Patriot Group Exchange Program

Schedule of Benefits

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

PLAN INFORMATION & HIGHLIGHTS - Long-Term Annual Plan
Plan Maximum Customizable from $50,000 to a Lifetime Maximum of $5,000,000
Coinsurance 100%
Deductible In-patient $100; Out-patient $40
Treatment Period 60 days per chronic illness
MyIMGSM 24 hour secure access from anywhere in the world to manage your account at anytime
International Emergency Care A wide range of international emergency benefits available including emergency evacuation, emergency reunion, and return of mortal remains
Dependent Coverage Coverage not only provided for dependents, but for faculty, scholars, students and exchange participants as well
Optional Add-on Plan Additional coverage is available for high school sports, personal liability and legal assistance
MEDICAL BENEFITS *Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment.
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 Up to Policy Maximum
Eligible Medical Expenses URC*
Emergency Room URC*
Emergency Room Illness with In-patient Admission URC*
Emergency Room Illness without In-patient Admission Additional $250 deductible
Dental Click for more information
INTERNATIONAL EMERGENCY CARE When coordinated through the Plan Administrator
Emergency Evacuation Maximum Limit
Emergency Reunion $15,000
Return of Mortal Remains or Cremation/Burial Up to $25,000 for Return of Mortal Remains or $5,000 for Cremation/Burial
Political Evacuation Up to $10,000
ADDITIONAL BENEFITS
Accidental Death $25,000 (hazardous sports excluded)
Dismemberment $25,000 two limbs;
$12,500 one limb
Terrorism Up to $50,000 Lifetime Maximum
Sudden Recurrence of a Pre- existing Condition (U.S. citizens)
TMJ $5,000 Lifetime Maximum
High School Sports Coverage Organized sports coverage; Professional sports excluded
Baggage
OPTIONAL ADD-ON PLAN
Legal Assistance
Personal Liability