MEDOC® Supplemental Plan Change Form

We understand that plans change, so we’re making it easier for you to update your coverage online.

 

Use this form to change your supplemental trip dates for this year’s travel season (September 1, 2020 – August 31, 2021), or to downgrade to the base plan. We’ll process your request within 5 to 10 business days and reach out if necessary.

 

Please note, QCC members should call us at 1-866-606-3362 to make changes to their plans.

Member Details

The principal policyholder should fill out this section.

Up to 12 characters

Downgrade to Base Plan

 

We'll cancel all of your supplemental trips, and you won’t have coverage for any extended travel— beyond the number of days listed on your Base Plan policy.

 

Don’t worry, if you change your mind, you can always add supplemental trips at a later date.

You can enter up to 3 trips

Downgrade to Base Plan

 

We'll cancel all of your supplemental trips, and you won’t have coverage for any extended travel— beyond the number of days listed on your Base Plan policy.

 

Don’t worry, if you change your mind, you can always add supplemental trips at a later date.

You can enter up to 3 trips

Spouse details

Up to 12 characters