Patriot Extreme Medical Insurance Benefits

SCHEDULE OF BENEFITS - EACH PATRIOT EXTREME PLAN INCLUDES THE FOLLOWING BENEFITS:
INTERNATIONAL EMERGENCY CARE
Emergency Evacuation	To Policy Maximum when coordinated through IMG
Each Patriot Extreme 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 maximum.
Emergency Reunion	To US$10,000 when coordinated through IMG
Each Patriot Extreme plan includes emergency reunion coverage, up to US$10,000 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$15,000 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$15,000.
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.
Trip Cancellation	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 cover reimbursement 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

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	As described below
Injury due to an accident: 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 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.
Sports & Activities	To Policy Maximum for basic and extreme sports as described below
Subject to the terms of the complete policy wording, Patriot Extreme covers injuries incurred during non-contact amateur athletic activities and certain Extreme Sports including: Abseilling, BMX, Bungee jumping, Canyoning, Caving, Flying (private plane), Hang Gliding, Heli-skiing, High diving, Hot air ballooning, Kayaking, Inline skating, Mountain biking, Mountaineering (ropes and guides to 4500m), Paragliding, Parascending, Rappelling, Rock climbing (ropes and guides to 4500m), Scuba diving (to 50m), Skydiving, Spelunking and Whitewater rafting (to Class V). Activities may be organized and include scheduled practices, games, and/or competitions. Activities not covered include contact sports, professional sports and any athletic activities that are organized and/or sanctioned by the National Collegiate Athletic Association (or any other collegiate sanctioning body) or the International Olympic Committee.
PLAN INFORMATION
Deductible	US$250.00 per Period of Coverage

Coinsurance	As described below
For treatment received outside the U.S. & Canada: No Coinsurance For treatment received within the U.S. and Canada: In 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.

Kleinman General Insurance Services
P.O. Box 1047, Grass Valley, CA 95945
Voice (530) 273-9500 or (800) 575-1957 Fax (530) 273-9514
Email: info@Insure4Travel.com