International Medical Group

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Patriot Travel Medical Insurance

Schedule of Benefits and Limits
Maximum Limits $50,000, $100,000, $500,000, $1,000,000, $2,000,000
Deductible Your choice of $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 $5,000, then 100% up to the Maximum Limit
For treatment received within the US & Canada:
Out of PPO Network
The plan pays 80% of eligible expenses up to $5,000, then 100% up to the Maximum Limit
MEDICAL BENEFITS
Usual reasonable and customary charges, subject to deductible and coinsurance
Hospital Room and Board Up to Maximum Limit for average semi-private room rate
Intensive Care Up to Maximum Limit
Medical Expenses Up to Maximum Limit
Outpatient Medical Up to Maximum Limit
Local Ambulance Up to Maximum Limit
Emergency Room Accident Up to Maximum Limit
Emergency Illness
with in-patient admission
Up to Maximum Limit
Emergency Illness
without in-patient admission
Up to Maximum Limit with an additional $250 deductible
Dental
Injury due to accident
Up to Maximum Limit
Dental
Sudden dental pain
Up to $100
INTERNATIONAL EMERGENCY CARE
Emergency Evacuation Up to $500,000 independent of Maximum Limit.
Emergency Reunion Up to $50,000
Return of Mortal Remains Up to $50,000
Returning Minor Children Up to $50,000
Political Evacuation Up to $10,000
Natural Disaster $100 per day for five days
Identity Theft Assistance Up to $500 per Period of Coverage
ADDITIONAL BENEFITS
Terrorism Coverage Up to $50,000 lifetime maximum
Sports & Activities Coverage Up to Maximum Limit for basic sports
Incidental 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
Trip Interruption  To $5,000
Common Carrier Accidental Death $50,000 to Beneficiary; maximum of $250,000 per family
Accidental Death & Dismemberment $25,000 principal sum
Lost Luggage Up t o $50 per item or personal property; maximum of $250 per Period of Coverage
Benefit Period Six months
ADDITIONAL BENEFITS
Indemnity Up to $100 per night
Sudden & Unexpected Recurrence of a Pre-existing Condition
For US citizens only
- Up to age 65 with a Primary Health plan - URC up to certificate maximum
- Up to age 65 without a Primary Health plan - $20,000 lifetime maximum
- Age 65 + with or without a Primary Health plan - $2,500 lifetime maximum
Sudden & Unexpected Recurrence of a Pre-existing Condition
For non-US citizens only
- Up to age 65 - $50,000 lifetime maximum for eligible medical expenses
- Age 65 - $2,500 lifetime maximum
Sudden Recurrence of a Pre-existing Condition
Emergency Medical Evacuation
Up to $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 $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.

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.