| |
Insurance for International Travelers and Visitors
|
Click the link above to purchase one of these policies after
reviewing the Schedule of Benefits and Exclusions below.
Schedule of Benefits/Exclusions 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 country of citizenship 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: |
- 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.
|
| |
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, 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 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 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. |
| |
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. |
| |
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 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. |
|
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).
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.
|
|
