Request for Group Accident Insurance

*** Please note that Group Accident Insurance Requests must be submitted at least two (2) business days prior to the planned start of the trip for insurance purposes.

Requests for Group Accident Insurance cannot be guaranteed unless submitted to UNM Risk Services at least two (2) business days prior to the planned start date of the trip.


Please complete and submit the form, a request identification number will be issued via email after submission.

Select level 5 department.

Select or enter value
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Enter trip destination and details of planned activities.

Enter your index code.

Enter begin date of travel.

Enter end date of travel.

Enter total number of travel days.

Enter total number of travelers.

Enter name(s) of traveler(s). Please enter First Name and Last Name of all participants.


Ex. Jane Doe (Faculty), John Doe (Student)

Cost of Travel

Cost of travel is calculated at $1.00 for each traveler, for each travel day. A confirmation email will provide a summary of request information, including the total cost for the total number of travelers for the number of days of travel.


Example: (1 traveler), (3 travel days), (cost for each traveler for each travel day) = 1 x 3 x $1.00 = $3.00


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