Benefits

Patriot Adventure Travel Medical Insurance – Benefits and Plan Information

Below are the full details on the benefit schedule for the Patriot Executive 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

 

PLAN INFORMATION

Maximum Limit

$1,000,000

Maximum Limit for travelers
who are 70-75 years old

$50,000

Deductible

$250 per each covered Illness; deductible waived for
claims incurred as a result of a covered accident

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

Intensive Care

Up to the Maximum Limit

Medical Expenses

Up to the Maximum Limit

Out-patient Medical

Up to the Maximum Limit

Local Ambulance

Up to the Maximum Limit

Emergency Room Accident

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 with additional
$250 deductible

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

As described below

Injury due to an
accident:
Each Patriot
Adventure 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 the Maximum
Limit

Patriot Adventure includes coverage for
Emergency Medical Evacuations from a medical facility 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 Maximum Limit.

Emergency Reunion

Up to $10,000

Patriot Adventure also provides emergency
reunion coverage, up to $10,000 for a maximum of 15 days, for the reasonable
travel and lodging expenses of a relative or friend during an emergency
medical evacuation of the insured person: 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 $15,000

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 $15,000.

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.

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.

 

Additional Benefits

Benefit Period

Three months

If a covered injury or illness has
continuing treatment after the certificate expires, the three-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 three months before the certificate
expired, benefits for the covered injury or illness will continue subject to
the Maximum Limits until there has been three months of coverage for the
covered injury or illness.

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
beneficiary to a maximum of $250,000 per family

Sports &
Activities

Up to the Maximum
Limit for basic and Adventure sports as described below

Subject to the complete Certificate Terms
and Conditions, Patriot Adventure covers injuries incurred during non-contact
amateur athletic activities and the following activities: abseiling, BMX,
bungee jumping, canyoning, caving, cave tubing,
flying (private plane), hang gliding,heli-skiing,
high diving, horseback riding, hot air ballooning, jet skiing, jungle zip
lining, kayaking, inline skating, motorcycle/motorscooter
riding, mountain biking, mountaineering (ropes and guides to 4500m from
ground level), paragliding, parascending,
rappelling, rock climbing (ropes and guides to 4500m from ground level),
scuba diving (to 50m), skydiving, snorkeling, snow
skiing, snowboarding, snowmobiling, spelunking, surfing, trekking,
wakeboarding, water skiing, whitewater rafting (to
Class V), wildlife safaris, and windsurfing. These advenutre
activities must be engaged in solely for leisure, recreation or entertainment
purposes. Activities may be organized and include scheduled practices, games,
and/or competitions.

Activities not covered include contact
sports, professional sports and any athletic activities that are organized
and/or sanctioned by the National Collegiate Athletic Association (or any
other collegiate sanctioning body) or the International Olympic Committee.

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, the 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;
maximum of $250

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

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information

Patriot Adventure 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 $1,000 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 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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