Patriot Travel Medical Insurance

Schedule of Benefits

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

PLAN INFORMATION
Maximum Limits $50,000, $100,000, $500,000, $1,000,000, $2,000,000 (U.S. citizens only)
Individual Deductible options $0, $100, $250, $500, $1,000, $2,500
Coinsurance - for treatment received outside the U.S. No Coinsurance (0%)
Coinsurance - for treatment received within the U.S. In the PPO Network - 10% of eligible expenses up to $5,000, then 0% Out of the PPO Network - 20% of eligible expenses up to $5,000, then 0%
Continuation of Treatment Period Six months per injury or illness
Incidental Home Country Coverage Up to 14 days
End of Trip Home Country Coverage One month for every six months of travel coverage purchased, up to a maximum of two months.
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 Nursing Care Up to the maximum limit
Local Ambulance Expense Up to the maximum limit
Emergency Room Up to the maximum limit. Additional $250 deductible if not admitted as an inpatient.
Dental Emergency Up to maximum limit for treatment due to an accident. $100 maximum limit for treatment of unexpected pain to sound natural teeth.
Emergency Medical Evacuation Up to $500,000 lifetime maximum (independent of the Maximum limit). Not subject to deductible.
Emergency Reunion Up to $50,000 lifetime maximum
Return of Mortal Remains or Cremation/Burial Up to $50,000 for return of mortal remains or $5,000 for cremation/burial. Not subject to deductible.
Return of Minor Children Up to $50,000. Not subject to deductible.
Political Evacuation Up to $10,000. Not subject to deductible.
Natural Disaster Up to $100 per day and five days for accommodations. Not subject to deductible.
Terrorism Up to $50,000 lifetime maximum. Not subject to deductible.
Sudden and Unexpected Recurrence of a Pre-existing Condition - Medical (for U.S. citizens only) Up to age 65 with primary health plan: URC up to maximum limit. Up to age 65 without primary health plan: $20,000 lifetime maximum. Age 65+: $2,500 lifetime maximum.
Sudden and Unexpected Recurrence of a Pre-existing Condition - Emergency Medical Evacuation (for U.S. citizens only) Up to age 65: $25,000 maximum limit
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 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.