Comprehensive medical coverage for U.S. citizens traveling from 15 days to one year
Coverage for US citizens traveling abroad
from 15 days to one year. If you are traveling for six months or more, review
the ExPatriot PlusŪ plan for additional coverage options. Once the Period of
Coverage expires, Patriot InternationalSM can be
rewritten but is not renewable. This means new Deductible, Coinsurance,
Eligibility, Conditions of Coverage and Pre-existing Condition Exclusions apply
to any subsequent Period of Insurance.
|
PATRIOT INTERNATIONAL POLICY PREMIUMS |
|||||
| 50,000 MAX |
100,000 MAX |
500,000 MAX |
1,000,000 MAX |
2,000,000 MAX |
|
| option 5 | option 6 | option7 | option 8 | option 9 | |
|
AGE |
One Month | One Month | One Month | One Month | One Month |
|
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 |
|||||
All premium rates are in US dollars and are effective through 6/30/2002. 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
InsuranceSM 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.
To Report Claims...............................
Please mail to IMG
International Medical Group, Inc.
407 Fulton Street
Indianapolis, IN 46202 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 InsuranceSM 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 SM, 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