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Patriot Group Insurance:

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Benefits:

Standard Short-Term Travel Plan
Schedule of Benefits Benefit Description
Deductible $100 per illness or injury
Coinsurance 100%
Plan maximum Choice of $50,000, $250,000 or $500,000 per illness or injury with a lifetime maximum of $500,000
Treatment period 60 days per chronic illness
Hospital room & board Up to semi-private room rate
Hospital intensive care URC*
Physical therapy URC*, 1 visit per day
Physician visit URC*
Eligible medical expenses URC*
Dental Sudden and unexpected pain, $85; Accident, $500
Emergency Room
Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional $250 deductible if treatment does not require admittance to the hospital 		URC*
Emergency medical evacuation $50,000
Emergency reunion $15,000
Return of mortal remains $25,000
Accidental death $25,000
Dismemberment Dismemberment: $25,000 two limbs; $12,500 one limb
Optional Add-on Plan
Schedule of Benefits Benefit Description
Baggage  
•Loss/theft of Baggage $250
•Loss/theft of Valuables $250
•Loss/theft of Personal Papers $250
Legal Assistance  
•Binder Fee $500 when served with summons
Personal liability  
•Injury to third party $2,000 limit after $100 deductible
•Damage to third person property $500 limit after $100 deductible Secondary to any other insurance in force
Limited high school sports coverage  

*Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment.

BASIC SHORT-TERM TRAVEL PLAN
Schedule of Benefits Benefit Description
Deductible $100 per illness or injury
Coinsurance 100%
Plan maximum $10,000 per illness or injury with a lifetime maximum of $500,000
Treatment period 60 days per chronic illness
Hospital room & board Up to semi-private room rate
Hospital intensive care URC*
Physical therapy URC*, 1 visit per day
Physician visit URC*
Eligible medical expenses URC*
Emergency Room
Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional $250 deductible if treatment does not require admittance to the hospital 		URC*
Emergency medical evacuation $25,000 lifetime maximum
Emergency reunion $5,000 lifetime maximum
Return of mortal remains $7,500
Accidental death $5,000
Dismemberment Dismemberment: $5,000 two limbs; $2,500 one limb
Optional Add-on Plan
Schedule of Benefits Benefit Description
Baggage  
•Loss/theft of Baggage $250
•Loss/theft of Valuables $250
•Loss/theft of Personal Papers $250
Legal Assistance  
•Binder Fee $500 when served with summons
Personal liability  
•Injury to third party $2,000 limit after $100 deductible
•Damage to third person property $500 limit after $100 deductible Secondary to any other insurance in force
Limited high school sports coverage  
*Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment.
Plan Information

What is Coinsurance ?

For treatment received outside the US & Canada: No coinsurance

For treatment received within the US & Canada: The plan pays 80% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum

What is Benefit Period ?

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.

 
SPECIAL COVERAGES

What is a Home country coverages ?

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).

What is a Trip Interruption ?

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.

How you get Bene fitted if you Lost your Luggage ?

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 ?

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.

Accidental Death & Dismemberment ?
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. For more information, see the Conditions of Coverage section on page 14 of the Patriot Group brochure.
Exclusion
Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under the Patriot Group plans.
  1. 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.
  2. Treatment or surgeries which are elective, investigational, experimental or for research purposes.
  3. War, military action, terrorism, political insurrection, protest, or any act thereof.
  4. Immunizations and routine physical exams.
  5. Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.
  6. 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.
  7. Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
  8. 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, wind-surfing and whitewater rafting.
  9. Vision or ear tests and the provision of visual or hearing aids.
  10. Vocational, recreational, speech or music therapy.
  11. Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
  12. 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.
  13. Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
  14. 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.
  15. Willful self-inflicted injury or illness.
  16. Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.
  17. Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
  18. Treatment for mental and nervous disorders.
  19. Organ or tissue transplants or related services.
  20. 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.
  21. 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 Group 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.
 
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