| 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 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. |
| |
| INTERNATIONAL
EMERGENCY CARE |
| 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: |
- 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.
|
| |
| 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:
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. |
| |
|
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 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. |
| 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. |
| 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. |
| |
|
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 of the Patriot Group brochure. |
| 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. |
| |
| 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. |
