Patriot Travel Medical Insurance®
Individual & family (5 days up to 2 years coverage)
There are two Patriot Travel Medical Insurance products available to meet your needs, providing up to US$2,000,000 of medical coverage. Coverage can be obtained from a minimum of 5 days up to a maximum of 2 years. Patriot products address the travel medical insurance needs of U.S. citizens and foreign nationals who need temporary medical insurance while traveling for business or pleasure anywhere outside their home country. Coverage includes medical evacuation, repatriation, and your choice of deductibles and policy limits.
Designed for the
international traveler
There are two Patriot products available to meet
your needs and provide up to US$2,000,000 of
medical coverage.
Patriot International?
Patriot International provides coverage for U.S.
citizens traveling abroad for a minimum of 5
days up to a maximum of two years. If the plan
is purchased for a minimum of three months,
coverage may be renewed (without break in
coverage) for a total of up to two years.
Patriot America?
Patriot America provides coverage for non-US
citizens traveling outside their home country
for a minimum of 5 days up to a maximum of two
years. If the plan is purchased for a minimum of
three months, coverage may be renewed (without
break in coverage) for a total of up to two
years.
| SCHEDULE
OF BENEFITS
|
|
| MEDICAL BENEFITS | Usual, reasonable and customary charges, subject to deductible and coinsurance |
| Hospital Room and Board | Up to Policy Maximum for average semi-private room rate |
| Intensive Care | Up to Policy Maximum |
| Medical Expenses | Up to Policy Maximum |
| Outpatient Medical | Up to Policy Maximum |
| Local Ambulance | Up to Policy Maximum |
| 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. |
|
| Dental | As described below |
| Injury
due to an accident: Each Patriot
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. |
|
| INTERNATIONAL EMERGENCY CARE | |
| Emergency Evacuation | Up to Policy Maximum when coordinated through the Plan Administrator |
| Each Patriot 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
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 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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| 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. | |
| Coinsurance | As described below |
| For
treatment received outside the U.S. &
Canada: No coinsurance 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. | |
| ADDITIONAL BENEFITS | |
| 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 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 or 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 |
| 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. | |
| Sports & Activities Coverage | Up to Policy Maximum for basic sports Coverage as described below |
| Each Patriot
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. |
|
| Accidental Death & Dismemberment | US$25,000 principal sum |
| Each Patriot 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. | |
| Terrorism Coverage | Up to US$50,000 lifetime maximum |
| Each Patriot
plan provides coverage for injuries and
illness incurred as a result of an act of
Terrorism, limited in amount and by
circumstances. If an insured person is
injured as a result of an act of Terrorism,
and the insured person has no direct or
indirect participation in the act, the plan
will reimburse eligible medical claims
subject to a US$50,000 lifetime maximum.
However, claims incurred as a result of
radiological, nuclear, chemical or
biological weapons or events are not
covered. Terrorism is defined as the systematic or planned use of violence, fear, or threat of violence in order to intimidate a population or government, especially as a means of coercion or to obtain a granting of any demand. However, this benefit does not cover an act of Terrorism in any country or location where the United States government has issued a travel advisory that has been in effect within the 6 months prior to the insured person's date of arrival. This benefit also does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location. |
|
| Identity Theft Assistance | Up to US$500 per Period of Coverage |
| If an imposter
obtains key personal information such as a
Social Security or Driver's License number,
or other method of identifying an insured
person in order to impersonate or obtain
credit, merchandise or services in the
insured person?s name, the Patriot plans
will provide coverage for the reasonable,
customary and necessary costs incurred by
the insured for: re-filing a loan or other
credit application that is rejected solely
as a result of the stolen identity event;
notarization of legal documents,
long-distance telephone calls, and postage
that has resulted solely as a result of
reporting, amending and/or rectifying
records as a result of the stolen identity
event; up to three credit reports obtained
within one year of the insured person?s
knowledge of the stolen identity event; and
stop payment orders placed on missing or
unauthorized checks as a result of the
stolen identity event. The identity theft event must occur during the Period of Coverage and must be reported within 6 months of the termination of coverage date. |
|
| Additional Benefits for U.S. Citizens | |
| 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 in the Patriot Travel Medical Insurance brochure. | |
| Indemnity | |
| Patriot International 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. | |
| This web page contains only a consolidated and summary description of all current Patriot Travel Medical 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. | |
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Optional Riders
LEISURE SPORTS RIDER
The Leisure Sports Rider is available on
both Patriot plans and adds coverage for jet
skiing, scuba diving, snow skiing,
snowboarding, snowmobiling, snorkeling,
surfing, wakeboarding, water skiing and
windsurfing.
Base Premium x 20% EXTREME SPORTS RIDER The Extreme Sports Rider is available on both Patriot plans and adds up to 12 months of coverage for those under the age of 50. This rider provides up to US$50,000 lifetime maximum for the following activities: abseiling, BMX, bungee jumping, canyoning, caving, flying (private plane), hang gliding, heli-skiing, high diving, hot air ballooning, kayaking, inline skating, mountain biking, mountaineering (ropes and guides to 4500m from ground level), paragliding, parascending, rappelling, rock climbing (ropes and guides to 4500m from ground level), skydiving, spelunking, whitewater rafting (to Class V). These extreme activities must be engaged in solely for leisure, recreation, or entertainment purposes.
Monthly rates - Available in monthly
increments up to a maximum of 12 months.
PATRIOT RETURN RIDER The Patriot Return Rider is only available to non-U.S. citizens who have purchased Patriot America. When purchased at the time of application, Patriot Return provides temporary medical coverage for non-U.S. citizens returning to their home country. The insured person must be outside his/her home country at time of application. Base Premium x 5% ENHANCED AD&D RIDER This optional coverage is available for the primary insured person only. This coverage is in addition to the Accidental Death and Dismemberment already included in the Patriot plans. Coverage must be purchased for a minimum of three months.
Monthly Rates - coverage must be purchased
for a minimum of three months
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| This web page contains only a consolidated and summary description of all current Patriot Travel Medical 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. |
Exclusions
Charges for the following services,
treatments and/or conditions, among others,
are excluded from coverage under the Patriot
plans.
- 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, windsurfing 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).
