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 - Standard Short-Term Travel Plan
Plan Maximum Choice of $50,000, $250,000 or $500,000 per illness or injury with a Lifetime Maximum of $5,000,000
Coinsurance No coinsurance
Deductible $100 per Illness or Injury
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 provided for dependents of faculty, scholars, students and exchange participants
Optional Add-on Plan Additional coverage is available for high school sports, personal liability and legal assistance
Pre-existing Conditions Available to U.S. and non-U.S. citizens - see Additional Benefits for more information
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 URC*
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
INTERNATIONAL EMERGENCY CARE When coordinated through the Plan Administrator
Emergency Medical Evacuation $50,000 Lifetime Maximum
Emergency Reunion $15,000 Lifetime Maximum
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
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)
Pre-existing Conditions (U.S. & non-U.S.)(For U.S. citizens, this benefit will begin when the Sudden Recurrence benefit is exhausted) $500 per year; $50,000 lifetime maximum - after 12 months of continuous coverage
Incidental Home Country Coverage Up to a cumulative two weeks
OPTIONAL ADD-ON PLAN
Baggage
Legal Assistance
Personal Liability
Damage to third person property $500 limit after $100 deductible. Secondary to any other insurance in force
Limited High School Sports Coverage URC*

* 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.