Patriot Adventure Travel Medical Insurance

Schedule of Benefits

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

PLAN INFORMATION
Deductible $250 per Period of Coverage
Maximum Limit $50,000
Coinsurance As described below
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
Dental As described below
INTERNATIONAL EMERGENCY CARE (when coordinated through the Plan Administrator)
Emergency Evacuation Up to the Maximum Limit
Emergency Reunion Up to $10,000
Return of Mortal Remains or Cremation/Burial Up to $15,000 for Return of Mortal Remains or $5,000 for Cremation/Burial
Political Evacuation Up to $10,000
Additional Benefits
Benefit Period Three months
Common Carrier Accidental Death $50,000 to Beneficiary; maximum of $250,000 per family
Sports & Activities Up to the Maximum Limit for basic and Adventure sports as described below
Trip Interruption Up to $5,000
Lost Luggage Up to $50 per item; maximum of $250
Additional Benefits for U.S. Citizens
Indemnity Click for more information
Sudden Recurrence of a Pre-existing Condition Click for more information

* This Web page contains only a brief summary of current benefits, conditions, limitations and exclusions, and is subject to all the terms and conditions of the full Certificate of Insurance. The complete Certificate of Insurance with all terms, conditions and exclusions will be included in the fulfillment kit sent to approved applicants.  These plans are amended, modified or replaced from time to time, and IMG reserves the right to issue the most current Certificate of Insurance 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. Samples of current Certificate wordings are available upon request.