Applicable to the following plans from IMG: Patriot Platinum America, Patriot GoTravel America, Outreach America
These plans include coverage for a sudden and unexpected recurrence of pre-existing conditions for insured persons. You can better understand the coverage for a sudden and unexpected reoccurrence by knowing how it relates to a pre-existing condition.
Any Injury, Illness, sickness, disease, or other physical, medical, Mental or Nervous Disorder, condition 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 this insurance, whether or not previously manifested, symptomatic or known, diagnosed, Treated, or disclosed to the Company prior to the Effective Date, and including any and all subsequent, chronic or recurring complications or consequences related thereto or resulting or arising therefrom. See also Exclusions, Section V.(23).
Sudden and Unexpected Reoccurrence of a Pre-existing Condition
Subject to the Terms of this insurance, including without limitation the Exclusions section, the Conditions and Restrictions set forth below and the applicable Deductible and Coinsurance and other limits and sub-limits as specified in the Schedule of Benefits/Limits, in the event the Insured Person suffers or experiences an Unexpected reoccurrence of a Pre-existing Condition during the Period of Coverage for which immediate Treatment is essential and necessary to stabilize the Pre-existing Condition, the Insured Person will be reimbursed as follows:
- For Insured Persons up to age 65: Up to $50,000 Lifetime Maximum
- For Insured Persons age 65 and older: Up to $2,500 Lifetime Maximum
Conditions and Restrictions
To be eligible for the foregoing limited coverage and benefits for an Unexpected reoccurrence of a Pre-existing Condition, the Insured Person must be in compliance with all Terms of this insurance. The Company will provide such coverage and benefits only when all of the following conditions and restrictions have been met. At the time of the Unexpected reoccurrence of the Pre-existing Condition:
- The Insured Person must be under 65 years of age; and
- The Insured Person must not be traveling against or in disregard of the recommendations, established Treatment programs, or medical advice of a Physician or other healthcare provider; and
- The Insured Person must not be traveling with the intent or purpose to seek or obtain Treatment for the Pre-existing Condition; and
- The Insured Person must not be traveling during a period of time when the Insured Person is preparing or waiting for, involved in, or undertaking a new, changed or modified Treatment program with respect to the Pre-existing Condition, and is not traveling subsequent to any such new, changed or modified Treatment program having been advised or recommended; and
- The Pre-existing Condition must have been stabilized for at least thirty (30) days prior to the Effective Date without change in Treatment; and
- The Insured Person must be traveling outside their Home Country.
Any infection of the urinary tract (including, without limitation, infection of the kidney, ureter, bladder, prostate or urethra) and any complication, medical condition or other Illness directly or indirectly arising therefrom, that occurs within ninety (90) days of the Effective Date of this Insurance and that requires Treatment of the Insured Person in a Hospital; provided that any such Illness, infection, complication or condition shall be deemed by the Company to be a Pre-existing Condition and eligible for coverage as otherwise provided herein.