Docusign Within Member Portal (Most Efficient Approach)
You can complete, sign, and submit the Claimant’s Statement and Authorization form online via Member Portal, our self-service portal for policyholders.
But First, Did You Register for a Member Portal Account?
To access Member Portal, you will first need to register an account. Click here to register.
If you have already registered your account, follow the instructions below.
If you have an existing Client Zone or Student Zone account, you do not need to register for Member Portal. Simply sign into Member Portal using your Client Zone or Student Zone log in information.
Haven’t Yet Added Your Policy to Your Member Portal Account?
You will need to add your policy to your Member Portal account before you will be able to submit a claim via Member Portal.
1. Visit Member Portal. Enter the email address associated with your account and then click the “Continue Sign In” button.
2. On the resulting Sign In page, enter your password below your email address. Then click the “Sign In” button.
3. You will be presented with your Member Portal home page. Click “Claims and Appeals” in the main navigation menu at the top of the page.
4. You will be presented with the Claims and Appeals page.
Don’t Have Access to the Claims and Appeals Page?
If you selected that you are not the insured or the insured’s legal guardian upon registration, you will not have immediate access to the Claims and Appeals page. Instead, you will see the Protected Health Information Authorization page. To gain access to this section of Member Portal, enter the insured’s email address and click the “Send Request” button.
The insured will receive an email with a link to complete, sign, and submit the HIPAA form via DocuSign. You will gain access to the Claims and Appeals section and will be able to submit a claim for the policyholder within 3-5 days of the date the policyholder completed and submitted the form.
To file a new claim via DocuSign, click the "Submit New Claim Via DocuSign" button under the "Claimant's Statement and Authorization Form" subheader in the "File a Claim" section.
5. Enter your name and email address and click the “Begin Signing” button.
6. Click the white box next to “I agree to use electronic records and signatures.” Then click the yellow “Continue” button to the right.
7. Fill in all the required information (as indicated by the red text boxes) and sign everywhere a signature is required (as indicated by the yellow “Sign” boxes).
Attach your supporting documents (medical records, receipts, itemized bills, etc.), if necessary, in the appropriate section via the yellow attachment boxes. If you have more than 3 attachments or exceed the 5MB attachment limit.
8. When you are done, click the yellow “Finish” button in the top righthand corner. Clicking “Finish” submits your documents and sends a PDF of your signed Claimant’s Statement and Authorization form to your email.
Download or print a copy of your completed form for your records. If you do not receive a confirmation email with your completed form attached within 24 hours, please contact WorldTrips to make sure your form was properly submitted.
Need to Attach More Than 3 Supporting Documents OR Submit Additional Supporting Documents After You Have Already Submitted Your Claim Via DocuSign?
Return to the Claims and Appeals page of the Member Portal and click the “Submit Additional Supporting Documents” button under the “Submit Additional Supporting Documents (If Needed)” subheader in the “File a Claim” section.
You will land on the Submit Additional Supporting Documents page. Use the dropdown to choose your claim number. (If you have just submitted your Claimant’s Statement and Authorization form and do not yet have a claim number to select, you can still submit your documents without selecting a claim number.) Then upload your files and click the “Submit” button.
Once your documents have been successfully submitted, you will receive a confirmation email with your policy number, confirmation of the types of documents submitted (for a claim or appeal), your claim number (if selected), and the number of documents you submitted.
- Download the Claimant’s Statement and Authorization form here.
- Print, complete, and sign the Claimant’s Statement and Authorization form. Mail the completed form, along with additional supporting documentation (medical records, receipts, itemized bills, etc.), to:
WorldTrips
Claims Department
PO Box 240358
Apple Valley, MN 55124
U.S.A.
WorldTrips is also happy to fax, e-mail, or mail the form to you upon request.
FAQs: WorldTrips' Insurance Plans
How Do I Register for a Member Portal Account?
1. Visit Member Portal at https://worldtrips.my.site.com/MemberPortal.
2. Under “Continue Sign In” click “First-time user? Register for an account.”
3. On the Register page, enter the email address you wish to use to sign into your account. This email does not need to match the email address associated with your policy.
Enter your policy number and select whether or not you are the insured or the insured’s legal guardian. Enter the insured’s first and last name as entered on the policy. (You can see how the insured’s name was entered on your ID card and fulfillment documents that were sent to you upon purchase.)
Enter the insured’s date of birth. Then choose a password. Follow the password instructions noted on the page.
Read and agree to the terms and conditions by checking the box. Then click the “Continue” button.
4. You will be taken to the Sign In page. Enter the email address and password you used to register your account and click “Sign In.”
5. To add an additional layer of security when signing into your account, you will be prompted to choose your preferred multifactor authentication method.
Options Include:
a. Okta Verify - Click "Setup" if you wish to use a push notification sent to the mobile app
b. SMS Authentication* - Click "Setup" if you wish to enter a single-use code that is sent to your mobile phone
c. Voice Call Authentication* - Click "Setup" if you wish to follow voice instructions via phone
d. Security Question - Click "Setup" if you wish to answer a security question
*Please be sure to use a method which you will have continual access to on your travels. Do not use phone numbers that will not work outside of your current service area.
6. Follow the setup instructions of your chosen multifactor authentication method. Then click “Finish.”
7. On the resulting page, choose a "Forgot Password" question. Make sure you select a question with only one correct answer that is easy to remember.
Type the answer into the blank box below "Answer." You will need this answer to access your account if you ever forget your Member Portal password and need to reset it.
You may also choose to add a phone number for resetting your password or unlocking your account using SMS text message or a voice call if you don’t have access to your email.
Click "Create My Account."
How Do I Submit a Claim?
You must complete, sign, and submit a Claimant's Statement and Authorization form along with proof of claim (itemized bills, payment receipts, medical records, police reports, etc.) for every incident. (Click here to download the form in Spanish).
Filing a Claim on Behalf of Someone Else? If you are filing this claim on behalf of another person, you MUST fill out the section of the Claimant's Statement and Authorization form labeled "Supplement D - Authorization Form for Use and/or Disclosure of Protected Health Information" – also known as a HIPAA form. This section must be signed by the policyholder in order for us to speak with you regarding any of the policyholder's Protected Health Information (PHI). Without this signed form, we may only disclose to you the status of the claim.
You can complete and submit the Claimant's Statement and Authorization form along with supporting documents in one of the following ways:
Via DocuSign within Member Portal (Most Efficient Approach)
1. Go to Member Portal (formerly Client Zone / Student Zone).
2. Log in to your account. If this is your first time using Member Portal, please click here to view instructions for registering your new account.
If you already have a Client Zone / Student Zone account, you do not need to register for a Member Portal account. Simply log in to Member Portal using your Client Zone / Student Zone login details.
3. Click "Claims and Appeals" in the main navigation menu.
4. Click “Submit New Claim Via DocuSign” button under the “Claimant’s Statement and Authorization Form” subheader in the “File a Claim” section and follow the instructions.
For more extensive step-by-step instructions, including screenshots, please see our “How to Submit a Claim” guide
Don’t Have Access to the Claims and Appeals Page? If you noted that you are not the insured or the insured’s legal guardian, you will see the Protected Health Information Authorization page in place of the Claims and Appeals page. Enter the insured’s email address and click “Send Request.” Once the insured has completed and submitted our HIPAA form, you will gain access to the Claims and Appeals page and have the ability to submit a claim within 3-5 days.
By Mail
1. Download the Claimant's Statement and Authorization form. (Click here to download the form in Spanish.)
2. Print, complete, and sign the form. Mail to: WorldTrips Claims Department PO Box 240358 Apple Valley, MN 55124 U.S.A. WorldTrips is also happy to fax, e-mail, or mail the form(s) to you upon request.
Important Note for Students
For eligibility purposes, you must submit the following along with a Claimant's Statement and Authorization form:
- A copy of your education-related visa (F-1, J-1, OPT, etc.) or valid I-20/DS2019
- Proof of full-time student status (not necessary if submitting a valid F-1 visa including OPT, or J-1 visa)
Can I Submit a Claim on Behalf of Someone Else?
How Do I Submit the Authorization Form for Use and/or Disclosure of Protected Health Information (HIPPA Form) If I Did Not Complete This Section of the Claim Form?
If you have already submitted a claim on behalf of someone else and did not complete this section OR if WorldTrips has requested that you submit the Authorization Form for Use and/or Disclosure of Protected Health Information (HIPAA), you do not need to fill out another claim form. You can submit the HIPAA form separately in one of the following ways:
Electronically via Member Portal
- Go to Member Portal.
- Log in to your account. If this is your first time using Member Portal, please click here to view instructions for registering your new account.
If you already have a Client Zone / Student Zone account, you do not need to register for a Member Portal account. Simply log in to Member Portal using your Client Zone / Student Zone login details. - Click "Claims and Appeals" in the main navigation menu.
If You See the Protected Health Information Authorization Page:
- Because you selected that you are not the insured or the insured's legal guardian upon registering for Member Portal, you do not yet have access to the Claims and Appeals page.
- Under the "Protected Health Information Authorization" header, enter the insured's email address and click the "Send Request" button.
- The insured will receive an email with a link to complete, sign, and submit the HIPPA form via DocuSign. You will gain access to the Claims and Appeals page and will be able to see the status of any pending claims within 3-5 days of the date the policyholder completed and submitted the form.
If You See the Claims and Appeals Page:
- Click the "Fill Out and Submit Via DocuSign" button under the "Authorization Form for Use and/or Disclosure of Protected Health Information (HIPPA)" subheader in the "File a Claim" section.
- Enter the insured's name and an email address and click the "Begin Signing" button.
- Click the yellow "Continue" button, fill out the form and the required information (as noted by the red boxes); have the policyholder sign the form, and click the yellow "Finish" button.
- Clicking "Finish" submits the document and sends a PDF of your signed Authorization Form for Use and/or Disclosure of Protected Health Information to the email address entered. Download or print a copy of your completed form for your records. If you do not receive a confirmation email with your completed form attached within 24 hours, please contact WorldTrips to make sure your form was properly submitted.
- Download the Authorization Form for Use and/or Disclosure of Protected Health Information.
- Print, complete, and have the policyholder sign the form.
- Mail to:
WorldTrips Claims Department
PO Box 240358
Apple Valley, MN 55124
U.S.A.
When and How Will I Receive My Fulfillment Documents?
During the checkout process, you will have the option to receive your ID cards and other fulfillment documents by:
- Email only OR by
- Email and hard copy
If you select “Email only,” you will receive your ID cards and fulfillment documents by email as soon as your application has been processed and your credit card has been approved. This typically takes a few minutes or less.
If you select “Email and hard copy,” you will receive your ID cards and fulfillment documents by email as soon as your application has been processed and your credit card has been approved. You will also receive hard copies of your ID cards and fulfillment documents by mail to the address you entered on your application.
How Long Do I Have to File a Claim?
What If I Do Not Agree with a Claim's Denial?
There may be situations when you choose to appeal how a claim was processed. You may appeal your claim decision using one of the following methods:
Submit the Claimant Appeal Request Form Via DocuSign within Member Portal:
- Sign into Member Portal. You will be presented with your Member Portal home page.
- Click “Claims and Appeals” in the main navigation menu at the top of the page. You will be presented with the Claims and Appeals page.
- Switch the toggle at the top of the page under the “Claims and Appeals” header from “Claims” to “Appeals.”
- To file an appeal via DocuSign, click the “Fill Out and Submit Via DocuSign” button under the “Claimant Appeal Request Form” subheader in the “File an Appeal” section.
- Enter your name and email address on the PowerForm Signer Information page and click the “Begin Signing” button.
- Click the yellow “Continue” button to the right.
- Fill in all the required information on the form (as indicated by the red text boxes) and sign everywhere a signature is required (as indicated by the yellow “Sign” boxes).
- Attach your supporting documents (medical records, receipts, itemized bills, etc.), if necessary, at the bottom righthand corner of the page via the yellow attachment boxes. If you have more than 3 attachments or exceed the 5MB attachment limit, see instructions for submitting additional documents here.
- When you are done, click the yellow “Finish” button at the bottom of the page. Clicking “Finish” submits your documents and sends a PDF of your signed Claimant Appeal Request Form to your email.
- Download or print a copy of your completed form for your records. If you do not receive a confirmation email with your completed form attached within 24 hours, please contact WorldTrips to make sure your form was properly submitted.
Want more detailed instructions including screenshots? See the “Claimant Appeal Request Form Submitted Via DocuSign within Member Portal (Most Efficient Approach)” section of our Claims Resource Center page.
Submit the Claimant Appeal Request Form Via Email or Mail- Download the Claimant Appeal Request Form. (Click here to download the form in Spanish).
- Fill out the form and email it, along with additional documentation that supports your reasoning and position (medical records, receipts, itemized bills, etc.), to appeals@worldtrips.com.
OR
Mail the form and supporting documents to:
WorldTrips Appeals
PO Box 240358
Apple Valley, MN 55124
U.S.A
Submit a Written Appeal Letter Via Email or Mail
- Write a letter of appeal following the appeal procedure instructions outlined in your policy documents/certificate of coverage.
- Email this written letter of appeal, along with additional documentation that supports your reasoning and position (medical records, receipts, etc.), to appeals@worldtrips.com.
OR
Mail the form and supporting documents to:
WorldTrips Appeals
PO Box 240358
Apple Valley, MN 55124
U.S.A
IMPORTANT! In order for our claims department to review the appeal, you must provide additional documentation or information to support a reversal of the denial. Please note that submission of the appeal will lead to re-evaluation of your claim but does not guarantee that the initial benefit determination will be altered.
Why Am I Receiving So Many Letters?
What Is Included in the Fulfillment Documents?
Your fulfillment documents will include:
Instructional Information
- How to seek medical treatment
- How to file a medical claim
- How to access Member Portal (our online self-service portal where members can manage their policies)
- How to contact WorldTrips
Declaration Page
- Link to the Description of Coverage for your policy
- Name, address, ID number, and citizenship of the insured
- Policy start and end dates and length of coverage
- Certain policy details including plan name, overall maximum limit, maximum per injury/illness, deductible, and any optional coverage elected
- Purchase date, payment type, and amount paid
- Name and address of plan administrator
Policyholder/Certificate Holder Notice
- Important notice about OFAC sanctions
European Union GDPR Data Protection Notice (Note that you will only receive this notice if you are a citizen or resident of the European Union OR if you are a visitor traveling to the European Union)
- Information about our privacy policy
- How we use your personal and sensitive information and who we may disclose it to
- Information about your data protection rights
- How to opt out of marketing communications or withdraw your consent
ID Card
- Name of insured(s)
- Certificate/policy number and effective date of coverage
- Instructions on how to file a claim
- Name and logo of PPO network
- Instructions on how to find a provider
How Do I Access My Visa Letter?
What Information Is Included in the Visa Letter?
- Your name
- Your home country and citizenship
- Your destination country or countries
- Your certificate (policy) number
- Your policy’s effective date
- Your policy’s termination date
- An overview of your policy details, including your overall policy maximum, maximum per injury/illness, and deductible
- An overview of important benefits and their coverage amounts
- WorldTrips contact information
How Does My Deductible Work?