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Patriot Group Travel Medical InsuranceSM

Overview • Benefits • Exclusions • Quote / Buy Online
Premiums: Patriot InternationalSM • Patriot AmericaSM

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.

All premium rates are in US dollars and are effective through 12/31/2006. Rates include 2.5% surplus lines tax where applicable. A dependent child is a child shown on the Application Form over 14 days and under 18 years of age, traveling with the group as a dependent of a group member, and for whom premium has been paid.

ANNUAL DEDUCTIBLE
$0 $100 $250 $500 $1000 $2500
 
POLICY LIMIT $50,000 $100,000 $500,000 $1,000,000
 
AGE Monthly Rates
18-29 $39.00 $45.00 $58.00 $68.00
30-39 $50.00 $60.00 $76.00 $87.00
40-49 $76.00 $86.00 $113.00 $128.00
50-59 $108.00 $132.00 $160.00 $185.00
60-64 $128.00 $157.00 $186.00 $223.00
65-69 $146.00 $187.00 $203.00 $243.00
70-79 $197.00 N/A N/A N/A
80+* $343.00 N/A N/A N/A
DEP. CHILD $23.00 $25.00 $32.00 $35.00
CHILD ALONE $35.00 $41.00 $53.00 $59.00
 
  Daily Rates (Minimum length of coverage is 5 days)
18-29 $1.30 $1.55 $1.95 $2.25
30-39 $1.65 $2.00 $2.55 $2.90
40-49 $2.55 $2.85 $3.80 $4.30
50-59 $3.60 $4.45 $5.40 $6.15
60-64 $4.30 $5.25 $6.25 $7.50
65-69 $4.90 $6.30 $6.80 $8.10
70-79 $6.60 N/A N/A N/A
80+* $11.45 N/A N/A N/A
DEP. CHILD $0.75 $0.90 $1.10 $1.20
CHILD ALONE $1.20 $1.40 $1.80 $2.00

* US$10,000 Maximum

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.

Precertification, Emergency Evacuation and Repatriation

For precertification, emergency evacuation and repatriation, 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.

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

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.

This web page contains only a consolidated and summary description of all current Patriot Group 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. IMG reserves the right to issue the most current Policy 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 Policy Wordings are available upon request.

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