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Patriot Platinum Travel Medical InsuranceSM
Patriot Platinum Travel Medical InsuranceSM

All amounts shown are in U.S. dollars.
PLAN INFORMATION
Maximum Limits $2,000,000 to $8,000,000
Deductible $0 to $25,000
Extensions Up to 36 continuous months
Emergency Medical Evacuation
Up to maximum limit
Coinsurance for treatment received inside the U.S ( Patriot America Platinum ) ( In-Network ) IMG pays 100%
Coinsurance for treatment received inside the U.S ( Patriot America Platinum ) ( Out-of-Network ) IMG pays 90% up to $5,000, then 100%
Coinsurance for treatment received outside the U.S ( Patriot International Platinum ) IMG pays 100%
Acute Onset of Pre-Existing Conditions
(Insured person must be under 70 years of age)
United States citizens:
Age 64 and under without a primary health plan:
  • Maximum limit: $20,000
Age 64 and under with a primary health plan:
  • Up to the period of coverage limit or $1,000,000 (whichever is lower)
Age 65 through age 69:
  • Maximum limit: $2,500
Non-United States citizens:
Age 69 and under:
  • Up to the period of coverage limit or $1,000,000 (whichever is lower)
$25,000 maximum limit for emergency medical evacuation
Remote Transportation $5,000 per period, $20,000 lifetime maximum
Supplemental Accident $300 per covered accident
Incidental emergency in the U.S ( Patriot International Platinum ) Up to 2 weeks
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
Emergency Reunion
(Must be approved in advance by the company)
$100,000 maximum limit. Not subject to deductible
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
Return of Minor Children
(Must be approved in advance by the company)
$100,000 maximum limit. Not subject to deductible
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
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
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
Chiropractic Care
Medical order or treatment plan required
Up to the maximum limit
Extended Care Facility
Upon direct transfer from an acute care facility
Up to the maximum limit
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%
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
Emergency Eye Examination
Loss or damage to prescription corrective lenses due to an accident
$150 maximum limit. $50 deductible per occurrence. Subject to coinsurance
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.
Pet Return
For a pet cat or dog traveling with the insured person
$1,000 maximum limit. Not subject to deductible
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.