Patriot Travel Medical Insurance Benefits

SCHEDULE OF BENEFITS- EACH PLAN INCLUDES THE FOLLOWING BENEFITS:
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

Emergency Room	As described below
Charges incurred for the use of the Emergency Room due to an accident are covered up to the Policy Maximum. Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional (extra) US$250 deductible if treatment does not require admittance to the hospital.

Dental	To Policy Maximum
Injury due to an accident: Each Patriot Travel Medical Insurance plan covers the cost of emergency dental treatment and dental procedures necessary to restore sound natural teeth lost or damaged in an accident up to the Policy Maximum. Sudden dental pain: Each plan will pay up to US$100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.
PLAN INFORMATION
Deductible	Your choice of US$0, 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: Inside the PPO Network: The plan pays 90% of eligible expenses up to US$5,000 then 100% up to the Policy Maximum. *Outside the PPO Network:* 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.
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.
Return of Mortal Remains	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 home country 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).
Political Evacuation	To US$10,000 when coordinated through IMG
If the United States Department of State, Bureau of Consular Affairs issues a travel advisory that becomes effective on or after the Insured Person’s date of arrival in the Host Country, the Company will pay up to US$10,000 for transportation to the nearest place of safety or for repatriation to the Insured Person’s home country or country of residence provided that: The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular affairs issues the travel advisory; Political Evacuation and Repatriation is approved and coordinated by the Company.
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 continuous coverage you purchase, you can purchase one (1) additional month of home country as an accommodation and supplemental travel benefit, up to a maximum of two months. To purchase this special home country extension coverage, please check the appropriate box on the Application Form, and calculate your premium to include the additional month(s).
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 of personal property; maximum of US$250 per Period of Coverage
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
Sports & Activities Coverage	Up to Policy Maximum for basic sports as described below
Each Patriot plan covers injuries incurred during amateur athletic activities which are non-contact and engaged in by the 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: racing of any kind, aviation (except when traveling as a passenger in a commercial aircraft), BMX, BASE jumping, , bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, luge, motocross (moto-x), mountain biking, mountaineering, parachuting, rappelling, rock climbing, rodeo, scuba diving, ski jumping, sky diving, snow skiing, snow boarding, snowmobiling, spelunking, snorkeling, surfing, wake boarding, water skiing, windsurfing, and whitewater rafting. Optional Leisure or Extreme Sports Riders available: Please see page 10 of the brochure for more information.
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.
Terrorism Coverage	Up to US$50,000 lifetime maximum
Each Patriot plan provides coverage for injuries and illness incurred as a result of an act of Terrorism, limited in amount and by circumstances. If an insured person is injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims subject to a US$50,000 lifetime maximum. However, claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered. Terrorism is defined as the systemic or planned use of violence, fear or threat of violence in order to intimidate a population or government, especially as a means of coercion or to obtain a granting of any demand. However, this benefit does not cover an act of Terrorism in any country or location where the United States government has issued a travel advisory that has been in effect within the 6 months prior to the insured person's date of arrival. This benefit also does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location
Identity Theft Assistance	Up to US$500 per Period of Coverage
If an imposter obtains key personal information such as a Social Security or Driver's License number, or other method of identifying an insured person in order to impersonate or obtain credit, merchandise or services in the insured person's name, the Patriot plans will provide coverage for the reasonable, customary and necessary costs incurred by the insured for; re-filing a loan or other credit application that is rejected solely as a result of the stolen identity event, notarization of legal documents, long distance telephone calls, and postage that has resulted solely as a result of reporting, amending and/or rectifying records as a result of the stolen identity event, up to three credit reports obtained within one year of the insured person's knowledge of the stolen identity event; and stop payment orders placed on missing or unauthorized checks as a result of the stolen identity event. The identity theft event must occur during the Period of Coverage and must be reported within 6 months of the termination of coverage date.
Additional Benefits for U.S. Citizens
Sudden Recurrence of a Pre-existing Condition
Sudden Recurrence of a Pre-existing Condition - Up to US$15,000 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.
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.