Patriot GoTravel America

Why Consider Travel Insurance? Traveling abroad can be an exciting experience. But what would happen if you or one of your family members become ill or injured whiled away from home? International travel can quickly turn frightening if you’re not prepared fro a medical emergency.

Most travelers assume they will be covered by their standard medical plan. The truth is, while traditional plans may offer adequate domestic coverage, they may not be designed for international travel. Without even realizing it, you may be putting your health - & that of your family - at risk.

What if you are injured or become ill during your trip? Could you get quality treatment at an unfamiliar hospital? How would you deal with the language and currency barriers? What if the treatment you need isn't available nearby? Who do you call? Imagine trying to call your insurance company at 3:00 a.m. from a foreign country during a medical emergency! Will they be there when you need them the most?

You have enough to worry about when you're traveling. Don't let your medical coverage be an uncertainty. International Medical Group® (IMG®) has developed Patriot GoTravelSM Medical Insurance plans to provide you and your family Coverage Without Boundaries. Each plan offers a complete package of international benefits available 24 hour a day. Simply select the one that best fits your needs.

Patriot GoTravel 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.

The Experienced Plan Administrator Since 1990, International Medical Group has provided a unique, full-service approach to insurance coverage. Dedicated exclusively to international insurance market, IMG provides coverage services to individuals and families in more than 170 countries. Medical treatment while traveling is often an unfortunate fact of life. Our goal is to make the medical process a smooth and efficient one. IMG's multilingual claims administrators, on-site medical staff and customer service professionals work together to ensure that your medical needs are met. We process as many as 100,000 claims each year from countries throughout the world, and can confidently handle virtually any language or currency.

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 precertifications. Our customer service is routinely rated among the highest in the industry. You can rest assured that IMG will be there for you, whether it be for routine treatment or during a medical emergency.

IMG gives you worldwide coverage experience, impeccable service and international expertise. Don't leave your medical care to chance. Let IMG reduce the uncertainties of international travel for you & your family.

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Benefits:
SCHEDULE OF BENEFITS  (all amounts listed are in U.S. dollars)
MEDICAL BENEFITS Usual, reasonable and customary charges, subject to deductible and coinsurance
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

Prescription Drugs Up 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) $250 deductible if treatment does not require admittance to the hospital.

PLAN INFORMATION
Deductible Your choice of $0, $100, $250, $500, $1,000 or $2,500
 Your premium rate is dependent on the deductible you choose.
Coinsurance As described below
For treatment received outside the U.S. & Canada: No coinsurance

For treatment received within the U.S. & Canada:
In the PPO Network: The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Policy Maximum

Outside the PPO Network: The plan pays 80% of eligible expenses up to $5,000, then 100% up to the Policy Maximum
Benefit Period Six months
If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the six-month Benefit Period may provide continued coverage. When the certificate expires, the Company will review the date of initial treatment for the covered injury or illness. If treatment began less than six months before the Period of Coverage expired, benefits for the covered injury or illness will continue subject to the Policy Limits and the other terms of the plan until there have been six months of continuous coverage for the covered injury or illness.

ADDITIONAL BENEFITS
Home Country Coverage As described below
Incidental Home Country Coverage - During the Period of Coverage an insured person may return to their home country 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.

End of Trip Home Country Coverage - For every five months of continuous coverage you purchase, you can purchase one additional month of home country coverage as an accommodation and supplemental travel benefit, up to a maximum of two months. To purchase this special home country extension coverage, please check the appropriate box on the Application Form, and calculate your premium to include the additional month(s).
Natural Disaster $100 per day for five days
This benefit is available in the event an insured person is required to depart his/her destination due to an evacuation order issued by prevailing authorities in connection with a Natural Disaster. Natural Disaster is defined as widespread disruption of human lives by disasters such as flood, drought, tidal wave, fire, hurricane, earthquake, windstorm, or other storm, landslide, or other natural catastrophe or event resulting in migration of the population for its safety.
Trip Interruption Up to $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, each Patriot 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.
Common Carrier Accidental Death $50,000 to Beneficiary; maximum of $250,000 per family
If accidental death should occur while traveling on a commercial Common Carrier, $50,000 will be paid to the designated beneficiary, to a maximum of $250,000 per family or group.
Sports & Activities Coverage Up to Policy Maximum for basic sports Coverage as described below
Each Patriot GoTravel  plan covers injuries incurred during amateur athletic activities which are non-contact and engaged in by the 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 unless the Extreme Sports Rider is purchased: abseiling, aviation (except when traveling as a passenger in a commercial aircraft), BMX, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, mountain biking, paragliding, parascending, rappelling, rock climbing, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, surfing, trekking, wind-surfing and whitewater rafting.

Racing of any kind, BASE jumping, mountaineering, climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, rodeo activity, ski jumping, whitewater rafting exceeding Class V difficulty; and/or extreme sports not expressly covered hereunder are excluded regardless of which plan or rider is selected.
Accidental Death & Dismemberment $25,000 principal sum
Each Patriot GoTravel plan includes $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.
Terrorism Coverage Up to $50,000 lifetime maximum
Each Patriot GoTravel plan provides coverage for injuries and illness incurred as a result of an act of Terrorism, limited in amount and by circumstances. If an insured person is injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims subject to a $50,000 lifetime maximum. However, claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered.

Terrorism is defined as the systematic or planned use of violence, fear, or threat of violence in order to intimidate a population or government, especially as a means of coercion or to obtain a granting of any demand. However, this benefit does not cover an act of Terrorism in any country or location where the United States government has issued a travel advisory that has been in effect within the 6 months prior to the insured person's date of arrival.

This benefit also does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location.

Identity Theft Assistance Up to $500 per Period of Coverage
If an imposter obtains key personal information such as a Social Security or Driver's License number, or other method of identifying an insured person in order to impersonate or obtain credit, merchandise or services in the insured person's name, the Patriot GoTravel plans will provide coverage for the reasonable, customary and necessary costs incurred by the insured for: re-filing a loan or other credit application that is rejected solely as a result of the stolen identity event; notarization of legal documents, long distance telephone calls, and postage that has resulted solely as a result of reporting, amending and/or rectifying records as a result of the stolen identity event; up to three credit reports obtained within one year of the insured person's knowledge of the stolen identity event; and stop payment orders placed on missing or unauthorized checks as a result of the stolen identity event.

The identity theft event must occur during the Period of Coverage and must be reported within 6 months of the termination of coverage date.

Additional Benefits for U.S. Citizens
Sudden Recurrence of a Pre-existing Condition
(U.S. citizens only) Up to $15,000 will be paid for the eligible expenses of a sudden and unexpected recurrence of a Pre-existing Condition (defined on page 16) while traveling outside of the U.S.
Indemnity
(U.S. citizens only) Patriot GoTravel international will pay directly to the insured person $100 for each night of a required overnight stay in a hospital. However, the hospital stay must be covered under this plan in order to receive this benefit.
 

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Exclusions:
Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under the Patriot GoTravel plans.
  1. A Pre-existing Condition is defined as 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 there from.
  2. Treatment or surgeries which are elective, investigational, experimental or for research purposes.
  3. War, military action, terrorism, political insurrection, protest, or any act thereof.
  4. Immunizations and routine physical exams.
  5. Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.
  6. 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.
  7. Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
  8. 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 unless the Extreme Sports Rider is purchased: abseiling, aviation (except when traveling as a passenger in a commercial aircraft), BMX, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, mountain biking, paragliding, parascending, rappelling, rock climbing, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, surfing, trekking, wind-surfing and whitewater rafting.

    Racing of any kind, BASE jumping, mountaineering, climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, rodeo activity, ski jumping, whitewater rafting exceeding Class V difficulty; and/or extreme sports not expressly covered hereunder are excluded regardless of which plan or rider is selected.
  9. Vision or ear tests and the provision of visual or hearing aids.
  10. Vocational, recreational, speech or music therapy.
  11. Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
  12. 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.
  13. Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
  14. 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.
  15. Willful self-inflicted injury or illness.
  16. Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.
  17. Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
  18. Treatment for mental and nervous disorders.
  19. Organ or tissue transplants or related services.
  20. 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.
  21. 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 GoTravel 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.

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Nationwide PPO Network: Click here to ACCESS THE PPO DIRECTORY

You may seek treatment under Patriot GoTravel Medical Insurance Plan worldwide, including in the United States, with the hospital or doctor of your choice. When seeking treatment in the U.S., you may use the independent Preferred Provider Organization (PPO) contracted by IMG, a separately organized network (First Health Group) of approximately 500,000 physicians and 4,700 privately owned and operated hospitals. * This PPO network includes a large number of hospitals including some of the most well recognized university medical centers and transplant facilities.

Using this provider network could significantly reduce your out-of-pocket expenses.

When a U.S. hospital outside the network is used, a co-payment of US $250 is required in addition to the regular deductible and coinsurance. This co-payment is waived, however, if there is not a network provider within 50 miles of the location of treatment.

Each proposed hospital admission, inpatient or outpatient surgery, and certain other medical procedures must be Pre-certified for medical necessity. This means the insured person or their attending physician must call the number listed on the IMG identification card prior to admittance to a hospital or performance of a surgery, or medical procedure. In the case of an emergency hospital admission, the Pre-certification call must be made within 48 hours of the admission, or as soon as reasonably possible. For a complete list of procedures requiring Pre-certification, please refer to your certificate wording.

If Pre-certification guidelines are not followed, eligible claims and expenses will be reduced by 50%.




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Rates:Patriot GoTravel America The following rates are based on a $250 deductible in all the policy maximum options.
Options: Other lower and Higher deductible options available as follows to improve the deductible or reduce the cost. please use these rate factors.
Deductible Rate Factors. Deductible Rate Factors.
US $ Zero 1.25 US $500 .90
US $100 1.10 US $1,000 .80
US $250 1.00 US $2,500 .70

PATRIOT GOTRAVEL AMERICA RATES (For Non U.S. Citizens)
Rates are based on a $250 deductible option.


ONE MONTH RATES
(Four Policy Maximum options. Maximums are per insured per certificate period.)
Option 1 Option 2 Option 3 Option 4
$50,000 $100,000 $500,000 $1,000,000
Age One Month One Month One Month One Month
18-29 $42 $49 $63 $74
30-39 $55 $66 $82 $95
40-49 $82 $94 $123 $139
50-59 $118 $144 $174 $202
60-64 $139 $171 $203 $243
65-69 $159 $204 $221 $265
70-79 $215 N/A N/A N/A
80+* $373 N/A N/A N/A
Dep. Child $36 $43 $55 $62
Child Alone $38 $45 $58 $65
*$10,000 Maximum

DAILY RATES (5 day minimum)
Option 1 Option 2 Option 3 Option 4
$50,000 $100,000 $500,000 $1,000,000
Age Daily Daily Daily Daily
18-29 $1.42 $1.72 $2.16 $2.50
30-39 $1.86 $2.21 $2.79 $3.19
40-49 $2.79 $3.19 $4.17 $4.70
50-59 $3.97 $4.85 $5.88 $6.76
60-64 $4.70 $5.73 $6.81 $8.18
65-69 $5.34 $6.86 $7.45 $8.87
70-79 $7.20 N/A N/A N/A
80+* $12.50 N/A N/A N/A
Dep. Child $1.20 $1.45 $1.85 $2.10
Child Alone $1.32 $1.57 $1.96 $2.21
*$10,000 Maximum

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EXTREME SPORTS RIDER:.
The Extreme Sports Rider is available on both Patriot plans for those up to the age of 65. The following activities are covered to the lifetime maximum amounts: abseiling, aviation, BMX, bobsleigh, bungee jumping, canyoning, caving, flying (private plane), hang gliding, heli-skiing, high diving, hot air ballooning, inline skating, jet skiing, kayaking, mountain biking, paragliding, parascending, rappelling, rock climbing (ropes and guides to 4500m from ground level), skydiving, snow boarding, snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), wind-surfing. These extreme activities must be engaged in solely for leisure, recreation, or entertainment purposes.
Age Lifetime Maximum
0 - 49 $50,000
50 - 59 $30,000
60 - 64 $15,000
PATRIOT GoTravel RETURN RIDER
(Non-U.S. citizens only) When purchased at the time of application, the Patriot GoTravel Return Rider provides temporary medical coverage for non-U.S. citizens returning to their home country.
Up to Policy Maximum
ENHANCED AD&D RIDER
This optional coverage is available for the primary insured person only. This coverage is in addition to the Accidental Death and Dismemberment already included in the Patriot GoTravel plans. Coverage must be purchased for a minimum of three months.
Up to an Additional $400,000