| SCHEDULE OF
BENEFITS- EACH PLAN INCLUDES THE FOLLOWING BENEFITS: |
| INTERNATIONAL
EMERGENCY CARE |
|
Emergency Evacuation
|
To Policy Maximum when coordinated through IMG
|
|
Each Patriot Travel Medical Insurance plan also provides
for Emergency Medical Evacuations to the nearest qualified medical
facility or the country of residence (as determined by IMG® expenses
for reasonable travel and accommodations resulting from the evacuation;
and the cost of returning to either the country of residence or the
country where the evacuation occurred up to the policy limit.
|
| Emergency
Reunion |
To US$15,000
when coordinated through IMG |
| Each Patriot®
plan includes emergency reunion coverage, up to US$15,000 for a maximum of
15 days, for the reasonable travel and lodging expenses of a relative or
friend during an Emergency Medical Evacuation: either the cost of
accompanying the insured during the evacuation or traveling from the
country of residence to be united with the insured. |
|
Repatriation
|
To US$25,000 when coordinated through IMG
|
|
If a covered illness/injury results in death, expenses for Repatriation
of bodily remains or ashes to the country of citizenship will be covered
up to a maximum of US$25,000.
|
|
Returning Minor Children
|
To US$5,000 when coordinated through IMG
|
|
If an insured person is hospitalized due to a covered illness/injury
and is traveling alone with child(ren) 19 or under that otherwise would be
left unattended, the Patriot plans will pay up to US$5,000 for one way
economy fare to their home country, including a chaperone, if necessary,
for the safety of the child(ren).
|
| SPECIAL
COVERAGES |
|
Home Country Coverage
|
As described below
|
|
Incidental Home Country Coverage -
During the period of coverage an insured person may return to their
country of citizenship for incidental visits of up to two weeks total,
subject to: a. The insured person must have left their country of
citizenship, b. The Total Period of Coverage must be for a minimum of 30
days, and c. The return to the country of citizenship may not be taken to
receive treatment for a condition incurred while traveling.
End of Trip Home Country Coverage-For every five (5) months of coverage
you purchase, you can purchase one (1) month of home country coverage up to
a maximum of 2 months.
|
|
Trip Interuption
|
To US$5,000
|
|
If, during a covered trip, there is a death of an immediate family
member (spouse, child, parent or sibling) or the substantial destruction
of the insured's principal residence, the plan will pay to return the
insured to the area of principal residence. The plan will pay 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
|
To US$50 per item; maximum of US$250
|
|
This benefit will be paid in the event that the Common Carrier
permanently loses an insured person's checked luggage. This coverage is
secondary to any other available coverage, including the Carrier's.
|
|
Common Carrier Accidental Death
|
US$50,000 to Beneficiary; maximum of US$250,000 per family
|
|
If accidental death should occur while traveling on a commercial Common
Carrier, US$50,000 will be paid to the beneficiary to a maximum of
US$250,000 per family
|
| MEDICAL
BENEFITS |
Usual
reasonable and customary charges, subject to deductible and coinsurance |
|
Hospital Room and Board
|
To Policy Maximum for average semi-private room rate
|
| |
|
|
Intensive Care
|
To Policy Maximum
|
| |
|
|
Medical Expenses
|
To Policy Maximum
|
| |
|
| Outpatient
Medical |
To Policy
Maximum |
|
|
|
|
Local Ambulance
|
To Policy Maximum
|
| |
|
|
Dental
|
To Policy Maximum
|
| Each Patriot plan
covers the cost of emergency dental treatment and dental procedures
necessary to restore sound natural teeth lost or damaged in an accident. www.imglobal.com |
|
Sports & Activities
|
To Policy Maximum for basic sports Coverage as described below
|
|
Each Patriot plan covers injuries incurred during amateur athletic
activities which are non-contact and engaged in by an insured person
solely for leisure, recreation, entertainment or fitness purposes.
However, activities not covered include amateur or professional sports or
other athletic activity which is organized and/or sanctioned, or which
involves regular or scheduled practices, games or competition. The
following hazardous activities are excluded, but may be added by the Optional
Sports Rider: Scuba diving, mountain climbing (up to 4500 meters or
where ropes or guides are normally used), jet, snow and water skiing and
snowboarding, sky diving, amateur racing, piloting an aircraft, bungee
jumping and spelunking.
|
| Accidental
Death&Dismemberment |
US$25,000
principal sum |
| Each Patriot plan
includes US$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. For more information see the Conditions of
Coverage section in the Patriot Travel Medical brochure. |
| PLAN
INFORMATION |
|
Deductible
|
Your choice of US$0, US$100, $250, $500, $1,000 or $2,500
|
| |
|
|
Coinsurance
|
As described below
|
|
For treatment received outside the US & Canada:
No coinsurance
For treatment received within the US & Canada:
In the PPO
Network: The plan pays 90% of eligible expenses up to US$5,000 then 100% up to the
Policy Maximum.
Out of the PPO Netwok:
The plan pays 80% of eligible expenses up to US$5,000, then 100% up to
the Policy Maximum
|
|
Benefit Period
|
Six months
|
| If a covered injury or
illness has continuing treatment after the policy expires, the Benefit
Period may provide continued coverage. When the policy expires, IMG will
review the date of 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. |
| Additional
Benefits for U.S. Citizens |
| Sudden
Recurrence of a Pre-existing Condition |
| Sudden Recurrence of a
Pre-existing Condition - Up to US$500 will be paid for the eligible
expenses of a sudden and unexpected recurrence of a Pre-existing Condition
while traveling outside of the US. In addition, up to US$25,000 will be
paid 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. For the definition of a Pre-existing Condition,
please see Exclusion number 1 in the Patriot Travel Medical brochure.
|
| Dental
Emergency |
| This plan will pay up
to $100 for the necessary treatment of sudden, unexpected pain to sound
natural teeth. |
| The above outline 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. |
