Patriot Platinum America^℠

Since 1990, the administrator has provided global benefits and assistance services to millions of customers in nearly every country around the world. Owned by Sirius Group, a 2.6 billion-dollar, AM Best "A" rated insurance industry leader, the administrator is uniquely positioned to deliver the Global Peace of Mind^® our members need.

• 24/7 medical and travel assistance services
• Multilingual staff & claims administrators
• Highly trained customer service professionals
• Core values driven by a commitment to customers
• Customer service centers located in the U.S. and U.K.
• Financial security to fulfill our promise when you need it most

International travel can become a scary situation if you're not prepared for a medical emergency. Most travelers assume they're already covered by their standard medical plan-but that isn't always the case. While domestic plans provide sufficient coverage at home, most are not designed to provide the coverage and assistance required for international travel. Don't let your medical coverage be an uncertainty. Choose the Patriot Travel^® plan that meets your needs and spend more time enjoying your international experience-not worrying about your medical coverage.

• Maximum limits: $2,000,000 to $8,000,000
• Deductible: $0 to $25,000
• Extensions: Up to 36 continuous months
• Emergency medical evacuation: Up to maximum limit
• Coinsurance:
  • In-network: The administrator pays 100%
  • Out-of-network: The administrator pays 90% up to $5,000, then 100%
• Acute onset of pre-existing conditions: Under 70 years of age, with varying limits by age up to $1,000,000. $25,000 maximum limit for medical evacuation
• Remote transportation: $5,000 per period, $20,000 lifetime maximum
• Supplemental accident: $300 per covered accident

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, Reasonable 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.

It's easy to customize your coverage to best meet your needs while away from home. When submitting your online or paper application, simply add the riders you need to the plan you've selected.

• Adventure Sports Rider

  If you're a thrill-seeking traveler who enjoys life's more adventurous activities, you may want to consider adding supplemental coverage to your plan. The Adventure Sports Rider provides coverage for injuries sustained during certain extreme sports that would otherwise be excluded from your travel insurance policy.

  Lifetime Maximum
  Age 0-49: $50,000
  Age 50-59: $30,000
  Age 60-64: $15,000

• Chaperone/Faculty Leader Replacement Rider^*

  If you are the designated chaperone/faculty leader and experience an unexpected death of a relative, a medical emergency, or the destruction of your residence that causes you to cancel or interrupt travel, this rider covers reimbursement for a round trip economy airline ticket up to $3,000 for a replacement chaperone/faculty leader.

  *Rider option is available on group plans only.

• Enhanced Accidental Death & Dismemberment Rider (AD&D)^**

  Accidents can happen-wouldn't you rather be prepared, especially when you're away from home? The AD&D rider will pay you or your beneficiaries up to $400,000 if your death or dismemberment is the direct result of an accident.

  Note: 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

  **Rider option is available on individual plans only.

• Self-Service Member Portal

  The administrator provides service at your fingertips, giving you the information and tools to manage your administrator plans anytime, anywhere, through awardwinning, easy-to-use technology. You'll have immediate access to these important resources online, including our 24/7/365 service centers, plan document access, claims management tools, Explanations of Benefits, and much more.

• Pharmacy Discount Savings

  Universal Rx is a discount savings program that allows you to purchase prescriptions from one of 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 network offers a simplified claims process with minimal paperwork for the member if they visit an in-network provider.

  This program is not insurance coverage; it is purely a discount program.

• Extensive Network Access

  For travelers in the U.S., the UnitedHealthcare Options network is a longstanding reputable tier 1 network that gives you more access to more doctors and services, including:

  • Over 895,000 physicians
  • 5,600 hospitals in the U.S.
  • Retail urgent care facilities
  • A streamlined claims process

• International Provider Access^SM

  Travelers outside of the U.S. can also enjoy access to quality healthcare worldwide with our proprietary IPA network that includes:

  • Over 18,550 physicians and facilities
  • Direct billing arrangements that minimize time and upfront expense

• Step 1:

  Contact us directly to obtain an application or to apply online.

• Step 2:

  Complete your application: If applying as a family, you may include yourself, your spouse, and dependents on one application. Please complete a group application if you have two or more primary insureds.

• Step 3:

  Receive a fulfillment kit that includes an identification card, declaration of insurance, and a Certificate of Insurance outlining the details of the plan. Welcome to the family!

To meet the needs of our customers, Patriot Travel Series plans can be purchased for up to a 12-month period. Patriot Platinum America can be extended up to a maximum of 36 continuous months. To renew your coverage, please visit our website.

Additional Deductible Options

New premium rates per Insured Person effective May 1, 2019 for eligible individuals whose applications are approved by the administrator. The administrator 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.

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.

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 Travel Medical Insurance, please contact your attorney or CPA.

FOR ADDITIONAL INFORMATION

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

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