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Patriot Multi-Trip Group 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 age 70-75	$50,000
Deductible	$250 per insured person for each covered illness. This deductible is 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
Benefit Period	Click for more information
If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the thirty day Benefit Period may offer continued coverage for that injury or illness. When the Certificate expires, the Company will review the date of initial treatment for the covered injury or illness. If treatment began less than thirty days before the Period of Coverage expired, benefits for the covered injury or illness continues. This is subject to the $5,000 Maximum Limit, proof of current medical insurance and the other terms of the plan, until there have been thirty days of continuous coverage for the covered injury or illness.

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 admission to the hospital.
Dental	As described below
Injury due to an accident: The plan covers the cost of emergency dental treatment and dental surgical procedures necessary to restore or replace sound natural teeth lost or damaged in an accident up to the Maximum Limit. Sudden dental emergency: The plan pays up to $100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.
Sudden and Unexpected Recurrence of a Pre-existing Condition - Medical	As described below
The plans 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 of Insurance).
Sudden and Unexpected Recurrence of a Pre-existing Condition - Emergency Medical Evacuation	As described below
Up to $25,000 is payable for the eligible costs and expenses of an Emergency Medical Evacuation arising or resulting from a Sudden and Unexpected Recurrence of a Pre-existing Condition.
Hospital Daily Indemnity (for U.S. citizens only)	Up to $100 per night up to a maximum of 10 days
Patriot Multi-Trip Group International pays $100 directly to the insured person for each night of a required overnight stay in a hospital up to a maximum of 10 days. The hospital stay must be covered under this plan in order to receive this benefit.

INTERNATIONAL EMERGENCY CARE	(when coordinated through the Plan Administrator)
Emergency Evacuation	Up to the Maximum Limit
The Patriot Multi-Trip Group plan offers coverage for emergency medical evacuation to the nearest qualified medical facility; expenses for reasonable transportation resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred. The plan pays up to the Maximum Limit for covered incidents for insured persons under age 66; and up to $50,000 for covered incidents for insured persons from ages 66 to 75.
Emergency Reunion	Up to $50,000
The Patriot Multi-Trip Group plan also offers emergency reunion coverage, up to $50,000 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 $50,000
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 $50,000.
Return of Minor Children	Up to $50,000
If an insured person is admitted to the hospital in-patient 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 Group plan will reimburse up to $50,000 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 pays 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 is payable to the designated beneficiary, up to a maximum of $250,000 per family.
Sports & Activities Coverage	Up to the Maximum Limit for basic sports as described below
Each Patriot Multi-Trip Group plan covers injuries incurred during athletic activities which are non-organized, non-contact and engaged in by the insured person solely for leisure, recreation, entertainment or fitness purposes. Some of these sports and activities include, but are not limited to, motor cycle/motorscooter riding, recreational downhill and/or cross country snow skiing, horseback riding, sub-aquatic activites (to 10m), wakeboarding, and water skiing. However, activities not covered include amateur or professional sports or other athletic activity which is organized, sponsored and/or sanctioned by the National Collegiate Athletic Association (and/or any other collegiate sanctioning or governing body), or the International Olympic Committee, and/or Adventure Sports. Please note this is only a summary of sports and activities and exclusions. For additional information, please refer to the Certificate of Insurance.
Accidental Death & Dismemberment	$25,000 principal sum
The Patriot Multi-Trip Group plan offers a $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 two Members - principal sum • Accidental Loss of one Member - 50% of principal sum. “Member” means hand, foot or eye.
Terrorism Coverage	$50,000 lifetime maximum
The Patriot Multi-Trip Group plan provides coverage for injuries and illness incurred as a result of an act of Terrorism, limited in amount and by circumstances. 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 reimburses eligible medical claims subject to a $50,000 lifetime maximum Terrorism includes criminal acts, including against civilians, committed with the intent to cause death or serious bodily injury, or taking of hostages, with the purpose to provide a state of terror in the general public or in a group of persons or particular persons, intimidate a population, or compel a government of international organization to do or to abstain from doing an act. However, this benefit does not cover an act of Terrorism in any country or location where the United States government has issued a travel advisory that has been in effect within the six months prior to the insured person’s date of arrival. However, claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered. This benefit also 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 heed such warning or 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 Group plans provide coverage for up to $500 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.
Trip Interruption	Up to $5,000
If, during a covered trip, there is an Unexpected 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 Group plan pays to return the insured to the area of principal residence. The plan pays 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
A benefit of $50 per luggage item, up to a maximum of $250, is payable in the event that the Common Carrier permanently loses an insured person’s checked luggage while in transit. This coverage is secondary to any other available reimbursement, including the Carrier’s.

* 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.

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Patriot Multi-Trip Group Medical Insurance

Schedule of Benefits