Patriot Multi-Trip Travel Medical Insurance

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Patriot Multi-Trip Travel Medical Insurance

Schedule of Benefits

All amounts shown are in U.S. dollars. Click the orange headers for further information.

PLAN INFORMATION
Maximum Limit	$1,000,000
Maximum Limit for travelers who are 70-75 years old	$50,000
Deductible	$250 per each covered Illness; deductible waived for claims incurred as a result of a covered accident
Coinsurance	Click for more information
For treatment received outside the U.S. & Canada: No coinsurance For treatment received within the U.S. & Canada: In the PPO Network: The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Maximum Limit Outside the PPO Network: The plan pays 80% of eligible expenses up to $5,000, then 100% up to the Maximum Limit
Coinsurance	Click for more information
For treatment received outside the U.S. & Canada: No coinsurance For treatment received within the U.S. & Canada: In the PPO Network: The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Maximum Limit Outside the 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 the Maximum Limit for average semi-private room rate
Intensive Care	Up to the Maximum Limit
Medical Expenses	Up to the Maximum Limit
Out-patient Medical	Up to the Maximum Limit
Local Ambulance	Up to the Maximum Limit
Emergency Room Accident	Up to the Maximum Limit
Emergency Illness - with in-patient admission	Up to the Maximum Limit
Emergency Illness - without in-patient admission	Up to the Maximum Limit with additional $250 deductible
Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional (extra) $250 deductible if treatment does not require admittance to the hospital.
Dental	As described below
Injury due to an accident: The plan covers the cost of emergency dental treatment and dental procedures necessary to restore sound natural teeth lost or damaged in an accident up to the Maximum Limit. Sudden dental pain: The plan will pay up to $100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.
Pre-existing Conditions	Up to $5,000 per period of coverage
The plan will cover up to $5,000 maximum, per insured person, per period of coverage (not per trip), for the sudden and unexpected recurrence of a pre-existing condition, as defined in the certificate wording.

INTERNATIONAL EMERGENCY CARE	(when coordinated through the Plan Administrator)
Emergency Evacuation	Up to the Maximum Limit
The Patriot Multi-Trip plan includes coverage for emergency medical evacuation to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred. The plan will pay up to the Maximum Limit for covered incidents for insured persons under age 66; up to $50,000 for covered incidents for insured persons from ages 66 to 75; and up to $25,000 for evacuations resulting from a pre-existing condition.
Emergency Reunion	Up to $15,000
The Patriot Multi-Trip plan also provides emergency reunion coverage, up to $15,000 for a maximum of 15 days, for the reasonable travel and lodging expenses of a relative or friend during an emergency medical evacuation of the insured person: either the cost of accompanying the insured during the evacuation or traveling from the home country to be reunited with the insured.
Return of Mortal Remains	Up to $25,000
If a covered illness/injury results in death, expenses for repatriation of bodily remains or ashes to the home country will be covered up to a maximum of $25,000.
Return of Minor Children	Up to $5,000
If an insured person is hospitalized due to a covered illness/injury and is traveling alone with child(ren) 19 or under that otherwise would be left unattended, the Patriot Multi-Trip plan will reimburse up to $5,000 for one way economy fare to their home country, including a chaperone, if necessary, for the safety of the child(ren).
Political Evacuation	Up to $10,000
If the United States Department of State, Bureau of Consular Affairs, or similar government organization of the Insured Person’s Home Country, orders the evacuation of all non-emergency government personnel from the Host Country, due to political unrest, that becomes effective on or after the Insured Person’s date of arrival in the Host Country, the Company will pay up to a $10,000 lifetime maximum for transportation to the nearest place of safety or for repatriation to the Insured Person’s home country or country of residence provided that: The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular Affairs, or similar government organization of the Insured Person’s Home Country, issuance of the evacuation order; and The evacuation order pertains to persons from the same Home Country as the Insured Person; and Political Evacuation and Repatriation is approved and coordinated by the Company; In no event will the Company pay for a Political Evacuation if there is a Travel Warning in effect on or within six (6) months prior to the Insured Person’s date of arrival in the Host Country.

ADDITIONAL BENEFITS
Common Carrier Accidental Death	$50,000 to Beneficiary; maximum of $250,000 per family
If accidental death should occur while traveling on a commercial Common Carrier, $50,000 will be paid to the designated beneficiary, to a maximum of $250,000 per family.* * Notwithstanding separate benefits, limits and sublimits for Common Carrier Accidental Death benefit and Accidental Death & Dismemberment benefits (above), no more than $50,000 dollars per individual will be paid to a beneficiary in the event of any death that occurs while covered by the Patriot Multi-Trip plan.
Sports & Activities Coverage	Up to the Maximum Limit for basic sports as described below
The Patriot Multi-Trip 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, kiteboarding, 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.
Accidental Death & Dismemberment	$25,000 principal sum
The Patriot Multi-Trip plan includes $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 life which occurred during a hijacking, kidnapping or attempted kidnapping - two times the 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 Additional Coverage Information page.
Terrorism Coverage	$50,000 lifetime maximum
The Patriot Multi-Trip plan provides coverage for injuries and illness incurred as a result of an act of Terrorism, subject to one $50,000 lifetime maximum. If an insured person is injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims subject to a $50,000 lifetime maximum. Claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered. Terrorism is the systematic or planned use of violence, fear, or threat of violence in order to intimidate a population or government, especially as a means of coercion or to obtain a granting of any demand. This benefit does not cover an act of Terrorism in a country or location where the United States government has issued a travel advisory that has been in effect within the 6 months prior to the insured person's date of arrival. This benefit does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location.
Identity Theft Assistance	Up to $500 per Period of Coverage
If an imposter obtains key personal information such as a Social Security or Driver's License number, or other method of identifying an insured person in order impersonate or obtain credit, merchandise or services in the insured person's name, the Patriot Multi-Trip plans will provide coverage for the reasonable, customary and necessary costs incurred by the insured for: re-filing a loan or other credit application that is rejected solely as a result of the stolen indentity event; notarization of legal documents, long distance telephone calls, and postage that has resulted solely as a result of reporting, amending and /or rectifying records as a result of the stolen identity event; up to three credit reports obtained within one year of the insured person's knowledge of the stolen identity event; and stop payment orders placed on missing or unauthorized checks as a result of the stolen identity event. The identity theft event must occur during the Period of Coverage and must be reported within six months of the termination of coverage date.
Trip Interruption	Up to $5,000
If, during a covered trip, there is a death of an immediate family member (spouse, child, parent or sibling), a break-in at the insured’s principle residence, or the substantial destruction of the insured’s principal residence due to a fire or natural disaster, each Patriot Multi-Trip 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.
Lost Luggage	Up to $50 per item of luggage; maximum of $250
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.

* 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. These plans are amended, modified or replaced from time to time, and 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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Schedule of Benefits

Patriot Multi-Trip Travel Medical Insurance

Schedule of Benefits