We're committed to being there with our members wherever they may be in the world, providing them Global Peace of Mind®. With 24/7 worldwide assistance and medical management services, multilingual claims administrators and highly trained customer service professionals, we deliver the insurance products international members need, backed by the services they want.
- 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. With a team of international, multilingual specialists, we are 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 Patriot America?
International travel can quickly turn into a frightening situation if you're not prepared for a medical emergency. Most travelers assume they will be covered by their standard medical plan, but that isn't always the case. 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 at risk.
Don't let your medical coverage be an uncertainty. Travel with our Patriot America Medical Insurance® plan so you can spend more time enjoying your international experience and less time worrying about medical coverage.
Patriot America® provides coverage for people traveling outside their home country whose destination includes the United States or its territories.
It is available for individuals and families for a minimum of five days up to a maximum of two years, and offers a complete package of international benefits.
Additional World-Class Services
Service at your fingertips that's what we provide. A proprietary online service located in our Client Center provides you information and tools to manage your accounts anytime, anywhere. Our service centers in the U.S. and Europe are available to assist with emergencies 24 hours a day, and you have immediate access to important tools and resources. Some features include:
- Submit and manage claims
- Access to Explanations of Benefits (EOBs)
- Initiate pre-certification
- Access Customer Care via email or telephone
- Locate a Provider
- Recommend a provider/facility
- Obtain ID cards and other insurance documents
Universal Rx Pharmacy Discount Savings
This discount savings program allows you 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 program is not insurance coverage; it is purely a discount program.
Schedule of Benefits
| Maximum Limit Per Period of Coverage Options | $50,000, $100,000, $500,000, $1,000,000 |
| Individual Deductible options | $0, $100, $250, $500, $1,000, $2,500 |
| Hospital Room and Board | Average semi-private room rate up to the maximum limit. Includes nursing service. |
| Intensive Care | Up to the maximum limit |
| Emergency Room | Up to the maximum limit. Additional $250 deductible if not admitted as an inpatient. |
| Surgery | Up to the maximum limit |
| Physician Visits | Up to the maximum limit |
| Diagnostic Procedures | Up to the maximum limit |
| Prescription Medication | Up to the maximum limit |
| Home Health Care | Up to the maximum limit |
| Emergency Local Ambulance | Up to the maximum limit |
| Durable Medical Equipment | Up to the maximum limit |
| Emergency Dental Treatment | $100 maximum limit due to dental accident or unexpected pain to sound natural teeth. |
| Emergency Medical Evacuation* | $500,000 maximum limit. Not subject to deductible. |
| Emergency Reunion* | $50,000 maximum limit. Not subject to deductible. |
| Return of Minor Children* | $50,000 maximum limit. Not subject to deductible. |
| Return of Mortal Remains or Cremation/Burial* | $50,000 maximum limit for return of mortal remains or ashes to country of residence, or $5,000 maximum limit for cremation or local burial at the place of death. Not subject to deductible. |
| Political Evacuation* | $10,000 maximum limit. Not subject to deductible. |
| Natural Disaster | $100 per day and maximum limit of five days for accommodations. Not subject to deductible. |
| Accidental Death & Dismemberment | $25,000 principal sum. Not subject to deductible |
| Common Carrier Accidental Death | $50,000 per insured person, $250,000 maximum limit per lifetime per family. Not subject to deductible. |
| Trip Interruption | $5,000 maximum limit. Not subject to deductible. |
| Lost Luggage | $50 per item, $250 maximum limit. Not subject to deductible. |
| Hospital Indemnity | $100 per overnight inpatient confinement, maximum limit of 10 overnights. Not subject to deductible. |
| Identity Theft | $500 maximum limit. Not subject to deductible. |
| Terrorism | $50,000 maximum limit. Not subject to deductible. |
| Incidental Trips to Home Country | 14 consecutive days maximum limit |
| Coinsurance - for treatment received outside of the U.S. | No coinsurance (0%) |
| Coinsurance - for treatment received within the U.S. |
In the PPO network - Company pays 90% of eligible expenses up to $5,000, then 100% Out of the PPO network - Company pays 80% of eligible expenses up to $5,000, then 100% |
| Pre-Certification | Fifty percent (50%) reduction of eligible medical expenses if pre-certification provisions are not met. |
| Continuation of Treatment | Six months per injury or illness |
| End of Trip Home Country Coverage | One month end of trip coverage for every six months of travel coverage purchased, up to a maximum of two months (Individual plan only). |
All coverage and benefits in this Policy are in United States (U.S.) dollars. Benefits are subject to the exclusions and limitations and are payable only at Usual, Resonable and Customary charges . This is a summary of a selection of plan benefits offered only as an illustration and does not supersede in anyway the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided. *Must be approved in advance and coordinated by the Company.
Optional Coverage
Patriot America Medical Insurance offers several optional coverages. You may review and choose any from the following list that meet your needs. To apply, simply add in the appropriate information and premiums, as outlined in the application, into the calculation for the total premium due. Please note: with the exception of the Enhanced AD&D Rider, optional riders apply to all individuals listed on the application.
| Adventure Sports Rider (available to insureds through age 64) |
|
|---|---|
| Age | Lifetime Maximum |
| 0 - 49 | $50,000 |
| 50 - 59 | $30,000 |
| 60 - 64 | $15,000 |
| Enhanced AD&D Rider (available to the primary insured on individual plans only) | Up to an additional $400,000 |
| Citizenship Return Rider | Up to the maximum limit (U.S. citizens have a 60-day maximum) |
| Evacuation Plus Rider (available to insureds up to age 65 on individual plans only) | Non life-threatening medical evacuation: Up to a maximum of $25,000. Natural disaster evacuation: Up to a maximum of $5,000 |
Eligibility
Patriot America Medical Insurance is is available for U.S. citizens and for non-U.S. citizens traveling outside of 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 medical coverage. U.S. citizens, please provide the name of your international insurance carrier on the application. If you are not in the U.S. at the time of application, please indicate your expected date of arrival on your application.
Enrollment
To apply, simply apply online or complete and 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 of Insurance containing a complete description of benefits, exclusions and terms of the plan.
Renewal & Extensions
Subject to the terms of the plan, Patriot America Medical Insurance can be extended for a minimum of five days up to a 12-month period, until reaching a maximum of 24 continuous months. Prior to the end of each period of coverage purchased, you will receive renewal information. You have the option to renew online or you may complete a paper renewal form. Each insured person must only satisfy one deductible and coinsurance within each 12-month period of coverage.
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 the Patriot America Medical Insurance, please contact your attorney or CPA.
Patriot America® Individual Rates 2017 (Destination includes the U.S.) Rates below reflect a $250 deductible
Individual Monthly Rate
| Maximum Limit | ||||
|---|---|---|---|---|
| Age | $50,000 | $100,000 | $500,000 | $1 Million |
| 18-29 | $37 | $46 | $59 | $71 |
| 30-39 | $49 | $62 | $78 | $91 |
| 40-49 | $73 | $90 | $119 | $133 |
| 50-59 | $107 | $138 | $169 | $194 |
| 60-64 | $135 | $174 | $207 | $248 |
| 65-69 | $154 | $208 | $226 | $270 |
| 70-79 | $208 | N/A | N/A | N/A |
| 80+* | $362 | N/A | N/A | N/A |
| Dep. Child | $34 | $41 | $53 | $59 |
| Child Alone | $37 | $46 | $59 | $66 |
*10,000 Maximum
Individual Daily Rate
| Maximum Limit | ||||
|---|---|---|---|---|
| Age | $50,000 | $100,000 | $500,000 | $1 Million |
| 18-29 | $1.25 | $1.55 | $2.20 | $2.40 |
| 30-39 | $1.65 | $2.10 | $2.60 | $3.05 |
| 40-49 | $2.45 | $3.00 | $4.00 | $4.45 |
| 50-59 | $3.60 | $4.60 | $5.56 | $6.50 |
| 60-64 | $4.50 | $5.85 | $6.95 | $8.35 |
| 65-69 | $5.15 | $7.00 | $7.60 | $9.05 |
| 70-79 | $6.95 | N/A | N/A | N/A |
| 80+* | $12.10 | N/A | N/A | N/A |
| Dep. Child | $1.15 | $1.40 | $1.80 | $2.00 |
| Child Alone | $1.25 | $1.55 | $2.00 | $2.25 |
*10,000 Maximum
Enhanced AD&D rider monthly rates*
| Up to $100,000 additional coverage | $8 |
| Up to $200,000 additional coverage | $16 |
| Up to $300,000 additional coverage | $24 |
| Up to $400,000 additional coverage | $32 |
*Available to the primary insured only. Available with a minimum purchase of three months of medical and AD&D rider coverage. Premium is charged in whole month increments.
Evacuation plus rider monthly rate*
| Premium per covered insured per month | $45 |
*Must be purchased for a minimum of three months regarless of the minimum number of days being traveled. Premium is charged in whole-month increments.
Additional deductible options
| Deductible | $0 | $100 | $250 | $500 | $1000 | $2500 |
|---|---|---|---|---|---|---|
| Rate Factor | $1.25 | $1.10 | $1.00 | $0.90 | $0.80 | $0.70 |
New premium rates per Insured Person effective June 28, 2017 for eligible individuals whose applications are approved by the administrator. The adminstrator reserves the right to assess the most current rates at the time of the effective date in the event these rates expire, are modified, or are replaced.
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
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 and registered and used by International Medical Group, Inc. and its representatives throughout the world. © 2007-2017 International Medical Group, Inc. All rights reserved.
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