Patriot America® provides coverage for non-U.S. citizens traveling outside
their home country for a minimum of 5 days up to a maximum of two years. If the plan is
purchased for a minimum of three months, coverage may be renewed (without break in coverage)
for a total of up to two years.
If you or other family members applying for coverage are age 65 or older, please see the Eligibility
section in the brochure for additional information.
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PATRIOT AMERICA POLICY PREMIUMS
All rates displayed are for a US$250 deductible |
|
50,000
MAX |
100,000
MAX |
500,000
MAX |
1,000,000
MAX |
|
option
1 |
option
2 |
option
3 |
option
4 |
|
AGE
|
One Month |
One Month |
One Month |
One Month |
|
18-29
|
$43.00
|
$50.00
|
$64.00
|
$76.00
|
|
30-39
|
$56.00
|
$67.00
|
$84.00
|
$97.00
|
|
40-49
|
$84.00
|
$96.00
|
$126.00
|
$142.00
|
|
50-59
|
$120.00
|
$147.00
|
$178.00
|
$206.00
|
|
60-64
|
$142.00
|
$174.00
|
$207.00
|
$248.00
|
|
65-69
|
$162.00
|
$208.00
|
$226.00
|
$270.00
|
|
70-79
|
$219.00
|
N/A
|
N/A
|
N/A
|
|
80 PLUS*
|
$381.00
|
N/A
|
N/A
|
N/A
|
|
DEP CHILD
|
$26.00
|
$28.00
|
$36.00
|
$39.00
|
|
CHILD ALONE
|
$39.00
|
$48.00
|
$59.00
|
$66.00
|
| *US$10,000
limit |
|
|
All premium rates are in US dollars and are effective through
12/31/2007. Rates include 2.5% surplus lines tax. A dependent child is your
child shown on the Enrollment Form over 14 days and under 18 years of age,
traveling with you, and for whom premium has been paid.
*See specific policy for age limit.
Benefit Period. If a covered injury or illness requires continuing
treatment after the policy expires, the Benefit Period may provide
continued coverage. When the policy expires, IMG will review the date of
the initial treatment for the covered injury or illness. If treatment
began less than six months before the policy expired, benefits for the
covered injury or illness will continue subject to the Policy Limits until
there has been six months of coverage. The Benefit Period serves as an
extension of benefits and does not limit the treatment time during the
Policy Period.
IMG®'s Quality Guarantee............................
Your satisfaction is very important to the plan underwriter, and to IMG as
the plan administrator. If, for any reason, you are not pleased with
this product, you may submit a written request for cancellation and
refund of your premium. In order to be considered for a full refund,
your request for cancellation must be received by IMG prior to your
effective date. If you do not have any claims filed with IMG, you may
cancel your plan after your effective date, however, the following
conditions will apply: 1) you will be required to pay a US$25
cancellation fee and 2) only full month premiums will be considered for
refunds (e.g., if you choose to cancel your coverage two months and two
weeks prior to the date your coverage ends, IMG will only consider the
two full months for a refund). If you have filed claims, your premium is
non-refundable.
For Precertification, Emergency Evacuation and Repatriation..............
Please call IMG
in the U.S. 1.800.628.4664
Outside the U.S. 01.317.655.4500
(collect if necessary).
IMG must be notified prior to treatment or within 48 hours of an
emergency.
To Report Claims...............................
Please mail to IMG
International Medical Group, Inc.
P.O. box 88500
Indianapolis, IN 46208 U.S.A.
Please include Identification Number in all correspondence.
This is only a consolidated and summary description of all current
Patriot Travel Medical Insurance benefits, conditions, limitations and
exclusions. A certificate containing the complete Policy Wording with all
terms, conditions and exclusions will be included with the fulfillment
kit. In support of Patriot Travel Medical Insurance,
IMG has established the Global Medical Services Group Insurance Trust in
Indiana. The trust owns a master group international travelers insurance
policy. Individual certificates of insurance are issued from the master
policy.
Underwritten by: Sirius International Insurance Corporation
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