jill.stone@insure4travel.com
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Patriot Travel Medical Insurance®
Patriot Travel Medical Insurance®

All amounts shown are in U.S. dollars.
PLAN INFORMATION
Maximum Limits $50,000, $100,000, $500,000, $1,000,000, $2,000,000 (Patriot International only)
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 within 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 Fifty percent (50%) reduction of Eligible Medical Expenses if pre-certification provisions are not met.
Hospital Room and 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 Up to the maximum limit
Diagnostic Procedures Up to the maximum limit
Prescription Medication Up to the maximum limit
Home Health Care Up to the maximum limit
Emergency Local Ambulance Up to the maximum limit
Durable Medical Equipment Up to the maximum limit
Emergency Dental Treatment $300 maximum limit due to accident or unexpected pain to sound natural teeth.
Traumatic Dental Injury
Treatment at a hospital due to an accident 		Up to the period of coverage maximum limit
Subject to deductible and coinsurance
Additional treatment for the same injury rendered by a dental provider will be paid at 100%
Emergency Medical Evacuation
Must be approved in advance and coordinated by the company 		$1,000,000 maximum limit. Not subject to deductible.
Emergency Reunion
Must be approved in advance by the company		 $50,000 maximum limit. Not subject to deductible.
Return of Mortal Remains or Cremation/Burial
Must be approved in advance by the company		 $50,000 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.
Return of Minor Children
Must be approved in advance by the company		 $50,000 maximum limit. Not subject to deductible.
Political Evacuation
Must be approved in advance by the company		 $10,000 maximum limit. Not subject to deductible.
Natural Disaster $250 per day and maximum limit of five days for accommodations. Not subject to deductible.
Terrorism Up to $50,000 lifetime maximum. Not subject to deductible.
Acute Onset of a Pre-existing Condition - Medical (Patriot International Only) U.S. citizen up to age 65 with primary health plan: Up to maximum limit.
U.S. citizen up to age 65 without primary health plan: $20,000 lifetime maximum.
U.S. citizen age 65 to age 70: $2,500 lifetime maximum.
Non-U.S. citizen up to age 70: Up to maximum limit or $500,000 - whichever is lower.
Acute Onset of a Pre-existing Condition - Emergency Medical Evacuation (Patriot International Only) Up to age 65: $25,000 maximum limit
Urgent Care $25 co-pay. Co-pay is not applicable when the $0 deductible is selected.
Not subject to deductible
Walk-in Clinic $15 co-pay. Co-pay 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: International Deductible waived
Hospital Emergency Room: United States 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
Hospital Indemnity Up to $100 per overnight up to a maximum of 10 overnights. Not subject to deductible.
Common Carrier Accidental Death $50,000 per insured person and $250,000 Maximum limit per lifetime and per Family. Not subject to deductible.
Accidental Death & Dismemberment $25,000 principal sum. Not subject to deductible.
Identity Theft Assistance Up to $500. Not subject to deductible.
Trip Interruption Up to $5,000. Not subject to deductible.
Lost Luggage Up to $50 per item; maximum of $250. 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.

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