field_C007"></script>
        <script data-sf-role="start_field_C041" data-sf-role-field-name="TextFieldController"></script>
        <!-- InputCssClass class variable -->
        <div class="form-group" data-sf-role="text-field-container" style="display: none;">
          <input data-sf-role="violation-restrictions" type="hidden" value="{&quot;maxLength&quot;:&quot;255&quot;, &quot;minLength&quot;: &quot;0&quot;}" autocomplete="off">
          <input data-sf-role="violation-messages" type="hidden"
            value="{&quot;maxLength&quot;:&quot;Producer / Agency / Broker Number field must be less than 255 characters&quot;, &quot;required&quot;: &quot;Producer / Agency / Broker Number is required&quot;, &quot;invalid&quot;: &quot;Entry is not valid!&quot;, &quot;regularExpression&quot;: &quot;Producer / Agency / Broker Number field input is invalid&quot;}"
            autocomplete="off">
          <div class="formBox">
            <div class="form-group no_margin__bottom">
              <label class="" for="Textbox-4">Producer / Agency / Broker Number</label>
            </div>
          </div>
          <div class="formBox">
            <div class="form_item">
              <input id="Textbox-4" type="text" class="form-control" name="TextFieldController" value="" aria-required="true" data-sf-role="text-field-input" required="required" pattern=".{0,255}" aria-describedby="TextboxErrorMessage-5"
                disabled="disabled">
              <p id="TextboxErrorMessage-5" data-sf-role="error-message" role="alert" aria-live="assertive" class="error_message"></p>
            </div>
          </div>
        </div>
        <script data-sf-role="end_field_C041"></script>
        <script data-sf-role="start_field_C023" data-sf-role-field-name="DropdownListFieldController_2"></script>
        <div class="form-group" data-sf-role="dropdown-list-field-container" style="display: none;">
          <input type="hidden" data-sf-role="violation-messages" value="{ &quot;required&quot;: &quot;Current policy holder is required&quot;}" autocomplete="off">
          <div class="formBox">
            <div class="form-group no_margin__bottom">
              <label for="Dropdown-2"> Is this regarding a current policy holder? </label>
              <span id="DropdownInfo-2" uib-tooltip="Select 'Yes' if your inquiry is in regards to a current policy holder." class="text-tooltip-help margin-left-5 helper_tooltip zmdi zmdi-help-outline" tooltip-append-to-body="true">
              </span>
            </div>
          </div>
          <div class="formBox form_item">
            <div class="selectpicker form-group">
              <select id="Dropdown-2" data-sf-role="dropdown-list-field-select" name="DropdownListFieldController_2" required="required" class="form-control" aria-required="true" aria-describedby="DropdownInfo-2 DropdownErrorMessage-2"
                disabled="disabled">
                <option value="">--</option>
                <option value="Yes">Yes</option>
                <option value="No">No</option>
              </select>
              <p id="DropdownErrorMessage-2" data-sf-role="error-message" role="alert" aria-live="assertive" class="error_message"></p>
            </div>
          </div>
        </div>
        <script data-sf-role="end_field_C023"></script>
        <script data-sf-role="start_field_C010" data-sf-role-field-name="DropdownListFieldController_0"></script>
        <div class="form-group" data-sf-role="dropdown-list-field-container" style="display: none;">
          <input type="hidden" data-sf-role="violation-messages" value="{ &quot;required&quot;: &quot;Policy type is required&quot;}" autocomplete="off">
          <div class="formBox">
            <div class="form-group no_margin__bottom">
              <label for="Dropdown-3"> What type of policy is this in reference to? </label>
              <span id="DropdownInfo-3"
                uib-tooltip="The name of the policy or service can be found on your ID card or certificate wording. If you are unsure on the exact name of your policy or service, please select &quot;Other / Not Sure.&quot; Please note, this may add an additional delay on response times."
                class="text-tooltip-help margin-left-5 helper_tooltip zmdi zmdi-help-outline" tooltip-append-to-body="true">
              </span>
            </div>
          </div>
          <div class="formBox form_item">
            <div class="selectpicker form-group">
              <select id="Dropdown-3" data-sf-role="dropdown-list-field-select" name="DropdownListFieldController_0" required="required" class="form-control" aria-required="true" aria-describedby="DropdownInfo-3 DropdownErrorMessage-3"
                disabled="disabled">
                <option value="">--</option>
                <option value="IMG">IMG</option>
                <option value="IMG Europe">IMG Europe</option>
                <option value="iTravelInsured">iTravelInsured</option>
                <option value="ALC">ALC</option>
                <option value="Global Response">Global Response</option>
                <option value="Other / Not Sure">Other / Not Sure</option>
              </select>
              <p id="DropdownErrorMessage-3" data-sf-role="error-message" role="alert" aria-live="assertive" class="error_message"></p>
            </div>
          </div>
        </div>
        <script data-sf-role="end_field_C010"></script>
        <script data-sf-role="start_field_C012" data-sf-role-field-name="TextFieldController_2"></script>
        <!-- InputCssClass class variable -->
        <div class="form-group" data-sf-role="text-field-container" style="display: none;">
          <input data-sf-role="violation-restrictions" type="hidden" value="{&quot;maxLength&quot;:&quot;255&quot;, &quot;minLength&quot;: &quot;0&quot;}" autocomplete="off">
          <input data-sf-role="violation-messages" type="hidden"
            value="{&quot;maxLength&quot;:&quot;Certificate / Policy Number is too long&quot;, &quot;required&quot;: &quot;Certificate / Policy Number is required&quot;, &quot;invalid&quot;: &quot;Entry is not valid!&quot;, &quot;regularExpression&quot;: &quot;Certificate / Policy Number field input is invalid&quot;}"
            autocomplete="off">
          <div class="formBox">
            <div class="form-group no_margin__bottom">
              <label class="" for="Textbox-5">Certificate / Policy Number</label>
              <span id="TextboxInfo-1" uib-tooltip="Your Certificate / Policy Number can be found on your insurance ID card." class="text-tooltip-help margin-left-5 helper_tooltip zmdi zmdi-help-outline" tooltip-append-to-body="true">
              </span>
            </div>
          </div>
          <div class="formBox">
            <div class="form_item">
              <input id="Textbox-5" type="text" class="form-control" name="TextFieldController_2" value="" aria-required="true" data-sf-role="text-field-input" required="required" pattern=".{0,255}"
                aria-describedby="TextboxInfo-1 TextboxErrorMessage-6" disabled="disabled">
              <p id="TextboxErrorMessage-6" data-sf-role="error-message" role="alert" aria-live="assertive" class="error_message"></p>
            </div>
          </div>
        </div>
        <script data-sf-role="end_field_C012"></script>
        <script data-sf-role="start_field_C013" data-sf-role-field-name="TextFieldController_3"></script>
        <!-- InputCssClass class variable -->
        <div class="form-group" data-sf-role="text-field-container" style="display: none;">
          <input data-sf-role="violation-restrictions" type="hidden" value="{&quot;maxLength&quot;:&quot;255&quot;, &quot;minLength&quot;: &quot;0&quot;}" autocomplete="off">
          <input data-sf-role="violation-messages" type="hidden"
            value="{&quot;maxLength&quot;:&quot;Insured ID / Customer Number is too long&quot;, &quot;required&quot;: &quot;Insured ID / Customer Number is required&quot;, &quot;invalid&quot;: &quot;Entry is not valid!&quot;, &quot;regularExpression&quot;: &quot;Insured ID / Customer Number field input is invalid&quot;}"
            autocomplete="off">
          <div class="formBox">
            <div class="form-group no_margin__bottom">
              <label class="" for="Textbox-6">Insured ID / Customer Number</label>
              <span id="TextboxInfo-2" uib-tooltip="Your Insured ID / Customer Number can be found on your insurance ID card." class="text-tooltip-help margin-left-5 helper_tooltip zmdi zmdi-help-outline" tooltip-append-to-body="true">
              </span>
            </div>
          </div>
          <div class="formBox">
            <div class="form_item">
              <input id="Textbox-6" type="text" class="form-control" name="TextFieldController_3" value="" aria-required="true" data-sf-role="text-field-input" required="required" pattern=".{0,255}"
                aria-describedby="TextboxInfo-2 TextboxErrorMessage-7" disabled="disabled">
              <p id="TextboxErrorMessage-7" data-sf-role="error-message" role="alert" aria-live="assertive" class="error_message"></p>
            </div>
          </div>
        </div>
        <script data-sf-role="end_field_C013"></script>
        <script data-sf-role="start_field_C034" data-sf-role-field-name="DropdownListFieldController_1"></script>
        <div class="form-group" data-sf-role="dropdown-list-field-container" style="display: none;">
          <input type="hidden" data-sf-role="violation-messages" value="{ &quot;required&quot;: &quot;Nature of Inquiry is required&quot;}" autocomplete="off">
          <div class="formBox">
            <div class="form-group no_margin__bottom">
              <label for="Dropdown-4"> Nature of Inquiry </label>
              <span id="DropdownInfo-4" uib-tooltip="Please select the reason for submitting this form request. If you don't see your reason, please select &quot;Other.&quot;"
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your costs, moving your files forward, and serving as an international resource
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INSURANCE

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international experience not worrying about your insurance coverage.

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WHAT TYPE OF COVERAGE
DO YOU NEED?

 * Vacation / Holiday
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 * Flights / Airfare
 * Cruises / Excursions


TRAVEL MEDICAL
INSURANCE

Temporary coverage for accidents, sicknesses, & emergency evacuations when
visiting or traveling outside of your home country.

POPULAR PLANS

Patriot Travel Series
Patriot Lite Patriot America Plus Patriot Platinum
Patriot Exchange Program GlobeHopper Senior
See All Plans


INTERNATIONAL HEALTH INSURANCE

Annually renewable international private medical insurance coverage for expats
and global citizens living or working internationally.

POPULAR PLANS

Global Medical Insurance GEO Group
See All Plans


TRAVEL
INSURANCE

Coverage designed to protect you from financial losses should your trip be
delayed, interrupted, or cancelled.

POPULAR PLANS

iTravelInsured Travel Series
iTravelInsured Lite iTravelInsured SE iTravelInsured LX
See All Plans

ENTERPRISE SERVICES

Meet your duty of care obligations with confidence, knowing your travelers are
safe, healthy, and connected wherever they may be in the world.

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WHAT TYPE OF ORGANIZATION DO YOU REPRESENT?

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MEDICAL & TRAVEL
ASSISTANCE

Your travelers can access 24/7 global support should they need medical
attention, travel assistance, or medical transport services.

See All Services Included


GLOBAL WORKERS' COMPENSATION CASE MANAGEMENT

Rest assured knowing you have an experienced team who is committed to reducing
your costs, moving your files forward, and serving as an international resource
for all your work injury claims.

See All Services Included


SECURITY ASSISTANCE
SERVICES

Keep your travelers safe, no matter where they are, with real-time alerts and
intelligence on safety, health, political, and other global risks.

See All Services Included


INSURANCE ADMINISTRATIVE
SERVICES

You’ll have experts to guide you through all things related to your health care
plan needs, from enrollment to claim reimbursement.

See All Services Included


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OfMoldova, Republic
OfMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlands,
TheNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth
MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New
GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint
BarthélemySaint Helena, Ascension And Tristan Da CunhaSaint Kitts And NevisSaint
LuciaSaint MartinSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And
PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten
(Dutch Part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia And
The South Sandwich IslandsSouth SudanSpainSri LankaSt. Pierre And
MiquelonSudanSurinameSvalbard And Jan Mayen IslandsSwedenSwitzerlandSyrian Arab
RepublicTaiwanTajikistanTanzania, United Republic
OfThailandTimor-LesteTogoTokelauTongaTrinidad And
TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited
Arab EmiratesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands
(British)Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwe--
Residence
--United StatesUnited Kingdom of Great Britain and Northern
IrelandCanadaAfghanistanAland IslandsAlbaniaAlgeriaAmerican
SamoaAndorraAngolaAnguillaAntarcticaAntigua And
BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire,
Sint Eustatius And SabaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish
Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina
FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African
RepublicChileChinaChristmas IslandCocos (Keeling)
IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook
IslandsCosta RicaCote
D'IvoireCroatiaCuracaoCyprusCzechiaDenmarkDjiboutiDominicaDominican
RepublicEcuadorEgyptEl SalvadorEquatorial
GuineaEritreaEstoniaEswatiniEthiopiaFalkland Islands (Malvinas)Faroe
IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern
TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard
And Mcdonald IslandsHoly See (Vatican City State)HondurasHong
KongHungaryIcelandIndiaIndonesiaIraqIrelandIsle Of
ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Republic
OfKuwaitKyrgyzstanLao People's Democratic
RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States
OfMoldova, Republic
OfMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlands,
TheNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth
MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New
GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto
RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint Helena, Ascension And
Tristan Da CunhaSaint Kitts And NevisSaint LuciaSaint MartinSaint Vincent And
The GrenadinesSamoaSan MarinoSao Tome And PríncipeSaudi
ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch
Part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia And The
South Sandwich IslandsSouth SudanSpainSri LankaSt. Pierre And
MiquelonSudanSurinameSvalbard And Jan Mayen
IslandsSwedenSwitzerlandTaiwanTajikistanTanzania, United Republic
OfThailandTimor-LesteTogoTokelauTongaTrinidad And
TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited
Arab EmiratesUnited States Minor Outlying
IslandsUruguayUzbekistanVanuatuVietnamVirgin Islands (British)Virgin Islands
(U.S.)Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwe--
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INTERNATIONAL HEALTH AND TRAVEL INSURANCE OFFERINGS FROM IMG

IMG is an award-winning global benefits and assistance services company and one
of the only companies in the market to offer travel medical, international
health, and travel insurance plans. Get a quote now and choose the right plan
for your next trip:

Travel Medical Insurance protects you in the event of an illness or injury while
traveling outside of your home country.

Travel Insurance protects you from financial losses should your trip be delayed,
interrupted, or cancelled. It also includes coverage for medical expenses while
abroad.

International Health Insurance provides medical coverage for individuals and
families living abroad (or away from their home country) and includes benefits
such as preventive care, routine check-ups, and treatment for illnesses and
injuries.


TRAVEL MEDICAL INSURANCE

Temporary coverage for accidents, sicknesses, & emergency evacuations when
visiting or traveling outside of your home country.

Get covered During your Travels


INTERNATIONAL HEALTHINSURANCE

Annually renewable international private medical insurance coverage for expats
and global citizens living or working internationally.

Stay covered internationally


TRAVELINSURANCE

Coverage designed to protect you from financial losses should your trip be
delayed, interrupted, or cancelled.

Protect your trip investment


SELECT WHY YOU ARE AWAY FROM HOME.

GET PLAN RECOMMENDATIONS
AND HELPFUL RESOURCES.


 


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You can find more information on health, travel, tourism, and insurance on our
blog, Global Connect.

Read More
   
   
 * "Although one hopes never to use travel insurance, IMG was a godsend
   throughout our ordeal. We couldn’t have done it without your continued
   assistance."
   Joan D. United States

See More Testimonials
   

 * "I took comfort in the fact
   that IMG had my back."
   
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   While skiing in Chile, Mark, an IMG member, found himself on the brink of
   paralysis.

   

 



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