Patriot Travel Medical Insurance®
All amounts shown are in U.S. dollars.
All amounts shown are in U.S. dollars.
| PLAN INFORMATION | |
| Maximum Limits | $50,000, $100,000, $500,000, $1,000,000 |
| Individual Deductible Options | $0, $100, $250, $500, $1,000, $2,500 |
| Coinsurance for treatment received outside the U.S. | Company pays 100% |
| Coinsurance for treatment received in the U.S. |
In the PPO network: Company pays 100%
Out of the PPO network: Company pays 80% of eligible expenses up to $5,000, then 100% |
| Incidental Trips to Home Country |
14 consecutive days maximum limit
Insured person’s country of residence is not the U.S. |
| Incidental Emergency Coverage in the U.S.
(Patriot International only) | 14 consecutive days maximum limit. Available only for a covered emergency medical evacuation or an emergency injury or illness that manifested during travel through the United States to or from the host country |
| Pre-Certification | 50% reduction of eligible medical expenses if pre-certification provisions are not met |
| Hospitalization/Room & Board | Average semi-private room rate up to the maximum limit. Includes nursing service |
| Intensive Care | Up to the maximum limit |
| Surgery | Up to the maximum limit |
| Physician Visits/Services | Up to the maximum limit |
| Radiology/X-ray | Up to the maximum limit |
| Prescriptions (Dispensing limit per prescription: 90 days) | Up to the maximum limit |
| Home Nursing Care (Upon direct transfer from an acute care facility) | Up to the maximum limit |
| Emergency Local Ambulance (Injury or illness resulting in an inpatient hospital admission) | Up to the maximum limit. Subject to deductible and coinsurance |
| Durable Medical Equipment | Up to the maximum limit |
| Dental Treatment | $300 maximum limit due to dental accident or unexpected pain to sound natural teeth. Subject to deductible and coinsurance |
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Emergency Medical Evacuation (Must be approved in advance and coordinated by the company) | $1,000,000 |
|
Emergency Reunion (Must be approved in advance by the company) | $100,000 maximum limit. Not subject to deductible |
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Return of Mortal Remains or Cremation/Burial (Must be approved in advance by the company) | Up to the maximum limit for return of mortal remains or ashes to country of residence, or $5,000 maximum limit for cremation or local burial at the place of death. Not subject to deductible |
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Return of Minor Children (Must be approved in advance by the company) | $100,000 maximum limit. Not subject to deductible |
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Political Evacuation & Repatriation (Must be approved in advance by the company) | $100,000 maximum limit. Not subject to deductible |
| Natural Disaster Evacuation Must be approved in advance by the company | $25,000 maximum limit. Not subject to deductible. |
| Terrorism | $50,000 maximum limit. Not subject to deductible |
| Acute Onset of Pre-Existing Conditions
(Insured person must be under 70 years of age) (Patriot International only) |
United States citizens:
Age 64 and under without a primary health plan:
Age 69 and under:
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| Urgent Care Clinic | $25 copay. Copay is not applicable when the $0 deductible is selected. Not subject to deductible. |
| Walk-In Clinic | $15 copay. Copay is not applicable when the $0 deductible is selected. Not subject to deductible |
|
Physical Therapy
(Medical order or treatment plan required) | Up to the maximum limit |
| Hospital Emergency Room
(Outside the U.S.) | Up to the maximum limit |
| Hospital Emergency Room
(Inside the U.S.) |
Injury not subject to emergency room deductible Illness: Subject to a $250 deductible for each emergency room visit for treatment that does not result in direct inpatient hospital admission. Up to the maximum limit |
| Hospital Indemnity | $250 per overnight inpatient confinement, maximum limit of 10 overnights. Not subject to deductible |
| Common Carrier Accidental Death | $25,000 per insured child, $100,000 per insured adult, $250,000 maximum limit per family. Not subject to deductible |
| Accidental Death & Dismemberment (AD&D) Death must occur within 90 days of the accident | $50,000 principal sum. Not subject to deductible. |
| Identity Theft | $500 maximum limit. Not subject to deductible |
| Trip Interruption | $10,000 maximum limit. Not subject to deductible |
| Lost Luggage | $50 per item, $500 maximum limit. Not subject to deductible |
| Eligible Medical Expenses | Up to the maximum limit |
| Bedside Visit
Hospitalized in an intensive care unit | $1,500 maximum limit. Not subject to deductible. |
| Outpatient Surgical / Hospital Facility | Up to the maximum limit |
| Laboratory | Up to the maximum limit |
| Chemotherapy / Radiation Therapy | Up to the maximum limit |
| Pre-Admission Testing | Up to the maximum limit |
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Reconstructive Surgery
Surgery is incidental to and follows surgery that was covered under the plan | Up to the maximum limit |
| Assistant Surgeon | 20% of the primary surgeon’s eligible fee |
| Anesthesia | Up to the maximum limit |
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Chiropractic Care
Medical order or treatment plan required | Up to the maximum limit |
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Extended Care Facility
Upon direct transfer from an acute care facility | Up to the maximum limit |
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Interfacility Ambulance Transfer
Transfer from one licensed health care facility to another licensed health care facility resulting in an inpatient hospital admission | Company pays 100% |
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Traumatic Dental Injury
Treatment at a hospital due to an accident | Up to the maximum limit. Additional treatment for the same injury rendered by a dental provider will be paid at 100%. Subject to deductible and coinsurance. |
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Emergency Eye Examination
Loss or damage to prescription corrective lenses due to an accident | $150 maximum limit. $50 deductible per occurrence. Subject to coinsurance. |
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Personal Liability
Secondary to any other insurance | $25,000 combined maximum limit. Injury to a third person: $100 per injury deductible. Damage to a third person’s property: $100 per damage deductible. No coverage for injury to a related third party or damage to related third person’s property. |
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Pet Return
For a pet cat or dog traveling with the insured person | $1,000 maximum limit. Not subject to deductible |
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Small Pet Common Air Carrier Accidental Death Benefit
For a pet cat or dog up to 30 pounds traveling with the insured person | $500 maximum limit. Not subject to deductible. |
| Natural Disaster | $250 per day and maximum limit of five days for accommodations. Not subject to deductible. |
* This Web page contains only a consolidated and summary description of all current 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 Web page, application, and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.