Coverage for US and Non-US citizens traveling abroad for a minimum of 30 days up to a maximum of 6 months. Although
the Patriot Extreme 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.
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PATRIOT EXTREME® INTERNATIONAL POLICY PREMIUMS
US$50,000 POLICY MAXIMUM
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US CITIZEN ONE MONTH
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NON-US CITIZEN ONE MONTH
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AGE
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17 or younger
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$54.00
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$72.00
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18-39
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$64.00
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$94.00
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40-49
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$100.00
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$142.00
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Click Here to view the Benefits included in the Patriot Extreme International Travel Medical Insurance.
Each Additional Fifteen (15) day premium is 50% of the monthly rate. Coverage under the Patriot Extreme plan must be purchased for a minimum of one month.
All premium rates are in US dollars and are effective through 10/31/2008 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.
Benefit Period
If a covered injury or illness requires continuing treatment after the certificate expires, the 3-month Benefit Period may provide
continued coverage. When the certificate expires, the Company will review the date of initial treatment for the covered injury or
illness. If treatment began less than three months before the certificate expired, benefits for the covered injury or illness will
continue subject to the Policy Limits until there have been three months of coverage for the covered injury or illness.
Optional Policy Rider
Patriot T.R.I.P. LiteSM
Trip cancellation coverage is also available for your trip. With this plan, the loss of pre-paid,
non-refundable, and unused payments may be recovered when a trip is cancelled or interrupted due to: illness, injury or death to you, a
family member or travel companion; bankruptcy or financial default; a terrorist incident; jury duty; home made uninhabitable by fire, wind,
storm, flood or vandalism; quarantine; auto accident on way to airport; job termination; cancelled leave for active duty military, police
or fire fighters. The benefits are outlined below:
Benefits: Maximum benefit per insured person
Trip cancellation for Trip cost up to US$20,000
Travel Delay up to US$500
Baggage delay up to US$100
The Patriot T.R.I.P. Lite cost is calculated by dividing the trip cost by 100 and multiplying the result by 4.52.
Example: A Trip cost of $2000.00 divided by 100 = 20 X 4.52= $90.40
Click Here to view all of our Patriot T.R.I.P. Cancellation Products
Patriot Extreme International for US Citizens also provides the additional benefits outlined below,
subject to all Conditions of Coverage.
1)Sudden Recurrence of a Pre-existing - Up to US$1,000 will be reimbursed 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
reimbursed 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.
2)Indemnity - Patriot
Extreme 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.
Refund of Premium
IMG will refund premium only if a written request is received prior to the policy's effective date. The premium is
non-refundable after that date.
For Precertification, Emergency Evacuation and Repatriation
Please call IMG
in the U.S. 1.800.628.4664
Outside the U.S. 01.317.655.4500
(collect if necessary).
IMG must be notified prior to treatment or within 48 hours of an emergency.
To Report Claims
Please mail to IMG
International Medical Group, Inc.
2960 Meridian Street
Indianapolis, IN 46208 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
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