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Patriot Adventure America

30 Days to 6 Months

We enable our members to worry less and experience more by delivering the protection they need, backed by the support they deserve. We offer a full line of international medical insurance products, as well as trip cancellation programs, stop loss insurance, medical management services and 24/7 emergency medical and travel assistance — all designed to provide members Global Peace of Mind ® while they’re away from home.

  • Global Support. With offices and partners across the globe, we provide the support you need, when you need it. In fact, it’s our corporate mission to be there to protect and enhance your health and well-being.
  • Service Without Obstacles. Our team of international, multilingual specialists is accustomed to working in multiple time zones, languages and currencies. Our global reach means we can work without barriers.
  • International Provider AccessSM (IPA). In addition to our expansive PPO network available for treatment received within the U.S., our proprietary IPA network of more than 17,000 accomplished physicians and facilities allows you to access quality care worldwide. Our direct billing arrangements can also ease the time and upfront expense at select providers.
  • Financial Stability. Our globally recognized underwriters, A-rated Sirius International Insurance Corporation (publ) and certain underwriters at Lloyd’s, offer the financial security and reputation demanded by international consumers.
  • Accessible Technology. Log on to the secure, 24-hour online portal to submit and view your claims, manage your account, search for providers, and more.
  • International Emergency Care. When you’re away from home and a medical emergency occurs, you may not be able to wait for regular business hours. With our on-site medical staff, you have 24-hour access to highly qualified coordinators of emergency medical services and international treatment.

Why Choose Patriot America Adventure

Accidents and emergencies happen — and when they do, you wouldn’t want to be hundreds or thousands of miles away from home without the proper coverage, especially when you’re participating in adventure sports.

Don’t let your medical coverage be an uncertainty. Travel with Patriot Adventure America plan, which offers a complete package of international benefits available 24 hours a day.

Patriot Adventure America provides coverage for non-U.S. citizens traveling outside of their home country and is available for a minimum of 30 days up to a maximum of six months.

Additional World-Class Services

Service at your fingertips anytime, anywhere — that’s what we provide. Client Center is our online member portal that allows you to easily access and manage your insurance information. Our service centers in the U.S. and Europe are always available to assist with emergencies 24 hours a day, and you have immediate access to a wealth of information about your account and plan, and can manage routine areas to help you save time when you may need it most. Key features include:

  • Manage your claims
  • Initiate precertification
  • Locate a provider
  • Obtain plan documents
  • Request ID cards
  • Recommend a provider/facility

Universal Rx Pharmacy Discount Savings

This discount savings program allows you to purchase prescriptions at one of more than 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 program is not insurance coverage; it is purely a discount program.

Plan Information & Highlights

Maximum Limit$50,000
Deductible$250
Coinsurance - Treatment Received Within the U.S. & CanadaIn the PPO Network - The plan pays 90% of eligible medical expenses up to $5,000, then 100% up to the maximum limit
Out of the PPO Network - The plan pays 80% of eligible medical expenses up to $5,000, then 100% up to the maximum limit
Benefit PeriodThree months
Client Center 24-hour secure access from anywhere in the world to manage your account
World-Class Medical BenefitsCoverage available for inpatient and outpatient medical expenses
International Emergency CareA wide range of international emergency benefits available, including emergency medical evacuation, emergency reunion, return of mortal remains, return of minor children and more

Schedule of Benefits (All coverages, benefits and premium amounts shown are in U.S. dollars.)

Medical Benefits
Usual, reasonable and customary charges. Subject to deductible and coinsurance.
Hospital Room and BoardUp to the maximum limit for average semi-private room rate
Intensive CareUp to the maximum limit
Medical ExpensesUp to the maximum limit
Outpatient Medical ExpensesUp to the maximum limit
Local AmbulanceUp to the maximum limit
Emergency Room AccidentUp to the maximum limit
Emergency Room Illness with Inpatient AdmissionUp to the maximum limit
Emergency Room Illness without Inpatient AdmissionUp to the maximum limit with additional $250 deductible
Dental - Injury Due to AccidentUp to the maximum limit
Dental - Sudden Dental EmergencyUp to $100
International Emergency Care
When coordinated through the plan administrator.
Emergency Medical EvacuationUp to the maximum limit
Emergency ReunionUp to $10,000
Return of Mortal Remains or Cremation/BurialUp to $15,000 for return of mortal remains or $5,000 for cremation/burial
Political EvacuationUp to $10,000
Additional Benefits
Sports & Activities Coverage Up to the maximum limit for basic sports
Common Carrier Accidental Death$50,000 to beneficiary; maximum of $250,000 per family
Trip InterruptionUp to $5,000
Adventure SportsUp to the maximum limit
Lost LuggageUp to $50 per item of personal property; maximum of $250

Patriot Adventure America Rates (Coverage from 30 days to 6 months*)

MONTHLY RATES($50,000 maximum limit)Each Additional 15 Days($50,000 maximum limit)
AgeOne MonthAge15 Days
17 or younger$7217 or younger$36
18 - 39$9418 - 39$47
40 - 49$14240 - 49$71

*Coverage under Patriot Adventure America must be purchased for a minimum of one month.

The administrator reserves the right to issue the most current rates in the event these expire, are modified or replaced with a newer version. Rates include surplus lines tax where applicable.

Conditions of Coverage

  1. The coverage and benefits are subject to the deductible and coinsurance, and all terms of the Certificate of Insurance and Master Policy.
  2. Coverage under Patriot Adventure America is secondary to any other coverage.
  3. Coverage and benefits are for medically necessary, 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 the administrator for payment within 90 days from the date the claim was incurred.

Eligibility

The following conditions apply to all persons applying for and/or enrolling in Patriot Adventure America :

  • For coverage while participating in any of the covered adventure sports activities, you must be medically and physically fit to engage in such activity and hold the necessary qualifications as approved by the applicable governing body or authority.
  • Patriot Adventure America is for non-U.S. citizens traveling outside of their home country.

Extension of Coverage

Patriot Adventure America can be rewritten for succeeding or subsequent periods, but it is not renewable. New deductible, coinsurance, eligibility, conditions of coverage and pre-existing condition exclusions apply to any succeeding or subsequent period of coverage. A new application must also be completed.

Enrollment

To apply, simply complete online or return the Paper Application. If you are applying as a family, you may include yourself, your spouse and dependents on one application. If you have dependents who are 18 years of age or older, you must complete a separate application for those individuals. If approved, you will receive a fulfillment kit, which includes an identification card, declaration of insurance and a Certificate Wording containing a complete description of benefits, exclusions and terms of the plan.

You can apply over the phone by calling us as well.

Quality Guarantee

Your satisfaction is very important to us. If you are not pleased with this product for any reason, you may submit a written request, prior to your effective date, for cancellation and refund of your premium.

Administrator

IMG
P.O. Box 88509
2960 North Meridian Street
Indianapolis, IN 46208-0509 USA

FOR ADDITIONAL INFORMATION

Insubuy®, Inc.
4200 Mapleshade Ln, Suite 200
Plano, TX 75093

Toll Free: (866) INSUBUY
Phone: (972) 985-4400
Fax: (972) 767-4470
Website: www.insubuy.com

IMPORTANT NOTICE REGARDING PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA): This insurance is not subject to and does not provide benefits required by PPACA. As of January 1, 2014, PPACA requires U.S. citizens, U.S. nationals and certain U.S. residents to obtain PPACA-compliant insurance coverage unless they are exempt from PPACA. Penalties may be imposed on persons who are required to maintain PPACA-compliant coverage but do not do so. Eligibility to purchase, extend or renew this product, or its terms and conditions, may be modified or amended based upon changes to applicable law, including PPACA. Please note that it is an insured person’s sole and exclusive responsibility to determine the insurance requirements applicable to them, and the company and the administrator shall have no liability whatsoever, including for any penalties a person may incur, for failure to obtain coverage required by any applicable law including, without limitation, PPACA. For information on whether PPACA applies to you or whether you are eligible to purchase Patriot Adventure, please contact your attorney or CPA.

This invitation to inquire allows eligible applicants an opportunity to seek information about the insurance offered, and is limited to a brief description of any loss for which benefits may be payable. Benefits are offered as described in the insurance contract. Benefits are subject to all deductibles, coinsurance, provisions, terms, conditions, limitations and exclusions in the insurance contract. Certain contracts do contain a pre-existing condition exclusion and do not cover losses or expenses related to a pre-existing condition.

This brochure contains many of the valuable trademarks, names, titles, logos, images, designs, copyrights and other proprietary materials owned, registered and used by International Medical Group and its representatives throughout the world. ©2007-2016 International Medical Group. All rights reserved.

Version: 0717

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