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SCHEDULE OF BENEFITS- EACH PLAN INCLUDES THE FOLLOWING BENEFITS:
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| INTERNATIONAL
EMERGENCY CARE |
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Emergency Evacuation
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To Policy Maximum when coordinated through IMG
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Each Patriot Travel Medical InsuranceSM plan also provides for
Emergency Medical Evacuations to the nearest qualified medical facility or the
country of residence (as determined by IMGSM)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.
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Emergency Reunion
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To US$15,000 when coordinated through IMG
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Each PatriotSM 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.
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Repatriation
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To US$25,000 when coordinated through IMG
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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.
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Returning Minor Children
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To US$5,000 when coordinated through IMG
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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).
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| SPECIAL
COVERAGES |
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Home Country Coverage
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As described below
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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 ou
purchase, you can purchase one (1) month of home country coverage up to a
maximum of 2 months.
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Trip Cancellation
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To US$5,000
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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.
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Lost Luggage
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To US$50 per item; maximum of US$250
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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.
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Common Carrier
Accidental Death
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US$50,000 to Beneficiary;
maximum of US$250,000 per family
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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
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| MEDICAL
BENEFITS |
Usual
reasonable and customary charges,subject to deductible and coinsurance |
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Hospital Room and Board
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To Policy Maximum for average semi-private room rate
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Intensive Care
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To Policy Maximum
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Medical Expenses
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To Policy Maximum
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Outpatient Medical
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To Policy Maximum
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Local Ambulance
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To Policy Maximum
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Dental
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To Policy Maximum
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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
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Sports & Activities
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To Policy Maximum for basic sports Coverage as described below
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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.
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Accidental Death&Dismemberment
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US$25,000 principal sum
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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.
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| PLAN
INFORMATION |
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Deductible
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Your choice of US$100, $250, $500, $1,000 or $2,500
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Coinsurance
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As described below
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For treatment received outside
the US & Canada: No
coinsurance
For treatment receivd within
the US & Canada: The
plan pays 80% of eligible expenses up to US$5,000 then 100% up to the
Policy Maximum.
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Benefit Period
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Six months
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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.
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| Additional
Benefits for U.S. Citizens |
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Sudden Recurrence of a Pre-existing Condition
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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.
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Dental Emergency
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This plan will pay up to $100 for the necessary treatment of sudden, unexpected
pain to sound natural teeth.
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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.
Benefits
| Exclusions
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