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Patriot Travel Medical Insurance^sm Plan Details

Short Term (10 days to 24 months) Medical Insurance for US and Non-US Citizens traveling outside of their country of citizenship.

Each Patriot Travel Plan includes the following benefits for Medical Insurance International Travelers:

• Patriot International Travel^sm
  Patriot American^sm and
  ExPatriot Plus^sm
  Benefits (go there) and
  Exclusions (go there)
  
  
• Patriot Executive^sm
  Benefits (go there) and
  Policy Limits (go there)

BENEFITS

SCHEDULE OF BENEFITS- EACH PLAN INCLUDES THE FOLLOWING BENEFITS FOR MEDICAL INSURANCE INTERNATIONAL TRAVELERS:

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 six (6) months of coverage you purchase, you can purchase one (1) month of home country coverage up to a maximum of 2 months.

Trip Interruption		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.

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$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: 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$15000 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.

Indemnity

Patriot International will pay directly to you US$100 for each night of a required overnight stay in a hospital. The hospital stay must be covered under this plan in order to receive this benefit.

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.

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Patriot International Travel, Patriot American and ExPatriot Plus

Exclusions

Charges for the following services, treatments and/or conditions are excluded from coverage under the Patriot plans.

1. Pre-existing Conditions. A pre-existing condition is defined as any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that existed at the time of application or at any time during the three years prior to the effective date of the insurance, including any subsequent, chronic or recurring complications or consequences related thereto or arising there from.
   
   
2. Treatment or surgeries which are elective, investigational, experimental or for research purposes.
   
   
3. War, political insurrection, protest, or any act thereof.
   
   
4. Immunizations and routine physical exams.
   
   
5. Treatment of Temporomandibular Joint or dental treatment, except as provided for herein.
   
   
6. Venereal disease, AIDS virus, AIDS related illness, ARC Syndrome, or AIDS, and the cost of testing for these conditions, and charges for treatment or surgeries which are incurred by any Insured who was HIV+ at time of enrollment into this insurance.
   
   
7. Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
   
   
8. Injury sustained while participating in 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, skydiving, amateur racing, piloting an aircraft, bungee jumping and spelunking.
   
   
9. Vision or ear tests and the provision of visual or hearing aids.
   
   
10. Vocational, recreational, speech or music therapy.
    
    
11. Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
    
    
12. Charges, injuries and/or illnesses resulting or arising from or occurring during the commission or continuing perpetration of a violation of law by the insured, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
    
    
13. Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
    
    
14. Injury and/or illness resulting or arising from or sustained while under the influence of or disablement of drugs or alcohol.
    
    
15. Willfull self-inflicted injury or illness.
    
    
16. Treatment required as a result of or arising from complications from a treatment or condition not covered hereunder.
    
    
17. Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
    
    
18. Treatment for mental and nervous disorders.
    
    
19. Organ or tissue transplants or related services.
    
    
20. Illness or injury where the trip to the host country is undertaken for treatment or advice for such Illness or injury, except as provided for herein.
    
    
21. Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).

This information is only a consolidated and summary description of all current Patriot Travel Medical Insurance^sm benefits, conditions, limitations and exclusions. A certificate containing the complete Policy Wording with all terms, conditions and exclusions will be included with the fulfillment.

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Patriot Executive

Policy Limits

• Deductible - $250 per insured person, per each and every Claim. The deductible shall be waived for Claims incurred as a result of a covered Accident.
  
  
• Maximum Policy Limit- U.S. $1,000,000 per insured Person per Policy Period.
  
  
• Pre-Existing Condition Benefit- U.S. $5,000 maximum per Insured Person per Policy Period.
  
  
• Emergency Medical Evacuation Expenses - U.S. $25,000 per Insured Person for Evacuations resulting from a Pre-existing Condition. U.S. $50,000 per Insured Person for Evacuations resulting from other covered Incidents.
  
  
• Repatriation Expenses - U.S. $25,000 when coordinated & approved through IMG.
  
  
• Emergency Reunion Expenses - U.S. $15,000 when coordinated & approved through IMG.
  
  
• Returning Minor Children benefit of up to US$5,000 when coordinated & approved through IMG.
  
  
• Trip Interruption benefit of up to US$5,000.
  
  
• Lost Luggage benefit of up to US$50 per item; maximum of US$250.
  
  
• Common Carrier Accidental Death benefit of up to US$50,000 to beneficiary; maximum of US$250,000.
  
  
• Local Ambulance Expense - U.S. $2,500.
  
  
• Accidental Death and Dismemberment - U.S. $25,000 principal sum.
  
  
• Hospital Room and Board - Average semi-private room rate up to the Policy Maximum.
  
  
• Intensive Care - 3x the average semi-private room rate up to the Policy Maximum.
  
  
• Medical Expenses - Usual, reasonable and customary up to the Policy Maximum.
  
  
• Outpatient Medical Expenses - Usual, reasonable and customary up to the Policy Maximum.
  
  
• Benefit Period - Six months.
  
  
• Period of Coverage - The period of time beginning on the date the Insured Person departs the home country and ending on the date the Insured Person arrives back in the home country. The Period of Coverage can be no longer that the option specified on the Insured's Enrollment Form and in any event no longer than thirty days.
  
  
• Maximum Duration of Any One Trip: Your choice , 15 days or 30 days. Trips for covered dependents will be limited to 15 days for any one trip.

Precertification

All proposed hospital admissions and surgeries, whether inpatient or outpatient, will be subject to Precertification. You or your attending physician must call the number listed on your Confirmation of Coverage prior to admittance to a hospital or performance of a surgery. In the event of an Emergency Admission, the Precertification call must be made within 48 hours after the admission, or as soon as reasonably possible. In the event an admission or surgery is not pre-certified, eligible expenses will be reduced by 50%.

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 Executive Insurance^sm 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.

This is only a summary of the coverage provided. Other conditions and exclusions may apply. Please consult the policy itself for a full description of the coverage. In support of Patriot Executive Insurance^sm, IMG has established the Group Health, Accident and Travel Insurance Trust, in Washington D.C. The trust owns a master group international insurance policy. Individual certificates of insurance are issued from the master policy. Rates include 2% surplus lines tax

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