Patriot Exchange Program<small><sup>SM</sup></small>

Patriot Exchange ProgramSM

Cultural Exchange Student insurance plans

 

Medical Insurance for Cultural Exchange Individuals Traveling Abroad

 

 

 

Designed for students studying abroad or participants of cultural exchange programs. Two plan options are available. Basic short term travel plan is an economical plan while the Standard short-term travel plan is designed to meet the U.S. visa travel insurance requirements. Plans are available in monthly increments and if a minimum of 3 months is purchased, coverage may be renewed (without break in coverage) for a total of 24 months.

 

The Patriot Exchange Program is designed for those who are:

  • actively engaged or participating in an educational or cultural exchange program in the country of assignment.
  • traveling to a destination that is not their home country.

 

Patriot Exchange ProgramSM Benefits

 

BASIC SHORT-TERM TRAVEL PLAN
Schedule of Benefits Benefit Description
Plan Maximum US$10,000 per illness or injury with a lifetime maximum of US$500,000
Coinsurance 100%
Deductible US$100 per illness or injury
Treatment Period 60 days per chronic illness
Hospital Room & Board Up to semi-private room rate
Hospital Intensive Care URC*
Physical Therapy URC*, 1 visit per day
Physician Visit URC*
Student Health Center US$5 co-pay per visit
Eligible Medical Expenses URC*
Emergency Room
 		 URC*
Emergency Illness-with in-patient admission URC*
Emergency Illness-without in-patient admission Additional US$250 deductible
Emergency Medical Evacuation US$25,000 lifetime maximum
Emergency Reunion US$5,000 lifetime maximum
Return of Mortal Remains US$7,500
Political Evacuation Up to US$10,000
Accidental Death US$5,000
Dismemberment US$5,000 two limbs; US$2,500 one limb
Terrorism Coverage Up to US$50,000 lifetime maximum
Sudden Recurrence of a Pre-existing Condition (U.S. citizens)  
* Medical Up to US$5,000 of eligible expenses
* Emergency Medical Evacuation Up to US$25,000 of eligible costs and expenses
 

Optional Add-on Plan

 
Schedule of Benefits Benefit Description
Baggage  
* Loss/theft of Baggage US$250
* Loss/theft of Valuables US$250
* Loss/theft of Personal Papers US$250
Legal Assistance  
* Binder Fee US$500 when served with summons
Personal liability  
* Injury to third party US$2,000 limit after US$100 deductible
* Damage to third person property US$500 limit after US$100 deductible. Secondary to any other insurance in force
Limited high school sports coverage  
*Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment.
This web page contains only a consolidated and summary description of all current Patriot Exchange Program Insurance benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this application and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.

 

Patriot Exchange ProgramSM Benefits

 

Standard Short-Term Travel Plan
Schedule of Benefits Benefit Description
Plan Maximum Choice of US$50,000, US$250,000 or US$500,000 per illness or injury with a lifetime maximum of US$500,000
Coinsurance 100%
Deductible US$100 per illness or injury
Treatment Period 60 days per chronic illness
Hospital Room & Board Up to semi-private room rate
Hospital Intensive Care URC*
Physical Therapy URC*, 1 visit per day
Physician Visit URC*
Student Health Center US$5 co-pay per visit
Eligible Medical Expenses URC*
Dental  
?Injury due to accident US$500
?Sudden & unexpected pain US$350
Emergency Room
 		 URC*
Emergency Illness-with in-patient admission URC*
Emergency Illness-without in-patient admission Additional US$250 deductible
Emergency Medical Evacuation US$50,000
Emergency Reunion US$15,000
Return of Mortal Remains US$25,000
Political Evacuation Up to US$10,000
Accidental Death US$25,000
Dismemberment US$25,000 two limbs; US$12,500 one limb
Terrorism Coverage Up to US$50,000 lifetime maximum
Sudden Recurrence of a Pre-existing Condition (U.S. citizens)  
* Medical Up to US$5,000 of eligible expenses
* Emergency Medical Evacuation Up to US$25,000 of eligible costs and expenses
 

Optional Add-on Plan

 
Schedule of Benefits Benefit Description
Baggage  
* Loss/theft of Baggage US$250
* Loss/theft of Valuables US$250
* Loss/theft of Personal Papers US$250
Legal Assistance  
* Binder Fee US$500 when served with summons
Personal liability  
* Injury to third party US$2,000 limit after US$100 deductible
* Damage to third person property US$500 limit after US$100 deductible. Secondary to any other insurance in force
Limited high school sports coverage  
*Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment.
This web page contains only a consolidated and summary description of all current Patriot Exchange Program Insurance benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this application and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.

Patriot Exchange ProgramSM Exclusions

 

Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under the Patriot Exchange Program.
 
  1. Pre-existing Conditions. A pre-existing condition is defined as any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that, with reasonable medical certainty, existed at the time of application or at any time during the three years prior to the effective date of the insurance, whether or not previously manifested or symptomatic, diagnosed, treated, or disclosed prior to the effective date, including any subsequent, chronic or recurring complications or consequences related thereto or arising therefrom.
  2. Treatment or surgeries which are elective, investigational, experimental or for research purposes.
  3. War, military action, terrorism, political insurrection, protest, or any act thereof. The Company will not pay for a Political Evacuation if there is a travel advisory in effect on or within six (6) months prior to the Insured Person?s date of arrival in the Host Country.
  4. Immunizations and routine physical exams.
  5. Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.
  6. Venereal disease, AIDS virus, AIDS related illness, ARC Syndrome, or AIDS, and the cost of testing for these conditions, and charges for treatment or surgeries which are incurred by any Insured who was HIV+ at time of enrollment into this insurance.
  7. Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
  8. Injury sustained while participating in amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition. The following hazardous activities are excluded: racing of any kind, aviation (except when traveling as a passenger in a commercial aircraft), BMX, BASE jumping, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, luge, motocross (moto-x), mountain biking, mountaineering, parachuting, rappelling, rock climbing, rodeo, scuba diving, ski jumping, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, wind-surfing and whitewater rafting.
  9. Vision or ear tests and the provision of visual or hearing aids.
  10. Vocational, recreational, speech or music therapy.
  11. Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
  12. Charges, injuries and/or illnesses resulting or arising from or occurring during the commission or continuing perpetration of a violation of law by the insured, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
  13. Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
  14. Injury and/or illness resulting or arising from being under the influence of alcohol or drugs; and injury or illness resulting from operating any type of vehicle after consuming any alcohol or drugs.
  15. Willful self-inflicted injury or illness.
  16. Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.
  17. Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
  18. Treatment for mental and nervous disorders.
  19. Organ or tissue transplants or related services.
  20. Illness or injury where the trip to the host country is undertaken for treatment or advice for such Illness or injury, except as expressly provided for in the certificate of insurance.
  21. Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).
  22. Charges for Treatment of a Chronic Illness incurred beyond sixty (60) days from the date of initial Treatment thereof.
This web page contains only a consolidated and summary description of all current Patriot Exchange Program benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this application and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.