PATRIOT TRAVEL MEDICAL INSURANCESM

PREMIUMS: PATRIOT INTERNATIONALSM

Premiums: Patriot InternationalSMBenefits
 | Buy Now | Exclusions

Coverage for US citizens traveling abroad from 15 days to one year. If you are traveling for six months or more, review the ExPatriot PlusŪ plan for additional coverage options. Once the Period of Coverage expires, Patriot InternationalSM can be rewritten but is not renewable. This means new Deductible, Coinsurance, Eligibility, Conditions of Coverage and Pre-existing Condition Exclusions apply to any subsequent Period of Insurance.

PATRIOT INTERNATIONAL POLICY PREMIUMS
50,000
MAX
100,000
MAX
500,000
MAX
1,000,000
MAX
2,000,000
MAX
option 5 option 6 option7 option 8 option 9

AGE

One Month One Month One Month One Month One Month

18-29

$36.00
$42.00
$48.00
$54.00
$60.00

30-39

$42.00
$48.00
$64.00
$70.00
$80.00

40-49

$66.00
$74.00
$82.00
$90.00
$110.00

50-59

$106.00
$122.00
$136.00
$152.00
$170.00

60-64

$122.00
$144.00
$170.00
$200.00
$224.00

65-69

$144.00
$154.00
$176.00
$210.00
$270.00

70-79

$210.00
N/A
N/A
N/A
N/A

80 PLUS*

$420.00
N/A
N/A
N/A
N/A

DEP CHILD

$20.00
$26.00
$30.00
$32.00
$38.00

CHILD ALONE

$36.00
$40.00
$46.00
$50.00
$58.00

*US$10,000 limit

   
Fifteen (15) day premium is 50% of the monthly rate.

All premium rates are in US dollars and are effective through 6/30/2002. 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.


*See specific policy for age limit.

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 Travel Medical InsuranceSM 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.


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.
407 Fulton Street
Indianapolis, IN 46202 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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