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Patriot Platinum America

First-class travel medical insurance for individuals, families and groups of five or more.

5 Days to 3 Years

If travel excludes USA, see Patriot Platinum International Group – Travel Medical Insurance

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 Platinum America Group

Most people assume they will be covered by their standard health insurance when they travel internationally, but that isn't always the case. Without even realizing it, you may be putting your health at risk. Don't let your medical coverage be an uncertainty. Travel with Patriot Platinum America Group Medical InsuranceSM so you can spend more time enjoying your international experience and less time worrying about your medical coverage.

Patriot Platinum America Group is designed for individuals, families, and groups of five or more who desire first-rate protection when traveling internationally. The plan is available for U.S. citizens for a minimum of 10 days up to three years. With a Patriot Platinum America Group plan, you'll also have exclusive access to enhanced benefits and services.

World-Class Services

Our online member portal allows you to easily access and manage your insurance information. Key features include:

  • Manage your claims
  • Initiate pre-certification
  • Locate a Provider
  • Obtain plan documents
  • Request ID cards
  • Recommend a provider/facility

Global Concierge & Assistance ServicesSM

Patriot Platinum America Group provides clients more than insurance protection. Global Concierge and Assistance Services offers the knowledge and information needed to keep you healthy and safe. Below is a list of services handled by a dedicated service team that is available 24 hours a day, seven days a week, exclusively for our Platinum members.

  • Dedicated Service Line & Claims Team
  • Bag Tracking
  • Embassy & Consulate Referrals
  • Emergency Cash Transfers
  • Security Updates & Country Profiles
  • Lost Passport/Travel Documents Assistance
  • Prescription Drug Replacement Assistance
  • Emergency Travel Arrangements
  • Legal Referrals
  • Drug Translation Services
  • Pre-Trip Health & Safety Advisories
  • Emergency Message Relay

eDocAmerica

As a registered user of online member portal you can access eDocAmerica, which allows you to consult with board-certified physicians, licensed psychologists, pharmacists, dentists, dieticians and fitness trainers to assist you with any routine health-related questions you have.

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.

Plan Information & Highlights

Maximum Limits$1,000,000 / $5,000,000 / $8,000,000
Individual Deductible$0 / $100 / $250 / $500 / $1,000 / $2,500 / $5,000 / $10,000 / $25,000
Family DeductibleThree times the individual deductible
Coinsurance - Treatment Received Outside of the U.S. & CanadaNo Coinsurance
Coinsurance - Treatment Received Within the U.S. & CanadaIn the PPO Network - No Coinsurance
Out of the PPO Network - The plan pays 90% of eligible medical expenses up to $5,000, then 100% up to the maximum limits
Benefit Period12 months
Global Concierge & Assistance ServicesExclusive access to additional emergency travel assistance services handled by dedicated team
eDocAmericaAccess to board-certified physicians, licensed psychologists, pharmacists, dentists, dieticians and fitness trainers to assist with any routine health-related questions
International Emergency CareA wide range of international emergency benefits available including emergency 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 when applicable.
Hospital Room and BoardUp to the maximum limit
Intensive CareUp to the maximum limit
Medical ExpensesUp to the maximum limit
Out-patient 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 $250
Hospital Daily IndemnityUp to $250 per night for a maximum of 10 days
Supplemental AccidentUp to $300
International Emergency Care
When coordinated through the plan administrator.
Emergency Medical EvacuationUp to the maximum limit
Emergency ReunionUp to $100,000
Return of Mortal Remains or
Cremation/Burial
Up to $100,000 for return of mortal remains;
$5,000 for cremation/burial
Return of Minor ChildrenUp to $100,000
Political EvacuationUp to $100,000
Natural Disaster$250 per day for five days
Remote Transportation$5,000 per period of coverage
$20,000 lifetime maximum
Identity Theft AssistanceUp to $500 per Period of Coverage
Lost/Stolen Luggage, Valuables, Personal PapersUp to $500
Felonious AssaultUp to $10,000
Additional Benefits
TerrorismUp to the maximum limit
Sports & Activities CoverageUp to the maximum limit for basic sports
Sudden and Unexpected Recurrence of a Pre-existing Condition - Medical
(for non-U.S. citizens only)
Up to age 65: $50,000 lifetime maximum for eligible medical expenses.
Age 65+: $2,500 lifetime maximum.
Sudden and Unexpected Recurrence of a Pre-existing Condition - Emergency Medical Evacuation
Up to $25,000 of eligible costs and expenses
Incidental Home Country CoverageUp to a cumulative two weeks
Trip InterruptionUp to $10,000
Common Carrier Accidental Death$100,000 per adult, $25,000 per child, maximum of $250,000 per family
Accidental Death & Dismemberment$50,000 principle sum
Small Pet Common Air Carrier Accidental DeathUp to $500

Plan Rates

Monthly Rates
AgeOption 4
$1,000,000
Option 5
$5,000,000
Option 6
$8,000,000
18-29$104$121$130
30-39$136$159$169
40-49$211$247$263
50-59$312$365$391
60-64$371$433$464
65-69$390$455$486
70-79*$400NANA
80+**$580NANA
Dependent Child$91$105$113
Individual Child$94$110$118
Daily Rates
(10-day minimum)
AgeOption 4
$1,000,000
Option 5
$5,000,000
Option 6
$8,000,000
18-29$3.50$4.05$4.35
30-39$4.55$5.30$5.65
40-49$7.05$8.25$8.80
50-59$10.40$12.20$13.05
60-64$12.40$14.45$15.50
65-69$13.00$15.20$16.20
70-79*$13.35NANA
80+**$19.35NANA
Dependent Child$3.05$3.50$3.80
Individual Child$3.15$3.70$3.95

Ages 70-79 $100,000 maximum
**Ages 80+ $20,000 maximum

Rates are based on a $250 deductible option. For other deductible options, please see the application.
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.

Plan Riders & Rates

Optional Riders With the exception of the enhanced AD&D Rider, optional riders apply to all individuals listed in the application form.
Adventure Sports Rider
(available to insureds up to age 65)
AgeLifetime Maximum
0 - 49$50,000
50 - 59$30,000
60 - 64$15,000
Citizenship Return RiderUp to the maximum limit
Personal Liability
   Injury to third party
   Damage to third person property

$2,000 limit after $100 deductible
$500 limit after $100 deductible
Chaperone/Faculty Leader Replacement RiderUp to $3,000 for round-trip economy airline ticket

Conditions of Coverage

  1. Coverage and benefits are subject to the deductible and coinsurance, and all terms of the Certificate of Insurance and Master Policy.
  2. Coverage under a Patriot Platinum plan 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 a Patriot Platinum individual or group plan.

  • Patriot Platinum is travel medical insurance for U.S. citizens traveling outside of the United States with coverage for brief returns to the U.S., 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 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.

Enrollment

To apply, simply complete online or return the Application. 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 as well by calling us.

Renewal of Coverage

Subject to the terms of the plan, Patriot Platinum America Group Insurance can be extended for a minimum of five days up to a 365-day 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 coverage period. Please note: Renewal rates may differ from initial rates. 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 the Patient Protection and Affordable Care Act (PPACA).

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. If you do not have any claims filed with the adminstrator, you may cancel your plan after your effective date; however, the following conditions will apply:

  1. You will be required to pay a $50 cancellation fee, and only full-month premiums will be considered for refunds.
  2. For example, if you choose to cancel your coverage two months and two weeks prior to the date your coverage ends, the administrator will only consider the two full months for a refund. If you have filed claims, your premium is non-refundable.

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.

Administrator

IMGTM
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, registered and used by International Medical Group and its representatives throughout the world. ©2007-2016 International Medical Group. All rights reserved.

Version: 0117

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