Patriot Group Exchange ProgramSM
Group cultural exchange student insurance plans
Medical Insurance for
Exchange Groups Traveling Abroad
Designed for a group of students studying abroad or participants of a group cultural exchange program. Three plan options are available. Basic short term travel plan is an economical plan. Standard short-term travel plan is designed to meet the U.S. visa travel insurance requirements. Long-term annual plan has the flexibility to be tailored to meet specific needs of each program and can be renewed annually. 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.
Exchange Program Group Plan plan is designed for
those who are:
- actively engaged or participating in an
educational or cultural exchange program in
the country of assignment through a
sponsoring organization or school.
- traveling in a group to a destination
that is not the home country of any of the
traveling members.
|
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 |
| 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 |
|
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 |
|
|
|
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 |
|
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 |
|
|
|
Benefit Description |
| Maximum Limit |
US$1,000,000 |
| Coinsurance |
100% |
| Deductible |
Inpatient:
US$100;
Outpatient: US$40 |
| 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* |
| Urgent Travel
Expense |
US$500 |
| Emergency Room |
URC* |
| Emergency
Illness-with in-patient admission |
URC* |
| Emergency
Illness-without in-patient admission |
Additional
US$250 deductible |
| Dental |
|
| * Injury due
to accident |
US$500 |
| * Sudden &
unexpected pain |
US$350 |
| Emergency
Medical Evacuation |
Maximum Limit |
| Emergency
Reunion |
US$15,000 |
| Return of
Mortal Remains |
US$25,000 |
| Political
Evacuation |
Up to
US$10,000 |
| Accidental
Death |
US$25,000
(hazardous sports excluded) |
| AD&D |
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
Conditions
(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 |
| TMJ |
US$5,000
lifetime maximum |
| High School
Sports coverage |
Organized
sports coverage; Professional sports
excluded |
| Baggage |
|
| * Loss/theft
of Baggage |
US$1,000 |
| * Loss/theft
of Valuables |
US$350 |
| * Loss/theft
of Personal Papers |
US$500 |
|
Schedule of Benefits |
Benefit Description |
| Legal
Assistance |
|
* Binder Fee
* Attorney Fees |
US$500
when served with summons
Up to US$20,000 |
| Sports Coverage |
|
| * Limited
hazardous sports coverage |
No AD&D |
| Personal
liability |
|
| * Injury to
third party |
US$5,000 medical payment sub-limit
after US$100 deductible; Up to
US$250,000 maximum with judgment |
| * Damage to
third person property |
US$1,000 sub-limit after US$100
deductible; Up to US$100,000 maximum
with judgment |
|
Schedule of Benefits |
Benefit Description |
| Sports Rider |
Up to Policy
Maximum |
| Chaperone /
Faculty Leader Replacement Rider |
Up to US$3,000
for a round trip economy airline
ticket for a replacement Chaperone/
Faculty Leader |
|
Exclusions
Charges for the following services,
treatments and/or conditions, among others,
are excluded from coverage under the Patriot
Group Exchange Program.
- 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.
- Treatment or surgeries which are
elective, investigational, experimental
or for research purposes.
- 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.
- Immunizations and routine physical
exams.
- Treatment of Temporomandibular Joint
or dental treatment, except as expressly
provided for in the certificate of
insurance.
- 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.
- Pregnancy, childbirth, birth
control, artificial insemination,
treatment for infertility or impotency,
sterilization or reversal thereof, or
abortion.
- 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.
- Vision or ear tests and the
provision of visual or hearing aids.
- Vocational, recreational, speech or
music therapy.
- Treatment while confined primarily
to receive custodial care, educational
or rehabilitative care, or nursing
services.
- 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.
- Treatment for, and injuries and/or
illnesses resulting or arising from,
substance abuse or drug addiction.
- 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.
- Willful self-inflicted injury or
illness.
- Treatment required as a result of or
arising from complications from a
treatment or condition not covered under
the certificate.
- Any services or supplies performed
or provided by a relative of the Insured
or provided at no cost to Insured.
- Treatment for mental and nervous
disorders.
- Organ or tissue transplants or
related services.
- 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.
- Treatment incurred as a result of or
arising from exposure to nuclear
radiation, and/or radioactive
material(s).
- 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 Group 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.
