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COMPLETE BROCHURE & RATES
FOR
Patriot
Platinum
AmericaSM
Underwritten by SIRIUS International Insurance
Corporation
High-limit Travel Medical, Emergency Evacuation and
Accident Insurance for
non-U.S. Citizens Traveling Outside of their home country
Click here for Instant
Quotes & Online Purchase
Please read the Benefits & Exclusions of this plan carefully before submitting your application.
Patriot
Platinum America®
Patriot International provides coverage for
non-U.S. citizens traveling outside their country for a minimum of 5 days up to a maximum of
three years. If the plan is purchased for a minimum of three months,
coverage may be renewed (without break in coverage) for a total of up to
three years.
SCHEDULE OF BENEFITS
& LIMITS |
MEDICAL BENEFITS |
Usual reasonable and customary charges, subject to deductible and coinsurance |
| Hospital Room and Board |
To Policy Maximum |
| Intensive Care |
To Policy Maximum |
| Medical Expenses |
To Policy Maximum |
| Outpatient Medical |
To Policy Maximum |
| Local Ambulance |
To Policy Maximum |
| Emergency Room |
As described below |
Charges incurred
for the use of the Emergency Room due to an accident are covered up
to the Policy Maximum.
Charges incurred for the use of the Emergency Room for treatment of
an illness are covered up to the Policy Maximum if treatment
requires admittance to the hospital.
Charges incurred for the use of the Emergency Room for treatment of
an illness are subject to an additional (extra) $250 deductible if
treatment does not require admittance to the hospital. |
| Dental |
As described
below |
Injury
due to an accident: Each Patriot Platinum plan covers the
cost of emergency dental treatment and dental procedures necessary
to restore sound natural teeth lost or damaged in an accident up to
the Policy Maximum.
Sudden dental pain: Each plan will pay up to $250
for the necessary treatment of sudden, unexpected pain to sound
natural teeth. |
| Hospital Daily
Indemnity |
Up to $250 |
| Supplemental
Accident |
Up to $300
|
| Each Patriot
Platinum plan provides up-front, additional protection for
unexpected injuries. This benefit provides up to $300 of
first-dollar benefits for treatment of an injury. |
|
INTERNATIONAL EMERGENCY CARE (when coordinated through the Plan
administrator) |
| Emergency
Evacuation |
Up to Policy
Maximum |
| Each Patriot
Platinum plan includes coverage for Emergency Medical Evacuations to
the nearest qualified medical facility; expenses for reasonable
travel and accommodations resulting from the evacuation; and the
cost of returning to either the home country or the country where
the evacuation occurred, up to the Policy Limit. |
| Emergency
Reunion |
Up to $100,000
|
| Each Patriot
Platinum plan also provides emergency reunion coverage, up to
$100,000 for a maximum of 15 days, for the reasonable travel and
lodging expenses of a relative or friend during an Emergency Medical
Evacuation: either the cost of accompanying the insured during the
evacuation or traveling from the home country to be reunited with
the insured. |
| Return of
Mortal Remains |
Up to $100,000
|
| If a covered
illness/injury results in death, expenses for Repatriation of bodily
remains or ashes to the home country will be covered up to a maximum
of $100,000. |
| Returning
Minor Children |
Up to $100,000
|
| If an insured
person is hospitalized due to a covered illness/injury and is
traveling alone with child(ren) 19 or under that otherwise would be
left unattended, the Patriot plans will pay up to $50,000 for one
way economy fare to their home country, including a chaperone, if
necessary, for the safety of the child(ren). |
| Political
Evacuation |
Up to $100,000
|
| If the United
States Department of State, Bureau of Consular Affairs issues a
travel advisory that becomes effective on or after the Insured
Person’s date of arrival in the Host Country, the Company will pay
up to $100,000 for transportation to the nearest place of safety or
for repatriation to the Insured Person’s home country or country of
residence provided that: |
- The Insured Person contacts the
Company within 10 days of the United States Department of State,
Bureau of Consular affairs issues the travel advisory;
- Political Evacuation and Repatriation
is approved and coordinated by the Company.
To be eligible for the Evacuation, Reunion
and Return benefits, these must be recommended by the attending
physician in critical medical situations, and approved in advance
and coordinated by IMG. |
| Natural
Disaster |
$250 per day
for five days |
| This benefit is
available in the event an insured person is required depart his/her
destination due to an evacuation order issued prevailing authorities
in connection with a Natural Disaster. Natural Disaster is defined
as widespread disruption of human lives disasters such as flood,
drought, tidal wave, fire, hurricane, earthquake, windstorm, or
other storm, landslide, or other natural catastrophe event resulting
in migration of the population for its safety. |
| Remote
Transportation |
$5,000 per
certificate period
$20,000 lifetime maximum |
in the event of a
diagnosis of a critical medical condition which is not necessarily
immediately life-threatening, but severe enough to result in death
or a permanent disability if not treated right away, Remote
Transportation will provide for eligible charges arising out of the
transportation of an insured person to a qualified facility for
further treatment (if the current facility is unable to provide such
treatment).
To be eligible for the Transportation, Evacuation, Reunion and
Return benefits, these must be recommended by the attending
physician in critical medical situations, and approved in advance
and coordinated by IMG. |
| Identity Theft
Assistance |
Up to $500 |
| If an imposter
obtains key personal information such as a Social Security or
Driver's License number, or other method of identifying an insured
person in order to impersonate or obtain credit, merchandise or
services in the insured person’s name, the Patriot Platinum plans
will provide coverage for the reasonable, customary and necessary
costs incurred by the insured for: re-filing a loan or other credit
application that is rejected solely as a result of the stolen
identity event; notarization of legal documents, long-distance
telephone calls, and postage that has resulted solely as a result of
reporting, amending and/or rectifying records as a result of the
stolen identity event; up to three credit reports obtained within
one year of the insured person’s knowledge of the stolen identity
event; and stop payment orders placed on missing or unauthorized
checks as a result of the stolen identity event.
The identity theft event must occur during
the Period of Coverage and must be reported within 6 months of the
termination of coverage date. |
Lost / Theft
(luggage, valuables, personal papers) |
Up to $500 |
| This benefit will
be paid in the event that damage to, loss of, or theft of your
checked or stored baggage or personal items by a common carrier or
while stored with your hotel and the replacement costs of travel
documents. |
| Felonious
Assault |
Up to $10,000 |
| If you are
injured as a result of a Felonious Assault while traveling outside
of your Home Country, each plan will pay $10,000. This benefit is
in addition to any other benefit available under Patriot Platinum. |
| PLAN
INFORMATION |
| Plan Maximum |
$1,000,000,
$5,000,000, $8,000,000 |
| Deductible |
Your choice of
$0, $100, $250, $500, $2,500, $5,000, $10,000 or $25,000 |
| On the
Application Form, you will be asked to circle your choice of a
deductible. Your premium rate is dependent on the deductible you
choose. Please see the Application Form for more information.
|
| Family
Deductible |
Three times
the individual deductible |
| Coinsurance |
As described
below |
For
treatment received outside the U.S. & Canada: 100%
For treatment received within the U.S. & Canada:
In the PPO Network: The plan pays 100% of eligible expenses up
to the Policy Maximum
Outside the PPO Network: The plan pays 90% of eligible expenses up
to $5,000, then 100% up to the Policy Maximum |
| Benefit Period |
12 months
|
| If a covered
injury or illness requires continuing treatment after the Period of
Coverage expires, the twelve-month Benefit Period may provide
continued coverage. When the certificate expires, the Company will
review the date of initial treatment for the covered injury or
illness. If treatment began less than twelve months before the
Period of Coverage expired, benefits for the covered injury or
illness will continue subject to the Policy Limits and the other
terms of the plan until there have been twelve months of continuous
coverage for the covered injury or illness. |
| Global
Concierge & Assistance ServicesSM |
Access to a
dedicated service team for assistance services |
| See brochure for
more information |
| MyIMGSM |
24 hour secure
access from anywhere in the world to manage your account at anytime |
| eDocAmericaSM |
Access to
board-certified physicians, licensed psychologists and pharmacists
to assist with any routine health related questions |
| World-class
Medical Benefits |
Premium
coverage available for in-patient and out-patient medical expenses |
| International
Emergency Care |
A wide range
of international emergency benefits available including emergency
evacuation, emergency reunion, return of mortal remains, return of
minor children and more |
| ADDITIONAL
BENEFITS |
| Terrorism |
Up to Policy
Maximum |
| Each Patriot
Platinum plan provides coverage for injuries and illness incurred as
a result of an act of Terrorism, limited in amount and by
circumstances. If an insured person is injured as a result of an
act of Terrorism, and the insured person has no direct or indirect
participation in the act, the plan will reimburse eligible medical
claims up to the Policy maximum. However, claims incurred as a
result of radiological, nuclear, chemical or biological weapons or
events are not covered. Terrorism is
defined as the systematic or planned use of violence, fear, or
threat of violence in order to intimidate a population or
government, especially as a means of coercion or to obtain a
granting orf any demand. However, this benefit does not cover an
act of Terrorism in any country or location where the United States
government has issued a travel advisory that has been in effect
within the 6 months prior to the insured person's date of arrival.
This benefit also does not cover an act of
Terrorism in the event that an advisory to leave a certain country
or location is issued by the United States government after the
insured person's arrival date, and the insured person unreasonably
fails or refuses to depart the country or location. |
| Sports &
Leisure Activities |
Up to Policy
Maximum for basic sports |
Each Patriot
Platinum plan covers injuries incurred during amateur athletic
activities which are non-contact and engaged in by the insured
person solely for leisure, recreation, entertainment or fitness
purposes. However, activities not covered include amateur or
professional sports or other athletic activity which is organized
and/or sanctioned, or which involves regular or scheduled practices,
games or competition.
The following hazardous activities are excluded unless the Extreme
Sports Rider is purchased: abseiling, aviation (except when
traveling as a passenger in a commercial aircraft), BMX, bobsleigh,
bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing,
hot air ballooning, inline skating, jet skiing, kayaking, mountain
biking, paragliding, parascending, rappelling, rock climbing, sky
diving, snow skiing, snowboarding, snowmobiling, spelunking,
surfing, trekking, wind-surfing and whitewater rafting.
Racing of any kind, BASE jumping, mountaineering, climbing or
trekking above elevation 4500 meters above ground level or without
proper ropes or guides; luge, motocross, Moto-X, rodeo activity, ski
jumping, whitewater rafting exceeding Class V difficulty; and/or
extreme sports not expressly covered here under are excluded
regardless of which plan or rider is selected. |
| Sudden
Recurrence of a Pre-existing Condition (for U.S. citizens
only) |
Up to $50,000 |
| Up to $50,000
will be paid for the eligible expenses of a sudden and unexpected
recurrence of a Pre-existing Condition while traveling outside of
the U.S. |
| Incidental
Home Country Coverage |
Up to a
cumulative two weeks |
| During the Period
of Coverage an insured person may return to their home country for
incidental visits up to a cumulative two weeks total, subject to:
a. The insured person must have left their home
country, b. The total Period of Coverage must be
for a minimum of 30 days, and c. The return to the
home country may not be taken to receive treatment for an illness or
injury incurred while traveling. |
| End of Trip
Home Country Coverage |
One month for
every four months of travel coverage, up to a maximum of three
months |
| For every four
months of continuous coverage you purchase, you can purchase one
additional month of home country coverage as an accommodation and
supplemental travel benefit, up to a maximum of three months. To
purchase this special home country extension coverage, please check
the appropriate box on the Application Form, and calculate your
premium to include the additional month(s). |
| Trip
Interruption |
Up to $10,000 |
| If, during a
covered trip, there is a death of an immediate family member
(spouse, child, parent or sibling) or the substantial destruction of
the insured's principal residence, each Patriot Platinum plan will
pay to return the insured to the area of principal residence. The
plan will play for a one way air or ground transportation ticket of
the same class as the unused travel ticket, less the value of the
unused return ticket. |
| Common Carrier
Accidental Death |
$100,000 per
adult, $25,000 per child, maximum of $250,000 per family |
| If accidental
death should occur while traveling on a commercial Common Carrier,
$100,000 per adult and $25,000 per child will be paid to the
designated beneficiary, to a maximum of $250,000 per family. |
| Accidental
Death & Dismemberment |
$50,000
principle sum |
| Each Patriot
Platinum plan includes $50,000 principal sum benefit for Accidental
Death and Dismemberment occurring during the Period of coverage:
Accidental Loss of life - principal sum; Accidental Loss of two
Members - principal sum; Accidental Loss of one Member - 50% of
principal sum. "Member" means hand, foot or eye. |
| Additional
Benefits for U.S. Citizens |
| Sudden
Recurrence of a Pre-existing Condition |
| Up to $50,000
will be paid for the eligible expenses of a sudden and unexpected
recurrence of a Pre-existing Condition while traveling outside of
the U.S.. In addition, up to $25,000 will be paid for the eligible
costs and expenses of an Emergency Medical Evacuation arising or
resulting from a sudden and unexpected recurrence of a Pre-existing
Condition. For the definition of a Pre-existing Condition, please
see Exclusion number 1 in the Patriot Platinum Travel Medical
Insurance brochure. |
| Indemnity
|
| Patriot Platinum
International will pay directly to the insured person $250 for each
night of a required overnight stay in a hospital. However, the
hospital stay must be covered under this plan in order to receive
this benefit. |
| This web page contains only a consolidated and
summary description of all current Patriot Platinum Travel Medical
Insurance benefits, conditions, limitations and exclusions. A
certificate containing the complete Certificate Wording with all
terms, conditions and exclusions will be included in the fulfillment
kit. IMG reserves the right to issue the most current Certificate
Wording for this insurance plan in the event this application and/or
brochure has expired, is modified, or is replaced with a newer
version. Current Certificate Wordings are available upon request.
|
Optional Leisure or Extreme
Sports Riders: Please contact
us at 877-211-3654 or
info@worldwidemedicalplans.com for more
information.
Exclusions:
Charges
for the following services, treatments and/or conditions are excluded from
coverage under the Patriot Platinum International.
- A Pre-existing Condition is defined as any
injury, illness, sickness, disease, or other physical, medical, mental
or nervous condition, disorder 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 the insurance, whether or not
previously manifested or symptomatic, diagnosed, treated, or disclosed
prior to the effective date, including any subsequent, chronic or
recurring complications or consequences related thereto or arising
therefrom.
- Treatment or surgeries which are elective,
investigational, experimental or for research purposes.
- War, military action, terrorism, political
insurrection, protest, or any act thereof. The Company will not pay for
a Political Evacuation if there is a travel advisory in effect on or
within six (6) months prior to the Insured Person’s date of arrival in
the Host Country.
- Immunizations and routine physical exams.
- Treatment of Temporomandibular Joint or dental
treatment, except as expressly provided for in the certificate of
insurance.
- Venereal disease, AIDS virus, AIDS-related
illness, ARC Syndrome, or AIDS, and the cost of testing for these
conditions, and charges for treatment or surgeries which are incurred by
any Insured who was HIV+ at time of enrollment into this insurance.
- Pregnancy, childbirth, birth control,
artificial insemination, treatment for infertility or impotency,
sterilization or reversal thereof, or abortion.
- Injury sustained while participating in
amateur or professional sports or other athletic activity which is
organized and/or sanctioned, or which involves regular or scheduled
practices, games or competition. The following hazardous activities are
excluded unless the Extreme Sports Rider is purchased: abseiling,
aviation (except when traveling as a passenger in a commercial
aircraft), BMX, bobsleigh, bungee jumping, canyoning, caving, high
diving, hang gliding, heli-skiing, hot air ballooning, inline skating,
jet skiing, kayaking, mountain biking, paragliding, parascending,
rappelling, rock climbing, sky diving, snow skiing, snowboarding,
snowmobiling, spelunking, surfing, trekking, wind-surfing and whitewater
rafting.
Racing of any kind, BASE jumping, mountaineering, climbing or trekking
above elevation 4500 meters above ground level or without proper ropes
or guides; luge, motocross, Moto-X, rodeo activity, ski jumping,
whitewater rafting exceeding Class V difficulty; and/or extreme sports
not expressly covered hereunder are excluded regardless of which plan or
rider is selected.
- Vision or ear tests and the provision of
visual or hearing aids.
- Vocational, recreational, speech or music
therapy.
- Treatment while confined primarily to receive
custodial care, educational or rehabilitative care, or nursing services.
- Charges, injuries and/or illnesses resulting
or arising from or occurring during the commission or continuing
perpetration of a violation of law by the insured, including without
limitation, the engaging in an illegal occupation or act, but excluding
minor traffic violations.
- Treatment for, and injuries and/or illnesses
resulting or arising from, substance abuse or drug addiction.
- Injury and/or illness resulting or arising
from being under the influence of alcohol or drugs; and injury or
illness resulting from operating any type of vehicle after consuming any
alcohol or drugs.
- Willful self-inflicted injury or illness.
- Treatment required as a result of or arising
from complications from a treatment or condition not covered under the
certificate.
- Any services or supplies performed or provided
by a relative of the Insured or provided at no cost to Insured.
- Treatment for mental and nervous disorders.
- Organ or tissue transplants or related
services.
- Illness or injury where the trip to the host
country is undertaken for treatment or advice for such illness or
injury, except as expressly provided for in the certificate of
insurance.
- Treatment incurred as a result of or arising
from exposure to nuclear radiation, and/or radioactive material(s).
This web page contains only a consolidated and summary
description of all current Patriot Platinum Travel Medical Insurance
benefits, conditions, limitations and exclusions. A certificate
containing the complete Certificate Wording with all terms, conditions
and exclusions will be included in the fulfillment kit. IMG reserves the
right to issue the most current Certificate Wording for this insurance
plan in the event this application and/or brochure has expired, is
modified, or is replaced with a newer version. Current Certificate
Wordings are available upon request.
PATRIOT PLATINUM
AMERICA
PREMIUM TABLE
for
non-U.S. Citizens
traveling
outside of their country
All premium rates are for Deductible $250 Option
(in USD)
Effective through 12/31/2009
Rates include surplus lines tax
where applicable.
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* $100,000 Maximum ** $20,000 Maximum
Refund of Premium
Quality Guarantee
Your satisfaction is very important to us and the plan underwriter. 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. In order to be considered for a full refund, your request for
cancellation must be received by IMG prior to your effective date. If you do
not have any claims filed with IMG, 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 2) only full month premiums will
be considered for refunds (e.g., if you choose to cancel your coverage two
months and two weeks prior to the date your coverage ends, IMG will only
consider the two full months for a refund). If you have filed claims, your
premium is non-refundable.
Click here for
Current Rates & Online Application
Please read the Benefits & Exclusions of this plan carefully before submitting your application.
Back to
Brochure of Patriot Travel Insurance
Bon Voyage!
Haben Sie eine sichere
Reise! Abbia un viaggio sicuro!
¡Tenga un viaje seguro! Ayez un
voyage sûr! Have a safe trip!
|
Experience
If you have any questions, please contact our friendly
specialists.