| SCHEDULE OF
BENEFITS- EACH PLAN INCLUDES THE FOLLOWING BENEFITS: |
| INTERNATIONAL
EMERGENCY CARE |
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|
Emergency Evacuation
|
To Policy Maximum when coordinated through IMG
|
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Each Patriot Travel Medical InsuranceSM plan also
provides for Emergency Medical Evacuations to the nearest
qualified medical facility or the country of residence (as
determined by IMGSM)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.
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|
| Emergency
Reunion |
To
US$15,000 when coordinated through IMG |
|
| Each PatriotSM
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. |
|
|
Repatriation
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To US$25,000 when coordinated through IMG
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If a covered illness/injury results in death, expenses for
Repatriation of bodily remains or ashes to the country of
citizenship will be covered up to a maximum of US$25,000.
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Returning Minor Children
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To US$5,000 when coordinated through IMG
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|
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).
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| SPECIAL
COVERAGES |
|
Home Country Coverage
|
As described below
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|
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 six (6) months
of coverage ou purchase, you can purchase one (1) month of home
country coverage up to a maximum of 2 months.
|
|
|
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 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; maximum of US$250
|
|
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
|
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| |
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Intensive Care
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To Policy Maximum
|
| |
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Medical Expenses
|
To Policy Maximum
|
| |
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| Outpatient
Medical |
To
Policy Maximum |
|
|
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|
Local Ambulance
|
To Policy Maximum
|
|
| |
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Dental
|
To Policy Maximum
|
| 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 |
|
|
Sports & Activities
|
To Policy Maximum for basic sports Coverage as described
below
|
|
|
Each Patriot plan covers injuries incurred during amateur
athletic activities which are non-contact and engaged in by an
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, but may be added by the Optional
Sports Rider: Scuba diving, mountain climbing (up to 4500
meters or where ropes or guides are normally used), jet, snow
and water skiing and snowboarding, sky diving, amateur racing,
piloting an aircraft, bungee jumping and spelunking.
|
| 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. |
| PLAN
INFORMATION |
|
|
Deductible
|
Your choice of US$100, $250, $500, $1,000 or $2,500
|
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| |
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Coinsurance
|
As described below
|
|
For treatment received outside the US
& Canada: No coinsurance
For treatment receivd within the US &
Canada: 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. |
|
| Additional
Benefits for U.S. Citizens |
|
| Sudden
Recurrence of a Pre-existing Condition |
| Sudden Recurrence of a
Pre-existing Condition - Up to US$500 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. |
| Dental
Emergency |
| This plan will pay up to
$100 for the necessary treatment of sudden, unexpected pain to
sound natural teeth. |
| 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. |
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