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Patriot International® provides coverage for U.S. citizens traveling abroad
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.
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PATRIOT INTERNATIONAL POLICY PREMIUMS
All rates displayed use a US$250 deductible |
|
50,000
MAX |
100,000
MAX |
500,000
MAX |
1,000,000
MAX |
2,000,000
MAX |
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option
5 |
option
6 |
option7 |
option
8 |
option
9 |
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AGE
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One
Month |
One Month |
One Month |
One Month |
One Month |
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18-29
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$32.00
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$37.00
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$43.00
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$48.00
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$54.00
|
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30-39
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$37.00
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$43.00
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$57.00
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$63.00
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$72.00
|
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40-49
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$59.00
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$66.00
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$73.00
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$81.00
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$99.00
|
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50-59
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$96.00
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$109.00
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$122.00
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$136.00
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$153.00
|
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60-64
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$109.00
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$129.00
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$153.00
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$180.00
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$201.00
|
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65-69
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$129.00
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$138.00
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$158.00
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$189.00
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$243.00
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70-79
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$189.00
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N/A
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N/A
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N/A
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N/A
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80 PLUS*
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$378.00
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N/A
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N/A
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N/A
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N/A
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DEP CHILD
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$18.00
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$23.00
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$27.00
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$28.00
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$34.00
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CHILD ALONE
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$32.00
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$36.00
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$41.00
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$46.00
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$52.00
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*US$10,000 limit
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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 The Benefit Period is the period of time specified in the
Policy Limits. It begins once an eligible incident occurs to the insured.
While coverage is in effect under this policy, the Benefit Period does not
apply. When coverage under this policy terminates, as defined, Patriot
Travel Medical Insurance will pay eligible expenses for
covered Injuries or Illnesses which commenced during the period of
coverage for up to, but not exceeding the Benefit Period, subject to the
Policy Limits.
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 brochure contains only a consolidated and summary description of all
current Patriot Travel Medical Insurance benefits, conditions,
limitations and exclusions. A certificate containing the complete
Certificate
Wording with all terms, conditions and exclusions will be included in
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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