Patriot Exchange Program

Summary of Benefits (Individual and Group)

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

Summary of Benefits
Plan Maximum Choice of $50,000, $100,000, $250,000 or $500,000 per illness or injury with a lifetime maximum of $5,000,000
Deductible $100 per illness or injury
Coinsurance No coinsurance
Treatment Period Maximum 60 days for chronic conditions
Inpatient/Outpatient Benefits
Hospital Room and Board Up to semi-private room rate
Hospital Intensive Care URC*
Physical Therapy URC* - 1 visit per day
Physician Visit URC* - 1 visit per day
Student Health Center $5 co-pay per visit
Prescription Drugs URC*
Eligible Medical Expenses URC*
Emergency Room visit with In-patient Admission URC*
Emergency Room visit without In-patient Admission Additional $250 deductible
Dental - Treatment Due to Accident $500 maximum
Evacuation Benefits
Emergency Medical Evacuation $50,000 lifetime maximum
Emergency Reunion $15,000 lifetime maximum
Return of Mortal Remains or Cremation/Burial $25,000 maximum for Return of Mortal Remains or $5,000 for Cremation/Burial
Political Evacuation $10,000 lifetime maximum
ADDITIONAL BENEFITS
Accidental Death & Dismemberment $25,000 ($25,000 two limbs; $12,500 one limb)
Terrorism $50,000 lifetime maximum
Sudden & Unexpected Recurrence of a Pre-existing Condition (U.S. Citizens plan only)
Pre-Existing Conditions For conditions existing within 36 months before effective date, charges excluded after 12 months of coverage and then $500 maximum per period of coverage and $50,000 lifetime maximum
Incidental Trip Coverage Up to a cumulative two weeks
OPTIONAL ADD-ON Riders
Lost Personal Property $250 maximum
Legal Assistance $500 maximum
Personal Liability
High School, Interscholastic, Intramural, or Club Sports URC*

This invitation to inquire allows eligible applicants an opportunity to inquire further about the insurance offered and is limited to a brief description of any loss for which benefits may be payable. Benefits are offered as described in the insurance contract. Benefits are subject to all deductibles, coinsurance, provisions, terms, conditions, limitations, and exclusions in the insurance contract. The contract does contain a pre-existing condition exclusion and does not cover losses or expenses related to a pre-existing condition.

Groups may also purchase a customizable long-term plan. Any coverages, benefits & premium rates offered are in U.S. Dollars.