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Patriot Group
5 days-2 years.
Group of 5 or more.
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Traveling abroad can be an exciting experience. But what would happen if a member of your group became ill or injured while away from home? How would you deal with the language and currency barriers? Who would 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?
Most travelers assume they will be covered by their standard
medical plan. The truth is, while traditional plans may offer adequate
domestic coverage, they are not designed for international
travel. Without even realizing it, you may be putting your
health - and that of your group - at risk.
Your group has enough to worry about when they travel. Don’t
let their medical coverage be an uncertainty. International
Medical Group® (IMG®) has developed two Patriot Group Travel
Medical Insurance® plans to provide you and your group
Coverage Without Boundaries® so you can spend more time
enjoying your international experience, and less time worrying
about your medical security.
The two Patriot Group plans offer a complete package of international
benefits available 24 hours a day. Patriot
International® Group provides coverage for a group of
U.S. citizens traveling outside the U.S. with coverage for brief returns to
the U.S., while Patriot America® Group provides
coverage for a group of non-U.S. citizens traveling outside their home country.
Both plans are available for a minimum of 5 days up to a maximum
of two years.
Additionally, the plans offer excellent benefits and services to meet
your global needs. You have access to international, multilingual
customer service centers, claims administrators who process claims
from all over the world, handling virtually every language and currency,
and 24 hour access to highly qualified coordinators of emergency
medical services and international treatment. You can also
choose from a wide range of deductibles, several Maximum Limits,
and you have access to more than 17,000 providers when seeking
treatment outside the U.S. using our International Provider Accesssm
(IPA). You can also reduce your out-of-pocket costs when seeking
treatment in the U.S. by locating providers through the independent
Preferred Provider Organization.
At IMG, we know that the reasons to travel
abroad are many and varied - that’s why our
services are designed to provide you with the
security you need no matter where you are. Our goal is to make the
medical process smooth and efficient. By providing global products
and services to vacationers, those working or living abroad for
short or extended periods, people traveling frequently between
countries, and those who maintain multiple countries of residence,
IMG is the single resource for all your international travel needs.
How we service and support your needs is what sets us apart. Since
1990, we’ve served more than a million people around the globe -
always focused on the specific needs of each individual. We’ve set
the benchmark for industry service levels by integrating independent
credentialing services with in-house, fully owned and operated
service divisions. At IMG, we’re with you, wherever you go - bringing
support for all your insurance needs around the globe - providing
you Global Peace of Mind®.
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Maximum Limits
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$50,000, $100,000, $500,000,
$1,000,000, $2,000,000
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Individual Deductible
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$0, $100, $250, $500, $1,000, $2,500
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Coinsurance - for treatment received
outside the U.S. & Canada
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No Coinsurance
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Coinsurance - for treatment received
within the U.S. & Canada
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In the PPO Network - The plan pays
90% of eligible expenses up to
$5,000, then 100% up to the Maximum Limit
Out of the PPO Network - The plan
pays 80% of eligible expenses up to
$5,000, then 100% up to the
Maximum Limit
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Benefit Period
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Six months
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MyIMGsm
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24 hour secure access from
anywhere in the world to manage
your account at anytime
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World-class Medical Benefits
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Coverage available for in-patient and
out-patient medical expenses
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International Emergency Care
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A wide range of international emergency
benefits available including
emergency evacuation, emergency
reunion, return of mortal remains,
return of minor children and more
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All coverages, benefits and premium amounts shown in this booklet are in U.S. dollars.
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MEDICAL BENEFITS
Usual, reasonable and customary charges. Subject to deductible and coinsurance.
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Hospital Room and Board
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Up to the Maximum Limit for
average semi-private room rate
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Intensive Care
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Up to the Maximum Limit
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Medical Expenses
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Up to the Maximum Limit
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Out-patient Medical Expenses
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Up to the Maximum Limit
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Local Ambulance
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Up to the Maximum Limit
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Prescription Drugs
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Up to the Maximum Limit
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Emergency Room Accident
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Up to the Maximum Limit
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Emergency Room Illness with
In-patient Admission
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Up to the Maximum Limit
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Emergency Room Illness without
In-patient Admission
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Up to the Maximum Limit with
additional $250 deductible
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Dental - Injury Due to Accident
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Up to the Maximum Limit
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Dental - Sudden Dental Pain
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Up to $100
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Indemnity
(for U.S. citizens only)
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Up to $100 per night
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INTERNATIONAL EMERGENCY CARE
When coordinated through the Plan Administrator.
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Emergency Medical Evacuation
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Up to $500,000 lifetime
maximum (independent of
the Maximum Limit)
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Emergency Reunion
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Up to $50,000
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Return of Mortal Remains
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Up to $50,000
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Return of Minor Children
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Up to $50,000
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Political Evacuation
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Up to $10,000
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Natural Disaster
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$100 per day for five days
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Identity Theft Assistance
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Up to $500 per Period of
Coverage
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ADDITIONAL BENEFITS
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Terrorism
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Up to $50,000 lifetime maximum
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Sports & Activities Coverage
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Up to the Maximum Limit for
basic sports
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Sudden Recurrence of a
Pre-existing Condition - Medical
(for U.S. citizens only)
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Up to $15,000 of
eligible expenses
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Sudden Recurrence of a
Pre-existing Condition -
Emergency Medical Evacuation
(for U.S. citizens only)
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Up to $25,000 of
eligible costs and expenses
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Incidental Home Country
Coverage
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Up to a cumulative two weeks
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End of Trip Home Country
Coverage
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One month for every five months
of travel coverage purchased, up
to a maximum of two months
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Trip Interruption
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Up to $5,000
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Common Carrier
Accidental Death
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$50,000 to beneficiary; maximum
of $250,000 per family
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Accidental Death
& Dismemberment
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$25,000 principle sum
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Lost Luggage
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Up to $50 per item of personal
property; maximum of $250 per
Period of Coverage
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OPTIONAL RIDERS
With the exception of the Chaperone/Faculty Leader Replacement Rider,
optional riders apply to all individuals listed on the Application Form.
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Adventure Sports Rider
(available to insureds up to age 65)
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Age
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Lifetime Maximum
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0 - 49
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$50,000
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50 - 59
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$30,000
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60 - 64
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$15,000
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Chaperone/Faculty Leader
Replacement Rider
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Up to $3,000 for round trip
economy airline ticket
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Citizenship Return Rider
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Up to the Maximum Limit
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The benefits and riders are a summary only.
Please see below for a list of descriptions.
Rates are based on a $250 deductible option.
For other deductible options, please see the application.
These are online application rates. Please look at the PDF brochure for paper application rates.
ONE MONTH RATES (Four Maximum Limit options.
Maximums are per covered insured per certificate period.)
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Option 1
$50,000
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Option 2
$100,000
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Option 3
$500,000
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Option 4
$1,000,000
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Age
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One Month
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One Month
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One Month
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One Month
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18-29
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$35
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$41
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$53
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$64
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30-39
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$47
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$56
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$70
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$82
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40-49
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$70
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$81
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$107
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$120
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50-59
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$102
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$124
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$152
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$175
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60-64
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$128
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$157
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$186
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$223
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65-69
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$146
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$187
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$203
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$243
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70-79
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$197
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N/A
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N/A
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N/A
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80+*
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$343
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N/A
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N/A
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N/A
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Dep. Child
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$32
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$37
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$48
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$53
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Child Alone
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$35
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$41
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$53
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$59
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*10,000 Maximum
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DAILY RATES (5 day minimum)
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Option 1
$50,000
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Option 2
$100,000
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Option 3
$500,000
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Option 4
$1,000,000
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Age
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One Month
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One Month
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One Month
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One Month
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18-29
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$1.20
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$1.40
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$1.80
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$2.15
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30-39
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$1.60
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$1.90
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$2.35
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$2.75
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40-49
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$2.35
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$2.70
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$3.60
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$4.00
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50-59
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$3.40
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$4.15
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$5.10
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$5.85
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60-64
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$4.30
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$5.25
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$6.25
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$7.50
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65-69
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$4.90
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$6.30
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$6.80
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$8.10
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70-79
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$6.60
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N/A
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N/A
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N/A
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80+*
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$11.45
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N/A
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N/A
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N/A
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Dep. Child
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$1.10
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$1.25
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$1.60
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$1.80
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Child Alone
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$1.20
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$1.40
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$1.80
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$2.00
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*10,000 Maximum
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Rates are based on a $250 deductible option.
For other deductible options, please see the application.
ONE MONTH RATES (Five Maximum Limit options.
Maximums are per covered insured per certificate period.)
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Option 5
$50,000
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Option 6
$100,000
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Option 7
$500,000
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Option 8
$1,000,000
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Option 9
$2,000,000
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Age
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One Month
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One Month
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One Month
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One Month
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One Month
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18-29
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$23
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$28
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$33
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$38
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$49
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30-39
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$28
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$33
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$44
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$51
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$65
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40-49
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$50
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$54
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$61
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$68
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$89
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50-59
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$81
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$92
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$103
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$108
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$138
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60-64
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$98
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$116
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$138
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$162
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$181
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65-69
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$116
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$124
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$158
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$170
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$219
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70-79
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$170
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N/A
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N/A
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N/A
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N/A
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80+*
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$340
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N/A
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N/A
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N/A
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N/A
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Dep. Child
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$21
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$25
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$30
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$33
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$37
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Child Alone
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$23
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$28
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$33
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$38
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$47
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*10,000 Maximum
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DAILY RATES (5 day minimum)
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Option 5
$50,000
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Option 6
$100,000
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Option 7
$500,000
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Option 8
$1,000,000
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Option 9
$2,000,000
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Age
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Daily
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Daily
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Daily
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Daily
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Daily
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18-29
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$0.80
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$0.95
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$1.10
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$1.30
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$1.65
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30-39
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$0.95
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$1.10
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$1.50
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$1.70
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$2.20
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40-49
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$1.70
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$1.80
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$2.05
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$2.30
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$3.00
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50-59
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$2.70
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$3.10
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$3.45
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$3.60
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$4.60
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60-64
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$3.25
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$3.90
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$4.60
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$5.40
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$6.05
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65-69
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$3.90
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$4.15
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$4.80
|
$5.70
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$7.30
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70-79
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$5.70
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N/A
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N/A
|
N/A
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N/A
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80+*
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$11.35
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N/A
|
N/A
|
N/A
|
N/A
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Dep. Child
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$0.70
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$0.85
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$1.00
|
$1.10
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$1.25
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Child Alone
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$0.80
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$0.95
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$1.10
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$1.30
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$1.60
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*10,000 Maximum
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All premium rates are effective through 3/31/2011. Rates include surplus lines tax where applicable.
A dependent child is your child shown on the Application Form over 14 days and under
18 years of age, traveling with you, and for whom premium has been paid. The maximum
amount of coverage for applicants who are 80 years of age or older is $10,000.
1) Coverage and benefits are subject to the deductible and coinsurance, and all terms of the certificate of coverage and Master Certificate.
2) Coverage under a Patriot Group plan is secondary to
any other coverage.
3) Coverage and benefits are for medically
necessary and usual, reasonable and customary charges only.
4) Charges must be administered or ordered by a physician.
5) Charges must be incurred during the Period of Coverage or the
Benefit Period.
6) Claims must be presented to IMG for payment
within the Period of Coverage, Benefit Period or during the three
months immediately following the Period of Coverage.
The following conditions apply to all persons applying for and/or
enrolling in Patriot Group Travel Medical Insurance.
- Patriot Group Travel Medical Insurance is travel insurance for U.S.
citizens traveling outside the United States with coverage for brief
returns to the U.S., and for non-U.S. citizens traveling outside their
home country.
- For those under 65 years of age and visiting the U.S., your initial
Period of Coverage must begin within six months of arrival in
the U.S. For those 65 years of age and older, it must begin within
30 days of arrival. These requirements will be waived with
proof of previous valid international travel insurance. Prior U.S.
domestic health care coverage does not meet this eligibility
requirement. Please provide the name of your international
insurance carrier on the Application Form. If you are not in the
U.S. at the time of application, please indicate your expected
date of arrival on your Application Form.
If your Patriot Group 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. Renewals are available in whole month increments.
Each insured person must only satisfy one deductible and
coinsurance within each 12 month coverage period. Please note:
Renewal rates may differ from initial rates.
The group’s satisfaction is very important to IMG and the plan underwriter. If the sponsoring organization or group is not pleased with this product for any reason, a written request may be submitted, prior to the effective date, for cancellation and refund of your premium. If the group does not have any claims filed with IMG, you may cancel the plan after the effective date, however, the following conditions will apply: 1) the group will be required to pay a $50 cancellation fee and 2) only full month premiums will be considered for refunds (e.g., if the group chooses to cancel coverage two months and two weeks prior to the date coverage ends, IMG will only consider the two full months for a refund). If anyone in the group has filed a claim, the premium is non-refundable.
You should read the following important information
prior to completing the Application Form.
You may either apply online for
Instant
Quotes & Purchase
or complete Paper
Application
If you are applying online, no papers are required to be mailed
or faxed. If you are completing a paper application, you can
either fax the credit card applications to (972) 767-4470 or
mail all applications to
Insubuy ®, Inc.
4700 Dexter Dr, Suite 100
Plano, TX 75093 USA
You can apply over the phone as well by calling toll-free (866) INSU-BUY.
You, your spouse and unmarried dependent children (over 14 days and under 18 years of age) listed on the Application Form and for whom premiums have been paid will be covered from the latest of the following dates:
- the date IMG receives your completed Application Form and the appropriate premium;
- the date you depart from your home country; or
- the date requested on your Application Form.
Patriot Travel Medical Insurance coverage ends on the earliest of the following dates:
- The end of the period for which premium has been paid;
- the date requested on your Application Form; or
- the date you return to your home country (however, see Home Country Coverage for incidental coverage).
IMG normally processes Application Forms within 24 hours of receipt. Once processing is complete, IMG will mail a fulfillment kit to the mailing address listed on the Application Form. The fulfillment kit will include an IMG
Identification Card, IMG contact numbers,
Claim Forms and your insurance certificate providing a complete description of your rights and benefits under the contract. Please note: If you require express mail delivery, there is an additional charge listed on the Application Form.
For your convenience, you may choose to download your fulfillment kit from
our web site
rather than having it mailed to you.
To do this, you must check the appropriate box listed in Section 2 of the Application Form.
We must have your correct email address to complete this process.
Once IMG has received and processed your Application Form, you will receive an email from IMG that
contains all of the hyperlinks to easily obtain the fulfillment information through the Internet.
PRECERTIFICATION
Each proposed hospital admission, in-patient or out-patient surgery,
and other procedures as noted in the Certificate Wording
must be Precertified for medical necessity, which 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. In case of an Emergency Admission,
the Precertification call must be made within 48 hours of the admission,
or as soon as reasonably possible. If a hospital admission or a
surgery is not Precertified, eligible claims and expenses will be
reduced by 50%. It is important to note that Precertification is only
a determination of medical necessity, not an assurance of coverage,
verification of benefits or a guarantee of payment. All medical
expenses must meet usual, reasonable, customary, and eligible
payment guidelines. Please refer to the Certificate Wording for full
details of the precertification requirements.
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.
Note: An insured person may begin the Precertification process through MyIMG or the
Client Resources section of our website, www.imglobal.com. Simply look for the
Precertification option. You will be asked to provide the required information, which can
then be submitted electronically to IMG. Once we have confirmed receipt of your request,
our utilization management and review team will review the information provided and
respond to the insured person or the provider within two business days. Please note that
this online service will only initiate the Precertification process, and it should not be used
to Precertify emergency admissions, procedures, or evacuations.
CLAIM PAYMENT
All benefits payable under Patriot Group Travel Medical Insurance
are subject to the provisions described in this brochure and as contained
in the Certificate Wording and certificate of coverage. To
make claim processing efficient, claims may be paid in two ways.
- Eligible claims that have been paid by or on behalf of the
Insured Person will be reimbursed by check directly to the
Insured Person.
- Eligible claims that have not yet been paid by the Insured
Person will, at the option of IMG, be paid either to the Insured
Person or directly to the provider.
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:
1.317.655.4505
The following is a partial list of benefits and terms that are offered on
the Patriot Group plans.
DEDUCTIBLE:
On the Application Form, you will be asked to circle your choice of a
deductible. Your premium rate is dependent on the deductible you
choose. Please see the Application Form for more information.
EMERGENCY ROOM:
Charges incurred for the use of the Emergency Room due to an accident
are covered up to the Maximum Limit.
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.
DENTAL:
Injury due to an accident - Each Patriot Group plan covers the cost of
emergency dental treatment and dental procedures necessary to
restore sound natural teeth lost or damaged in an accident up to the
Maximum Limit.
Sudden dental pain - Each plan will pay up to $100 for the necessary
treatment of sudden, unexpected pain to sound natural teeth.
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. In addition, up
to $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.
INDEMNITY:
(U.S. citizens only) Patriot International Group 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.
BENEFIT PERIOD:
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 Maximum Limits and the other terms of the plan until there have
been six months of continuous coverage for the covered injury or illness.
POLITICAL EVACUATION:
If the United States Department of State, Bureau of Consular Affairs
issues a travel advisory that becomes effective on or after the Insured
Person’s date of arrival in the Host Country, the Company will pay up to
$10,000 for transportation to the nearest place of safety or for repatriation
to the Insured Person’s home country or country of residence provided
that: 1) The Insured Person contacts the Company within 10
days of the United States Department of State, Bureau of Consular
affairs issues the travel advisory; 2) Political Evacuation and
Repatriation is approved and coordinated by the Company.
EMERGENCY EVACUATION:
Each Patriot Group plan includes coverage for Emergency Medical
Evacuations to the nearest qualified medical facility; expenses for reasonable
travel and accommodations resulting from the evacuation;
and the cost of returning to either the home country or the country
where the evacuation occurred, up to a $500,000 lifetime maximum
(independent of the Maximum Limit).
EMERGENCY REUNION:
Each Patriot Group plan also provides emergency reunion coverage, up
to $50,000 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 home country to be reunited with
the insured.
RETURN OF MORTAL REMAINS:
If a covered illness/injury results in death, expenses for Repatriation of
bodily remains or ashes to the home country will be covered up to a
maximum of $50,000.
RETURN OF MINOR CHILDREN:
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 Group plans will pay up to $50,000 for one
way economy fare to their home country, including a chaperone, if
necessary, for the safety of the child(ren).
To be eligible for the Evacuation, Reunion and Return benefits, these must
be recommended by the attending physician in critical medical situations,
and approved in advance and coordinated by IMG.
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:
- The insured person must have left their home country,
- The total Period of Coverage must be for a minimum of 30 days, and
- 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).
SPORTS AND ACTIVITIES COVERAGE:
Each Patriot Group 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 Adventure
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, paracending, 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, scuba below
10 meters; and/or adventure sports not expressly covered hereunder
are excluded regardless of which plan or rider is selected.
ACCIDENTAL DEATH AND DISMEMBERMENT:
Each Patriot Group 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.
COMMON CARRIER ACCIDENTAL DEATH:
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 of group.
NATURAL DISASTER:
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:
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 Group 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.
TERRORISM COVERAGE:
Each Patriot Group 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 six 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:
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 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 six months of the termination of coverage date.
LOST LUGGAGE:
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.
ADVENTURE SPORTS RIDER
The Adventure Sports Rider is available on both Patriot Group plans
for those up to the age of 65. The following activities are covered to the
lifetime maximum amounts listed on page four: 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), windsurfing.
These adventure activities must be engaged in solely for
leisure, recreation, or entertainment purposes.
CHAPERONE/FACULTY LEADER REPLACEMENT RIDER
In the event that an insured person who is designated as a
Chaperone/Faculty Leader by the sponsoring organization has an
unexpected death of a relative, a medical emergency, or the substantial
destruction of the principal residence in his/her home country,
which causes the insured person to have to cancel or interrupt travel,
Patriot Group covers reimbursement up to $3,000 for the expense of a
round trip economy airline ticket for a replacement Chaperone/Faculty
Leader. For premium information, please see the Application Form.
CITIZENSHIP RETURN RIDER
When purchased at the time of application, the Citizenship Return
Rider provides temporary medical coverage for non-U.S. citizens
returning to their home country. For U.S. citizens, the rider provides
up to 60 days of coverage for brief returns to the U.S. provided you
have a current health plan in force and have resided outside the U.S.
continuously for the past six months. Coverage for sudden recurrence
of pre-existing conditions is excluded if the rider is selected. For premium
information, please see the back of the Application Form.
Charges for the following services, treatments and/or conditions,
among others, are excluded from coverage under the Patriot
Group plans.
- 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 therefrom.
- Treatment or surgeries which are elective, investigational,
experimental or for research purposes.
- War, military action, terrorism, political insurrection, protest,
or any act thereof. The Company will not pay for a Political
Evacuation if there is a travel advisory in effect on or within six
(6) months prior to the Insured Person’s date of arrival in the
Host Country.
- Immunizations and routine physical exams.
- Treatment of Temporomandibular Joint or dental treatment,
except as expressly provided for in the certificate of
insurance.
- 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.
- Pregnancy, childbirth, birth control, artificial insemination,
treatment for infertility or impotency, sterilization or reversal
thereof, or abortion.
- 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 Adventure 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, paracending, 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, scuba below 10 meters; and/or adventure sports
not expressly covered hereunder are excluded regardless of
which plan or rider is selected.
- Vision or ear tests and the provision of visual or hearing aids.
- Vocational, recreational, speech or music therapy.
- Treatment while confined primarily to receive custodial
care, educational or rehabilitative care, or nursing services.
- 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.
- Treatment for, and injuries and/or illnesses resulting or arising
from, substance abuse or drug addiction.
- 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.
- Willful self-inflicted
- Treatment required as a result of or arising from complications
from a treatment or condition not covered under the certificate.
- Any services or supplies performed or provided by a relative
of the Insured or provided at no cost to Insured.
- Treatment for mental and nervous disorders.
- Organ or tissue transplants or related services.
- 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.
- Treatment incurred as a result of or arising from exposure to
nuclear radiation, and/or radioactive material(s).
This brochure 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 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.
MyIMGsm
Service at your fingertips anytime, anywhere - that’s what MyIMG provides.
MyIMG is our proprietary online service that allows you to
access information and manage accounts, 24 hours a day, seven days a
week, from anywhere in the world. Our service centers in the U.S. and
Europe are always available to help or handle emergencies 24 hours a
day, but through MyIMG you have immediate access to a wealth of
information about your account and can manage routine areas to help
you save time when you may need it most. Some features include:
- Get explanation of benefits
- Locate a provider
- Request ID cards
- Initiate precertification
- Obtain certificate documents
- Recommend provider/facility
Locating a Provider
With the Patriot Group plans, you may seek treatment with the hospital
or doctor of your choice. When seeking treatment in the U.S., you
can reduce your out-of-pocket costs by using the independent
Preferred Provider Organization (PPO), a separately organized network
of hundreds of thousands of established, highly qualified health care
physicians and many well-recognized hospitals in the U.S. contracted
by IMG. You can quickly search the network through MyIMG.
Additionally, to help you locate health care providers outside the U.S.,
IMG provides its online International Provider Access (IPA), a database
of over 17,000 providers.
Universal Rx Pharmacy Discount Savings
This is a discount savings program available to every certificate holder
of the Patriot Group travel plans. This program allows card members to
purchase prescriptions at one of over 35,000 participating pharmacies
in the U.S. and receive the lower of 1) Universal Rx contract price or 2)
the pharmacy regular retail price.
This discount program is not insurance coverage. It is purely a discount
program to purchasers of the Patriot Group travel plans. Use of the discount
card does not guarantee that prescribed medication is covered
under the insurance benefit plan.
Akeso Care Management® (ACM®)
The ability to access quality health care is of
paramount importance when a medical
emergency arises abroad. To coordinate
care and provide U.S. and internationally based medical management
services, IMG formed ACM, an on-site specialized division devoted
entirely to medical management.
The clinical staff consists of qualified physicians and
registered nurses who are experts at assessing the
need for services and ensuring those services are
delivered in a timely, cost-effective manner. ACM
has international medical experience, providing
services in more than 170 countries worldwide.
ACM is accredited by URAC, an independent, nonprofit organization
that is internationally recognized for promoting continuous improvement
in the quality and efficiency of health care management.
Through a rigorous and comprehensive review that ensures ongoing
compliance, ACM earned its URAC accreditation in Health Utilization
Management.
From routine medical care to complex case management, from checkups
to emergency medical evacuations, ACM is there for you. They are
committed to consumer protection and empowerment, quality operations
and regulatory compliance. This translates into better care for
you - around the world, around the clock.
One Call. One Company.
Your Complete International Resource.
IMG offers a comprehensive range of international medical insurance
and travel insurance products for every insurance need. Whether you
need individual coverage for a vacation, extended coverage for a long-term
stay abroad, or group coverage for employees in locations
around the world, we’ve got the right plan for you and the exceptional
services to back them up.
- Short-term Travel Plans
- Long-term Travel Plans
- Travel Insurance / Trip Cancellation Plans
- Employer Group Plans
- Mission Plans
- Marine Plans
- International Student and Educator Plans
- Adventure Sports Plans
- Emergency Evacuation Plans
- Green and Environmentally Friendly Plans
You can spend a great deal of time planning your trip and it is exciting
getting everything ready. But what would happen if the airline you
selected should go out of business or you’re prevented from taking
your trip? Your hard-earned payments could be lost. To help protect
you from losing the money you’ve spent to travel, IMG works with
iTravelInsured ® (iTI ®) to bring you the Patriot T.R.I.P. Lite program.
PATRIOT T.R.I.P. LITE
This iTI program is designed to provide peace of mind so you can enjoy
your travels. The benefits are outlined below and program cost information
can be found on the back of the Application Form.
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SCHEDULE OF BENEFITS
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Trip Cancellation
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Trip cost up to $20,000
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Travel Delay
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$500 ($100 per day after 24 hours
up to $500 for a missed connection)
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Baggage Delay
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$100
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Trip Cancellation - Provides coverage for the loss of non-refundable,
unused payments when a trip is cancelled prior to departure due to:
emergency illness, injury or death to you, a family member or travel
companion; financial default; a terrorist incident; jury duty; home
made uninhabitable by fire, wind, storm, flood, or vandalism; quarantine;
auto accident on way to airport; job termination; cancelled leave
for active duty military, police or fire fighters.
Travel Delay - Reimburses you up to $100 per day for reasonable additional
accommodations and traveling expenses, not otherwise paid by
a travel supplier or common carrier, when your trip is delayed for more
than 24 hours caused by: Travel supplier delay, lost or stolen passport,
medical quarantine, natural disaster, or emergency illness or injury to
you or a travel companion.
Baggage Delay - Reimburses you for the costs you incur to buy reasonable
additional clothing and essential personal items when your
checked baggage is delayed by a common carrier for more than 24
hours from the actual time of arrival at a destination.
When you purchase a Patriot T.R.I.P. Lite program you automatically
become a member of the National Small Business Travel & Health
Association (NSBTHA). Through this association members may access
travel insurance, emergency travel assistance services, and information
about events, legislation, and other matters that affect travel.
Information about NSBTHA is available at www.NSBTHA.org.
Certificate Form No. iTI100-11
We will not pay for any Illness, Injury or loss caused by or as a result of:
- A Pre-Existing Condition, except as waived by Us under the terms of the Policy.
- War or any act of war (whether declared or undeclared), civil disturbance,
riot or insurrection.
- Serving in one of the armed forces of any country or international
authority.
- Operating, learning to operate, piloting or riding in or on any aircraft
or flying device, other than riding as a passenger in a licensed
commercial aircraft.
- Suicide or attempted suicide, while sane; intentionally self-inflicted
Injury or Illness.
- Being under the influence of any intoxicant, drug or narcotic
unless prescribed by a Physician.
- Training, practicing or participating in any motor sport or motor racing.
- Parachuting, hang gliding, parasailing, hot air ballooning, scuba
diving below 135 feet or any type of scuba diving without the
proper diving training and certification from a professional organization,
rock or mountain climbing, or hunting.
- Pregnancy or childbirth when You are expected to give birth within
two months from the date of a Covered Trip or an elective abortion.
- Traveling against the advice of a Physician, traveling while on a
waiting list for inpatient Hospital or clinic treatment, or traveling
for the purpose of obtaining medical treatment abroad.
- Taking part in any scheduled athletic event or competition.
- Any emotional, psychological, mental or nervous disorder.
- Any potentially fatal condition which was diagnosed before the
date Your coverage became effective, or any condition for which
You are traveling to seek treatment.
- Dental treatment due to normal wear and tear or the normal maintenance
of dental health.
The Pre-Existing Condition exclusion is waived if coverage is purchased
within 14 days after the date your initial payment for the covered
trip was paid to the travel supplier. Insureds also must be medically
able to travel on the date coverage is purchased.
If the Pre-Existing Condition exclusion is not waived, your pre-existing
condition might still be covered if the answer to all of the following
questions is “no.” 1. Were you treated for a new illness in the last 60
days? 2. Has your condition worsened or required medical attention in
the past 60 days? 3. Have you received any new medications in the
past 60 days or have any of your current dosages been changed?
This is a summary of the principal provisions of the master policy offered through
NSBTHA for its members. It is not considered to be a contract of insurance. Coverage
may vary by state and may not be available in all states. For more information
regarding the exclusions and all other terms and conditions of Patriot T.R.I.P. Lite,
please see the certificate wording for your state which is available upon request.
This brochure is not intended to be an offer to sell Patriot T.R.I.P. Lite or a solicitation
by iTravelInsured in any jurisdiction where such action would be unlawful or in which
iTravelInsured is not qualified to do so.
Insurance products are underwritten and offered where available by Delos
Insurance Company, New York, NY 10036.
Plan Administrator:
As the Plan Administrator for Patriot Group Travel Medical Insurance ®, IMG acts as the authorized agent for and on behalf of Sirius International.
International Medical Group ®, Inc.
P.O. Box 88509
Indianapolis, IN 46208-0809, USA
Plan Underwriter:

These Patriot Group Travel Medical Insurance plans are surplus lines products underwritten by Sirius International Insurance Corporation (publ), rated A (excellent) by A.M. Best and A- by Standard & Poor's (at the time of printing). Sirius International is a White Mountains Re company.
IMG, International Medical Group, the IMG block design logo, imglobal, Patriot Group Travel Medical Insurance, Patriot International, Patriot America, Coverage Without Boundaries, and Global Peace of Mind are the trademarks, service marks and/or registered marks of International Medical Group, Inc.
Sirius, Sirius International, and the Sirius design logo are the trademarks, service marks and/or registered marks of Sirius International Insurance Corporation (publ).
04/15/2010
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