SCHEDULE
OF BENEFITS
EACH PLAN INCLUDES THE FOLLOWING BENEFITS: |
| INTERNATIONAL
EMERGENCY CARE |
Emergency
Evacuation |
To Policy
Maximum when coordinated through IMG |
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.
|
| 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 |
To US$25,000
when coordinated through IMG |
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. |
Returning
Minor Children |
To US$5,000
when coordinated through IMG |
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).
|
| SPECIAL
COVERAGE |
Home Country
Coverage |
As described
below |
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 you 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
insurer'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 semiprivate room rate |
| |
|
Intensive
Care |
To Policy
Maximum |
| |
|
Medical Expenses |
To Policy
Maximum |
| |
|
| Outpatient
Medical |
To
Policy Maximum |
|
|
Local Ambulance |
To Policy
Maximum |
| |
|
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 |
| |
|
Coinsurance |
As described
below |
For treatment
received outside the US & Canada: No coinsurance
For treatment
received 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 Preexisting Condition |
Sudden
Recurrence of a Preexisting Condition - Up to US$500 will be paid
for the eligible expenses of a sudden and unexpected recurrence of
a Preexisting 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 Preexisting Condition. For the definition
of a Preexisting 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. |
Travel Insurance Questions?
