Benefits

Patriot Travel Medical Insurance –Benefits and Plan Information

Below are the full details on the benefit schedule for the Patriot Travel Medical
Insurance which is all listed in US Dollars under the following sections:

Plan Information

Medical Benefits

International Emergency Care

Additional Benefits

Additional Benefits for US Citizens

Optional Riders

 

Patriot travel medical insurance 
PLAN INFORMATION

Maximum Limits

$50,000, $100,000,
$500,000, $1,000,000, $2,000,000

Deductible

Your choice of
$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

See 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 $5,000, then 100% up to
the Maximum Limit

Outside the
PPO Network: The plan pays 80% of eligible expenses up to $5,000, then 100%
up to the Maximum

MEDICAL
BENEFITS

Usual, reasonable and customary charges, subject
to deductible and coinsurance

Hospital Room and
Board

Up to the Maximum
Limit for average semi-private room rate

Medical Expenses

Up to the Maximum
Limit

Out-patient Medical

Up to the Maximum
Limit

Local Ambulance

Up to the Maximum
Limit

Prescription Drugs

Up to the Maximum
Limit

Emergency Room
Accident

Up to the Maximum
Limit

Charges incurred for the use of the
Emergency Room due to an accident are covered up to the Maximum Limit.

Emergency Illness –
with In-patient Admission

Up to the Maximum
Limit

Emergency Illness –
without In-patient Admission

Up to the Maximum
Limit

Charges incurred for the use of the
Emergency Room for treatment of an illness are subject to an additional
(extra) $250 deductible if treatment does not require admittance to the
hospital.

Dental

Benefit listed 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
Maximum Limit.

Sudden dental pain: Each plan will pay up to $100 for the necessary
treatment of sudden, unexpected pain to sound natural teeth.

 

INTERNATIONAL
EMERGENCY CARE

(when coordinated through the Plan Administrator)

Emergency Evacuation

Up to $500,000
lifetime maximum (independent of the Maximum Limit)

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 $500,000.

Emergency Reunion

Up to $50,000

Each
Patriot plan also provides emergency reunion coverage, up to $50,000 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 $50,000

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 $50,000.

Return of Minor
Children

Up to $50,000

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 $50,000
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 $10,000

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 $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:

1.
The Insured Person
contacts the Company within 10 days of the United States Department of State,
Bureau of Consular affairs issues the travel advisory;

2.
Political Evacuation
and Repatriation is approved and coordinated by the Company.

To be eligible for the Evacuation, Reunion
and Return benefits, these must be recommended by the attending physician in
critical medical situations, and approved in advance and coordinated by IMG.

 

ADDITIONAL
BENEFITS

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 Maximum Limits and the other terms of the plan until
there have been six months of continuous coverage for the covered injury or
illness.

Incidental Home
Country Coverage

Up to a cumulative two
weeks

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

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information

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).

Common Carrier
Accidental Death

$50,000 to
Beneficiary; maximum of $250,000 per family

If accidental death should occur while
traveling on a commercial Common Carrier, $50,000 will be paid to the
designated beneficiary, to a maximum of $250,000 per family.

Sports &
Activities Coverage

Up to the Maximum
Limit 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 unless the Adventure Sports Rider is purchased: abseiling, aviation
(except when traveling as a passenger in a commercial aircraft), BMX,
bobsleigh, bungee jumping, canyoning, caving, high
diving, hang gliding, heli-skiing, hot air
ballooning, inline skating, jet skiing, kayaking, mountain biking,
paragliding, parascending, rappelling, rock
climbing, sky diving, snow skiing, snowboarding, snowmobiling, spelunking,
surfing, trekking, wind-surfing and whitewater
rafting.

Racing of any kind, BASE jumping,
mountaineering, climbing or trekking above elevation 4500 meters above ground
level or without proper ropes or guides; luge,
motocross, Moto-X, rodeo activity, ski jumping, whitewater
rafting exceeding Class V difficulty, scuba below 10 meters; and/or adventure
sports not expressly covered hereunder are excluded regardless of which plan
or rider is selected.

Accidental Death &
Dismemberment

$25,000 principal sum

Each Patriot plan includes $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 $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 $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 $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 six months of the
termination of coverage date.

Natural Disaster

$100 per day for five
days

This benefit is available in the event an
insured person is required to depart his/her destination due to an evacuation
order issued by prevailing authorities in connection with a Natural Disaster.
Natural Disaster is defined as widespread disruption of human lives by
disasters such as flood, drought, tidal wave, fire, hurricane, earthquake,
windstorm, or other storm, landslide, or other natural catastrophe or event
resulting in migration of the population for its safety.

Trip Interruption

Up to $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 $50 per item of
personal property; maximum of $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.

 

Additional
Benefits for U.S. Citizens

Indemnity

Click for more
information

Patriot International will pay directly to
the insured person $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.

Sudden Recurrence of a
Pre-existing Condition

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information

Up to $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 $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 on the Exclusions page.

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.

 

 

Optional
RIDERS

Adventure Sports Rider

See below coverage
levels for each age band

The Adventure Sports Rider is available on both Patriot plans for those up to the
age of 65. The following activities are covered to the lifetime maximum
amounts listed below: abseiling, aviation, BMX, bobsleigh, bungee jumping, canyoning, caving, flying (private plane), hang gliding, heli-skiing, high diving, hot air ballooning, inline
skating, jet skiing, kayaking, mountain biking, paragliding, parascending, rappelling, rock climbing (ropes and guides
to 4500m from ground level), skydiving, snow boarding,
snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater
rafting (to Class V), wind-surfing. These adventure activities must be
engaged in solely for leisure, recreation, or entertainment purposes.

Age

Lifetime Maximum

0-49

$50,000

50-59

$30,000

60-64

$15,000

Adventure Sports Rider = Plus 20% premium
loading on base premium

for both US Citizens and Non US Citizens

 

Citizenship Return
Rider

Up to the Maximum
Limit

When purchased at the time of application, the
Citizenship Return Rider provides temporary medical coverage for non-U.S.
citizens returning to their home country. For U.S. citizens, the rider
provides up to 60 days of coverage for brief returns to the U.S. provided you
have a current health plan in force and have resided outside the U.S.
continuously for the past six months. Coverage for sudden recurrence of
pre-existing conditions is excluded if the rider is selected.

Citizenship Return Rider = Plus 5% premium
loading on base premium

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 plans. Coverage must be purchased for a minimum of three months.

Monthly rates
shown below (must purchase minimum of three months)

Up to $100,000 additional coverage

$8

Up to $200,000 additional coverage

$16

Up to $300,000 additional coverage

$24

Up to $400,000 additional coverage

$32

* This Web page contains
only a consolidated and summary description of all current 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 Web
page, 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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