PATRIOT EXECUTIVE^® TRAVEL MEDICAL INSURANCE

US citizens - You, your spouse and children while traveling together outside the United States and are: 1) under the age of 76, 2) are covered by an individual or group medical plan, and 3) travel outside the United States frequently throughout the year.

Non-U.S. Citizens - You, your spouse and children while traveling together outside your country of citizenship and are: 1) under the age of 76, 2) are covered by an individual or group medical plan, and 3) travel outside your country of citizenship frequently throughout the year.

This plan provides up toUS$1,000,000 of medical coverage for these individuals and their families up to age 69, from age 70-75 up to US$50,000.00 while they are traveling outside of the United States.

BENEFITS

• Deductible - $250 per insured person, per covered Illness. 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;US$50,000 for travelers who are 70-75 years old.
• 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 when coordinated through the Plan Administrator.
• 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 - To Policy Maximum
• 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 - 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
• Terrorism Coverage US$50,000 lifetime maximum. For full description of this benefit and premium information, please refer to either the Patriot Executive brochure or the premium calculation section when purchasing online.
• 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 than the option specified on the Insured's Enrollment Form and in any event no longer than thirty days.
• Maximum Duration of Any One Trip: 30 days.

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^® 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, 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 2.5% surplus lines tax

PREMIUMS
^{Rates - through age 75*}