|
 |
All premium rates below are based on a $250 deductible and include
2.5% surplus lines tax. Rates will change based on deductible
chosen. 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.
If you are an expatriate looking for expatriate health
insurance, traveling for three (3) months or more, please review
the ExPatriot Plus¨ plan,
which offers a 10% discount on rates for expatriate health insurance
and is renewable. (Go there)
We recommend running our secure on-line quote system for most
accurate calculation:
Patriot Internationalsm Quote
On-line, Patriot Americansm Quote
On-line, or ExPatriot Plus® Quote
On-line
Patriot Executivesm Quote
On-Line
Patriot Travel Medical
Insurance Plans
Patriot International provides
coverage for US citizens traveling abroad for a minimum of 10
days up to a maximum of one year. Although the Patriot International
Plan is not renewable, it can be rewritten for succeeding or
subsequent coverage periods. New Deductible, Coinsurance, Eligibility,
Conditions of Coverage and Pre-Existing Condition Exclusions
apply to any succeeding or subsequent Period of Coverage. A new
application also must be completed.
PATRIOT INTERNATIONAL POLICY PREMIUMS
|
AGE
|
One Month
|
One Month
|
One Month
|
One Month
|
One Month
|
|
$50,000
MAX
|
$100,000
MAX
|
$500,000
MAX
|
$1,000,000
MAX
|
$2,000,000
MAX
|
|
18-29
|
$36.00
|
$42.00
|
$48.00
|
$54.00
|
$60.00
|
|
30-39
|
$42.00
|
$48.00
|
$64.00
|
$70.00
|
$80.00
|
|
40-49
|
$66.00
|
$74.00
|
$82.00
|
$90.00
|
$110.00
|
|
50-59
|
$106.00
|
$122.00
|
$136.00
|
$152.00
|
$170.00
|
|
60-64
|
$122.00
|
$144.00
|
$170.00
|
$200.00
|
$224.00
|
|
65-69
|
$144.00
|
$154.00
|
$176.00
|
$210.00
|
$270.00
|
|
70-79
|
$210.00
|
N/A
|
N/A
|
N/A
|
N/A
|
|
80 PLUS*
|
$420.00
|
N/A
|
N/A
|
N/A
|
N/A
|
|
DEP CHILD
|
$20.00
|
$26.00
|
$30.00
|
$32.00
|
$38.00
|
|
CHILD ALONE
|
$36.00
|
$40.00
|
$46.00
|
$50.00
|
$58.00
|
|
*US$10,000
limit
|
PATRIOT INTERNATIONAL DAILY RATES
(minimum coverage is 10 days)
|
|
|
|
|
|
|
| AGE |
$50,000
MAX
|
$100,000
MAX
|
$500,000
MAX
|
$1,000,000
MAX
|
$2,000,000
MAX
|
|
18-29
|
$1.20 |
$1.40 |
$1.60 |
$1.80 |
$2.00 |
|
30-39
|
$1.40
|
$1.60 |
$2.15 |
$2.35 |
$2.70 |
|
40-49
|
$2.20
|
$2.50
|
$2.75
|
$3.00
|
$3.70
|
|
50-59
|
$3.55
|
$4.10
|
$4.55
|
$5.10
|
$5.70
|
|
60-64
|
$4.10
|
$4.80
|
$5.70
|
$6.70
|
$7.50
|
|
65-69
|
$4.80
|
$5.15
|
$5.90
|
$7.00
|
$9.00
|
|
70-79
|
$7.00
|
N/A
|
N/A
|
N/A
|
N/A
|
|
80 PLUS*
|
$14.00
|
N/A
|
N/A
|
N/A
|
N/A
|
|
DEP CHILD
|
$0.70
|
$0.90
|
$1.00
|
$1.10
|
$1.30
|
|
CHILD ALONE
|
$1.20
|
$1.35
|
$1.55
|
$1.70
|
$1.95
|
|
*US$10,000
limit
|
Patriot America provides
coverage for non-US citizens traveling outside their country
of citizenship for a minimum of 10 days up to a maximum of one
year. Although the Patriot America plan is not renewable, it
can be rewritten for succeeding or subsequent coverage periods.
New Deductible, Coinsurance, Eligibility, Conditions of Coverage
and Pre-Existing Condition Exclusions apply to any succeeding
or subsequent Period of Coverage. A new application also must
be completed. If you or other family members applying for coverage
are age 65 or older, please see the Eligibility section of the
Patriot brochure for additional information.
PATRIOT AMERICA POLICY PREMIUMS
|
$50,000
MAX
|
$100,000
MAX
|
$500,000
MAX
|
$1,000,000
MAX
|
|
AGE
|
One Month
|
One Month
|
One Month
|
One Month
|
|
18-29
|
$48.00
|
$56.00
|
$72.00
|
$84.00
|
|
30-39
|
$62.00
|
$74.00
|
$94.00
|
$108.00
|
|
40-49
|
$94.00
|
$106.00
|
$140.00
|
$158.00
|
|
50-59
|
$134.00
|
$164.00
|
$198.00
|
$228.00
|
|
60-64
|
$158.00
|
$194.00
|
$230.00
|
$276.00
|
|
65-69
|
$180.00
|
$232.00
|
$252.00
|
$300.00
|
|
70-79
|
$244.00
|
N/A
|
N/A
|
N/A
|
|
80 PLUS*
|
$424.00
|
N/A
|
N/A
|
N/A
|
|
DEP CHILD
|
$28.00
|
$32.00
|
$40.00
|
$44.00
|
|
CHILD ALONE
|
$44.00
|
$52.00
|
$66.00
|
$74.00
|
|
*US$10,000
limit
|
PATRIOT AMERICA DAILY RATES
(minimum coverage is 10 days)
|
|
|
|
|
|
| AGE |
$50,000
MAX
|
$100,000
MAX
|
$500,000
MAX
|
$1,000,000
MAX
|
|
18-29
|
$1.60 |
$1.90 |
$2.40 |
$2.80 |
|
30-39
|
$2.10
|
$2.50 |
$3.15 |
$3.60 |
|
40-49
|
$3.15
|
$3.55
|
$4.70
|
$5.30
|
|
50-59
|
$4.50
|
$5.50
|
$6.60
|
$7.60
|
|
60-64
|
$5.30
|
$6.50
|
$7.70
|
$9.20
|
|
65-69
|
$6.00
|
$7.75
|
$8.40
|
$10.00
|
|
70-79
|
$8.15
|
N/A
|
N/A
|
N/A
|
|
80 PLUS*
|
$14.15
|
N/A
|
N/A
|
N/A
|
|
DEP CHILD
|
$0.95
|
$1.10
|
$1.35
|
$1.50
|
|
CHILD ALONE
|
$1.50
|
$1.75
|
$2.20
|
$2.50
|
|
*US$10,000
limit
|
ExPatriot Plus provides
coverage for US citizens AND non-US citizens traveling outside
their country of citizenship for a minimum of three months up to
a maximum of two years. ExPatriot Plus must be purchased for
a minimum initial period of three months, and is renewable for
a total of two years by those traveling outside the US. For non-US
citizens traveling within the US, ExPatriot Plus may be renewed
for up to two years of total coverage. For ExPatriot Plus an
Insured must satisfy only one deductible and coinsurance limit
within any 12 month period.
For further information on expatriate
health insurance, plan benefits, apply on-line and/or
download a brochure for expatriate health insurance, click
here
ExPATRIOT PLUS POLICY PREMIUMS
|
$500,000
MAX
|
$1,000,000
MAX
|
$2,000,000
MAX
|
$500,000
MAX
|
$1,000,000
MAX
|
|
US CITIZEN
|
US CITIZEN
|
US CITIZEN
|
NON-US CITIZEN
|
NON-US CITIZEN
|
|
AGE
|
One Month
|
One Month
|
One Month
|
One Month
|
One Month
|
|
18-29
|
$43.00
|
$48.00
|
$54.00
|
$64.00
|
$75.00
|
|
30-39
|
$57.00
|
$63.00
|
$72.00
|
$84.00
|
$97.00
|
|
40-49
|
$73.00
|
$84.00
|
$99.00
|
$126.00
|
$142.00
|
|
50-59
|
$122.00
|
$136.00
|
$153.00
|
$178.00
|
$205.00
|
|
60-64
|
$153.00
|
$180.00
|
$201.00
|
$207.00
|
$248.00
|
|
65-69
|
$158.00
|
$189.00
|
$243.00
|
$226.00
|
$270.00
|
|
DEP CHILD
|
$27.00
|
$20.00
|
$34.00
|
$28.00
|
$39.00
|
|
DEP ALONE
|
$41.00
|
$45.00
|
$52.00
|
$49.00
|
$66.00
|
|
*US$10,000
limit
|
Patriot Executive Travel
Medical Insurance
|
Maximum Trip Duration
|
Annual
Premium
|
Spouse & 2 Dependents
|
Each Additional
Dependent
|
|
15 Days
|
US$200.00
|
US$100.00
|
US$40.00
|
|
30 Days
|
US$250.00
|
US$100.00
|
US$40.00
|
All premium rates are in US dollars and are effective
through 12/31/2004. Please use our on-line quote system
for most accurate calculation of rates. 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.
|