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Rates: Patriot America Rates / Patriot International Rates
International Travel Insurance > International Medical Group
Patriot International & America Benefit Schedule
| PLAN INFORMATION | |
| Deductible | Your choice of US$0, $100, $250, $500, $1,000 or $2,500 |
| Coinsurance | As described below |
| For treatment received outside the US & Canada: | No coinsurance |
| For treatment received within the US & Canada: In the PPO Network |
The plan pays 90% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum |
| For treatment received within the US & Canada: Out of PPO Network |
The plan pays 80% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum |
| 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 Accident | Up to Policy Maximum |
| Emergency Illness with in-patient admission |
Up to Policy Maximum |
| Emergency Illness with in-patient admission |
Up to Policy Maximum with an additional US$250 deductible |
| Dental Injury due to accident |
Up to Policy Maximum |
| Dental Sudden dental pain |
Up to US$100 |
| INTERNATIONAL EMERGENCY CARE | |
| Emergency Evacuation | Up to Policy Maximum |
| Emergency Reunion | Up to US$15,000 |
| Return of Mortal Remains | Up to US$25,000 |
| Returning Minor Children | Up to US$5,000 |
| Political Evacuation | Up to US$10,000 |
| ADDITIONAL BENEFITS | |
| Benefit Period | Six months |
| Home Country Coverage | Up to a cumulative two weeks |
| End of Trip Home Country Coverage | One month for every five months of travel coverage purchased, up to a maximum of two months |
| Common Carrier Accidental Death | US$50,000 to Beneficiary; maximum of US$250,000 per family |
| Sports & Activities Coverage | Up to Policy Maximum for basic sports |
| Accidental Death & Dismemberment | US$25,000 principal sum |
| Terrorism Coverage | Up to US$50,000 lifetime maximum |
| Identity Theft Assistance | Up to US$500 per Period of Coverage |
| Trip Interruption | To US$5,000 |
| Lost Luggage | Up t o US$50 per item or personal property; maximum of US$250 per Period of Coverage |
| ADDITIONAL BENEFITS FOR US CITIZENS ONLY | |
| Indemnity | Up to US$100 per night |
| Sudden Recurrence of
a Pre-existing Condition Medical |
Up to US$15,000 of eligible expenses |
| Sudden Recurrence of
a Pre-existing Condition Emergency Medical Evacuation |
Up to US$25,000 of eligible costs and expenses |
|
Sports and Activities Coverage The Patriot International 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 Sports Rider: The Leisure Sports Rider is available on the Patriot International plan and adds coverage for jet skiing, scuba diving, snow skiing, snowboarding, snowmobiling, snorkeling, surfing, wakeboarding, water skiing and windsurfing. Extreme Sports Rider: The Extreme Sports Rider is available on the Patriot International plan, and adds up to 12 months of coverage for those under the age of 49. This rider provides up to US$50,000 lifetime maximum for the following activities: abseiling, BMX, bungee jumping, canyoning, caving, flying (private plane), hang gliding, heli-skiing, high diving, hot air ballooning, kayaking, inline skating, mountain biking, mountaineering (ropes and guides to 4500m from ground level), paragliding, parascending, rappelling, rock climbing (ropes and guides to 4500m from ground level), skydiving, spelunking, whitewater rafting (to Class V). These extreme activities must be engaged in solely for leisure, recreation, or entertainment purposes. |
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| 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 Policy Wording with all terms, conditions and exclusions will be included with the fulfillment kit. IMG reserves the right to issue the most current Policy 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 Policy Wordings are available upon request. | |