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MEDICAL
BENEFITS |
Usual,
reasonable and customary
charges,subject to deductible
and coinsurance |
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Hospital Room and Board |
Up to
Policy Maximum for average
semi-private room rate |
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Intensive Care |
Up to
Policy Maximum |
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| Medical
Expenses |
Up to
Policy Maximum |
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Outpatient Medical |
Up to
Policy Maximum |
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| Local
Ambulance |
Up to
Policy Maximum |
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Emergency Room |
As
described below |
Charges incurred
for the use of the Emergency
Room due to an accident are
covered up to the Policy
Maximum.
Charges incurred for the use of
the Emergency Room for treatment
of an illness are subject to an
additional (extra) US$250
deductible if treatment does not
require admittance to the
hospital. |
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| Dental |
As
described below |
Injury
due to an accident:
Each Patriot Group plan covers
the cost of emergency dental
treatment and dental procedures
necessary to restore sound
natural teeth lost or damaged in
an accident up to the Policy
Maximum.
Sudden dental pain:
Each plan will pay up to US$100
for the necessary treatment of
sudden, unexpected pain to sound
natural teeth. |
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INTERNATIONAL EMERGENCY CARE
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Emergency Evacuation |
Up to
Policy Maximum when coordinated
through the Plan Administrator |
| Each Patriot
Group plan includes coverage for
Emergency Medical Evacuations to
the nearest qualified medical
facility; expenses for
reasonable travel and
accommodations resulting from
the evacuation; and the cost of
returning to either the home
country or the country where the
evacuation occurred, up to the
Policy Limit. |
|
Emergency Reunion |
Up to
US$15,000 when coordinated
through the Plan Administrator |
| Each Patriot
Group plan also provides
emergency reunion coverage, up
to US$15,000 for a maximum of 15
days, for the reasonable travel
and lodging expenses of a
relative or friend during an
Emergency Medical Evacuation:
either the cost of accompanying
the insured during the
evacuation or traveling from the
home country to be reunited with
the insured. |
| Return
of Mortal Remains |
Up to
US$25,000 when coordinated
through the Plan Administrator |
| If a covered
illness/injury results in death,
expenses for Repatriation of
bodily remains or ashes to the
home country will be covered up
to a maximum of US$25,000. |
|
Returning Minor Children |
Up to
US$5,000 when coordinated
through the Plan Administrator |
| If an insured
person is hospitalized due to a
covered illness/injury and is
traveling alone with child(ren)
19 or under that otherwise would
be left unattended, the Patriot
Group plans will pay up to
US$5,000 for one way economy
fare to their home country,
including a chaperone, if
necessary, for the safety of the
child(ren). |
|
Political Evacuation |
Up to
US$10,000 when coordinated
through the Plan Administrator |
| If the United
States Department of State,
Bureau of Consular Affairs
issues a travel advisory that
becomes effective on or after
the Insured Person?s date of
arrival in the Host Country, the
Company will pay up to US$10,000
for transportation to the
nearest place of safety or for
repatriation to the Insured
Person?s home country or country
of residence provided that:
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- The Insured Person
contacts the Company within
10 days of the United States
Department of State, Bureau
of Consular affairs issues
the travel advisory;
- Political Evacuation and
Repatriation is approved and
coordinated by the Company.
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PLAN
INFORMATION |
|
Deductible |
Your
choice of US$0, $100, $250,
$500, $1,000 or $2,500 |
| On the
Application Form, you will be
asked to circle your choice of a
deductible. Your premium rate is
dependent on the deductible you
choose. Please see the
Application Form for more
information. |
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Coinsurance |
As described below |
For treatment received
outside the U.S. & Canada:
No coinsurance
For treatment received
within the U.S. & Canada:
The plan pays 80% of eligible
expenses up to US$5,000, then
100% up to the Policy Maximum
For treatment received
within the U.S. & Canada:
In the PPO Network: The plan
pays 90% of eligible expenses up
to US$5,000, then 100% up to the
Policy Maximum
Outside the PPO Network: The
plan pays 80% of eligible
expenses up to US$5,000, then
100% up to the Policy Maximum |
|
Benefit Period |
Six months |
| If
a covered injury or illness
requires continuing treatment
after the Period of Coverage
expires, the six-month Benefit
Period may provide continued
coverage. When the certificate
expires, the Company will review
the date of initial treatment
for the covered injury or
illness. If treatment began less
than six months before the
Period of Coverage expired,
benefits for the covered injury
or illness will continue subject
to the Policy Limits and the
other terms of the plan until
there have been six months of
continuous coverage for the
covered injury or illness. |
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ADDITIONAL BENEFITS
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Home Country Coverage |
As described below |
Incidental Home Country
Coverage - During the
Period of Coverage an insured
person may return to their home
country for incidental visits up
to a cumulative two weeks total,
subject to: a. The insured
person must have left their home
country, b. The total Period of
Coverage must be for a minimum
of 30 days, and c. The return to
the home country may not be
taken to receive treatment for
an illness or injury incurred
while traveling.
End of Trip Home Country
Coverage - For every
five months of continuous
coverage you purchase, you can
purchase one additional month of
home country coverage as an
accommodation and supplemental
travel benefit, up to a maximum
of two months. To purchase this
special home country extension
coverage, please check the
appropriate box on the
Application Form, and calculate
your premium to include the
additional month(s). |
|
Trip Interruption |
Up to US$5,000 |
| If,
during a covered trip, there is
a death of an immediate family
member (spouse, child, parent or
sibling) or the substantial
destruction of the insured?s
principal residence, each
Patriot Group plan will pay to
return the insured to the area
of principal residence. The plan
will pay for a one way air or
ground transportation ticket of
the same class as the unused
travel ticket, less the value of
the unused return ticket. |
|
Lost Luggage |
Up to US$50 per item of
personal property; maximum of
US$250 per Period of Coverage |
|
This benefit will be paid in the
event that the Common Carrier
permanently loses an insured
person?s checked luggage. This
coverage is secondary to any
other available coverage,
including the Carrier?s. |
|
Common Carrier
Accidental Death |
US$50,000 to Beneficiary;
maximum of US$250,000 per family
of group |
| If
accidental death should occur
while traveling on a commercial
Common Carrier, US$50,000 will
be paid to the designated
beneficiary, to a maximum of
US$250,000 per family of group.
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Sports & Activities Coverage |
Up to Policy Maximum for
basic sports as described below |
Each Patriot Group plan covers
injuries incurred during amateur
athletic activities which are
non-contact and engaged in by
the insured person solely for
leisure, recreation,
entertainment or fitness
purposes. However, activities
not covered include 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,
windsurfing and whitewater
rafting.
Optional Leisure or
Extreme Sports Riders: Please
see the brochure for more
information.
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Accidental Death &
Dismemberment |
US$25,000 principal sum |
|
Each Patriot Group plan includes
US$25,000 principal sum benefit
for Accidental Death and
Dismemberment occurring during
the Period of Coverage: ?
Accidental Loss of life -
principal sum; ? Accidental Loss
of two Members - principal sum;
? Accidental Loss of one Member
- 50% of principal sum.
?Member? means hand, foot or
eye. |
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Additional Benefits for U.S.
Citizens |
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Sudden Recurrence of a
Pre-existing Condition |
| Up
to US$15,000 will be paid for
the eligible expenses of a
sudden and unexpected recurrence
of a Pre-existing Condition
while traveling outside of the
U.S. In addition, up to
US$25,000 will be paid for the
eligible costs and expenses of
an Emergency Medical Evacuation
arising or resulting from a
sudden and unexpected recurrence
of a Pre-existing Condition. For
the definition of a Pre-existing
Condition, please see Exclusion
number 1 of the Patriot Group
brochure. |
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Indemnity |
|
Patriot International Group will
pay directly to the insured
person US$100 for each night of
a required overnight stay in a
hospital. However, the hospital
stay must be covered under this
plan in order to receive this
benefit. |
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This web page contains only
a consolidated and summary
description of all current
Patriot Group Travel Medical
Insurance benefits, conditions,
limitations and exclusions. A
certificate containing the
complete Certificate Wording
with all terms, conditions and
exclusions will be included with
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.
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