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Patriot America
Patriot America provides coverage for non-US citizens traveling outside their home country for a minimum of 5 days up to a maximum of two years. If the plan is purchased for a minimum of three months, coverage may be renewed (without break in coverage) for a total of up to two years.

BENEFITS:
Hospital Room and Board - Up to Policy Maximum for average semi-private room rate
Intensive Care - Up to Policy Maximum
Medical Expenses - Up to Policy Maximum
Outpatient Medical - Up to Policy Maximum
Local Ambulance - Up to Policy Maximum
Emergency Room - 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.
Accidental Dental: dental treatment and dental procedures necessary to restore sound natural teeth lost or damaged in an accident up to the Policy Maximum.
Emergency Dental: Each plan will pay up to US$100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.
Emergency Evacuation to the nearest qualified medical facility and the cost of returning to either the home country or the country where the evacuation occurred, up to the Policy Limit when coordinated through the Plan Administrator.
Emergency Reunion - up to US$15,000 when coordinated through the Plan Administrator 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 home country to be reunited with the insured.
Return of Mortal Remains - up to a maximum of US$25,000 when coordinated through the Plan Administrator for expenses for Repatriation of bodily remains or ashes to the home country If a covered illness/injury results in death.
Returning Minor Children: 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 (when coordinated through the Plan Administrator) for one way economy fare to their home country, including a chaperone, if necessary, for the safety of the child(ren).
Home Country Coverage for incidental visits up to a cumulative two weeks total, subject to: a. The insured person must have left their home country, b. The total Period of Coverage must be for a minimum of 30 days, and c. The return to the home country may not be taken to receive treatment for an illness or injury incurred while traveling.
Trip Interruption - Up to US$5,000 to return the insured to the area of principal residence 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.
Lost Luggage - Up to US$50 per item to maximum of US$250 per Period of Coverage.
Common Carrier Accidental Death:US$50,000 to Beneficiary; maximum of US$250,000 per family
Sports & Activities Coverage - Up to Policy Maximum for injuries incurred during amateur athletic activities for leisure, recreation, entertainment or fitness purposes. Hazardous activities are excluded.
Optional Leisure or Extreme Sports Riders: Please see the brochure for more information.
Accidental Death & Dismemberment - US$25,000 principal sum.
Terrorism Coverage - Up to US$50,000 lifetime maximum for injuries and illness incurred as a result of an act of Terrorism.
Identity Theft Assistance - Up to US$500 per Period of Coverage for re-filing a loan or other credit application, notarization of legal documents, amending and/or rectifying records as a result of the stolen identity event.
Political Evacuation - Up to US$10,000 when coordinated through the Plan Administrator.
Benefit Period - up to six months after your insurance policy expires if a covered injury or illness requires continuing treatment.

EXCLUSIONS:
Deductible: Your choice of US$0, $100, $250, $500, $1,000 or $2,500.
Coinsurance:
- No coinsurance for treatment received outside the U.S. & Canada.
- 90% IN the PPO and 80% Outside the PPO Network up to US$5,000 after the deductible, then 100% up to the Policy Maximum.
Pre-existing Conditions - any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that, with reasonable medical certainty, existed at the time of application or at any time during the three years prior to the effective date of the insurance, whether or not previously manifested or symptomatic, diagnosed, treated, or disclosed prior to the effective date, including any subsequent, chronic or recurring complications or consequences related thereto or arising therefrom.
Other Exclusions:
- Treatment or surgeries which are elective, investigational, experimental or for research purposes.
- War, military action, terrorism, political insurrection, protest, or any act thereof. The Company will not pay for a Political Evacuation if there is a travel advisory in effect on or within six (6) months prior to the Insured Person’s date of arrival in the Host Country.
- Immunizations and routine physical exams.
-Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.
- Venereal disease, AIDS virus, AIDS-related illness, ARC Syndrome, or AIDS, and the cost of testing for these conditions, and charges for treatment or surgeries which are incurred by any Insured who was HIV+ at time of enrollment into this insurance.
- Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
- Injury sustained while participating in 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, bobsleigh, 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, snowboarding, snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, windsurfing and whitewater rafting.
- Vision or ear tests and the provision of visual or hearing aids.
- Vocational, recreational, speech or music therapy.
- Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
- Charges, injuries and/or illnesses resulting or arising from or occurring during the commission or continuing perpetration of a violation of law by the insured, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
- Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
- Injury and/or illness resulting or arising from being under the influence of alcohol or drugs; and injury or illness resulting from operating any type of vehicle after consuming any alcohol or drugs.
- Willful self-inflicted injury or illness.
- Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.
- Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
- Treatment for mental and nervous disorders.
- Organ or tissue transplants or related services.
- Illness or injury where the trip to the host country is undertaken for treatment or advice for such Illness or injury, except as expressly provided for in the certificate of insurance.
Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).

This web page contains only a consolidated and summary description of all current Patriot Travel Medical Insurance benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this application and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.

RATES:

Patriot America
Patriot America provides coverage for non-U.S. citizens traveling outside their home country for a minimum of 5 days up to a maximum of two years. If the plan is purchased for a minimum of three months, coverage may be renewed (without break in coverage) for a total of up to two years.
If you or other family members applying for coverage are age 65 or older, please see the Eligibility section in the brochure for additional information.

All premium rates are in U.S. dollars and are effective through 12/31/2007. Rates include 2.5% surplus lines tax where applicable. A dependent child is your child shown on the Application Form over 14 days and under 18 years of age, traveling with you, and for whom premium has been paid.

Displayed rates are for $250 Deductible Option (in USD)

CLAIMS:
IMG must be notified prior to treatment or within 48 hours of an emergency.

Pre-certification, Emergency Evacuation and Return of Mortal Remains
For pre-certification, emergency evacuation and return of mortal remains, please call: IMG in the US: 1-800-628-4664 (toll free) or 1-317-655-4500. Call IMG outside the US: 001-317-655-4500 (collect if necessary). This information will also be provided on your ID card.

To Report Claims
Please mail completed claim forms to International Medical Group, P.O. Box 88500, Indianapolis, IN 46208-0500 USA. All IMG contact numbers, claim forms and Certificate Wordings will be included in the fulfillment kit. IMG may also be contacted by fax: 317-655-4505 or e-mail: insurance@imglobal.com

Direct Payment to Providers
In many cases IMG works directly with the hospital or clinic, including those outside our independent Preferred Provider Organization, for payment of eligible medical expenses. To file a claim, complete a claim form and submit it with original itemized bills. In this case, you will be responsible for your deductible, coinsurance amounts and non-eligible expenses.
Reimbursement
If you have received treatment and need to be reimbursed for out-of-pocket medical expenses, complete a claim form and submit your original itemized bills and paid receipts within 90 days. We will reimburse your eligible medical expenses after applying the deductible and coinsurance.
Please remember to submit your bills and receipts as soon as you receive them. Do not hold them until the end of the year. IMG will apply eligible medical expenses to your deductible and coinsurance throughout the year.

F.A.Q.:
Quality Guarantee
Your satisfaction is very important to the plan underwriter, and to IMG as the plan administrator. If, for any reason, you are not pleased with this product, you may submit a written request for cancellation and refund of your premium. In order to be considered for a full refund, your request for cancellation must be received by IMG prior to your effective date. If you do not have any claims filed with IMG, you may cancel your plan after your effective date, however, the following conditions will apply: 1) you will be required to pay a US$25 cancellation fee and 2) only full month premiums will be considered for refunds (e.g., if you choose to cancel your coverage two months and two weeks prior to the date your coverage ends, IMG will only consider the two full months for a refund). If you have filed claims, your premium is non-refundable.

About IMG:
Since 1990, International Medical Group has provided a unique, full service approach to insurance coverage. Dedicated exclusively to the international insurance market, IMG provides coverage services to individuals and families in more than 150 countries.
IMG’s multilingual claims administrators, on-site medical staff, and customer service professionals work together to give you true Global Peace of Mind. IMG representatives are available 24 hours a day, seven days a week, 365 days a year for medical emergencies, evacuations and pre-certifications. You can rest assured that IMG will be there for you whether it be for routine treatment or during a medical emergency.

Plan Underwriter:
While IMG provides complete plan administration expertise, Sirius International Insurance Corporation (publ), offers the financial security and reputation demanded by international consumers. Rated A (excellent) by A.M. Best and A- by Standard & Poor's*, Sirius International shares IMG's vision of the international marketplace and offers the stability of a well-established insurance company.

Sirius International is part of the White Mountains Insurance Group Ltd. With approximately $2 billion of regulatory capital and over $2 billion in gross premiums, the Group ranks among the top insurance and reinsurance organizations in the world.

*Sources: A.M. Best reconfirmed their rating in a press release dated April 22, 2004; Standard & Poor's reconfirmed their rating in a press release dated November 19, 2004

IMG, International Medical Group, the IMG block design logo, imglobal, Patriot Travel Medical Insurance, Patriot America, Coverage without boundaries, and global Peace of Mind are the trademarks, service marks and/or registered marks of International Medical Group, Inc.

Sirius, Sirius International, and the Sirius design logo are the trademarks, service marks and/or registered marks.

DOWNLOADS:

Patriot America BROCHURE PDF

Patriot America Claim Form

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