Standard Short-Term Travel Plan Rates
Non-U.S. Citizens: Worldwide coverage except home country		Monthly Premium	Monthly Premium w/Optional Add-on Plan
A. $50,000 per illness/injury		$41.10	$43.15
B. $250,000 per illness/injury		$51.10	$53.65
C. $500,000 per illness/injury		$53.90	$56.55
U.S. Citizens: Worldwide coverage except home country		Monthly Premium	Monthly Premium w/Optional Add-on Plan
A. $50,000 per illness/injury		$30.55	$32.05
B. $250,000 per illness/injury		$37.80	$39.65
C. $500,000 per illness/injury		$40.00	$42.00
Europe to Europe travel only		Monthly Premium	Monthly Premium w/Optional Add-on Plan
A. $50,000 per illness/injury		$25.55	$26.85
B. $250,000 per illness/injury		$31.10	$32.65
C. $500,000 per illness/injury		$33.35	$35.00
Basic Short-Term Travel Plan Rates
Non-U.S. Citizens: Worldwide coverage except home country		Monthly Premium	Monthly Premium w/Optional Add-on Plan
$10,000 per illness/injury		$25.55	$28.10
U.S. Citizens: Worldwide coverage except home country		Monthly Premium	Monthly Premium w/Optional Add-on Plan
$10,000 per illness/injury		$18.95	$20.95
Europe to Europe travel only		Monthly Premium	Monthly Premium w/Optional Add-on Plan
$10,000 per illness/injury		$15.85	$17.45

A long-term plan is also available. For more information, please contact your independent insurance agent or International Medical Group at 1-800-628-4664.

Quality Guarantee

Your satisfaction is very important to IMG and the plan underwriter. If you are not pleased with this product for any reason, you may submit a written request prior to your effective date, for cancellation and refund of the premium.

Precertification, Emergency Evacuation and Repatriation

For precertification, emergency evacuation and repatriation, please call: IMG in the US: 1-800-628-4664 (toll free) or 1-317-655-4500. Call IMG outside the US: 001-317-655-4500 (collect if necessary). This information will also be provided on your ID card.

IMG must be notified prior to treatment or within 48 hours of an emergency.

To Report Claims

Please mail completed claim forms to International Medical Group, P.O. Box 88500, Indianapolis, IN 46208-0500 USA. All IMG contact numbers, claim forms and Certificate Wordings will be included in the fulfillment kit. IMG may also be contacted by fax: 317-655-4505 or e-mail: insurance@imglobal.com.

This web page contains only a consolidated and summary description of all current Patriot Exchange Program 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.