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Patriot Travel Medical Insurance®
Designed
for the international traveler
There are two Patriot products available to meet your needs
providing up to US$2,000,000 of medical coverage.
Patriot International®
Patriot
International provides coverage for US citizens traveling abroad for
a minimum of 5 days up to a maximum of one year. 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 two years. See the "Extension
of Coverage" section on page 16 of the brochure for more information.
Patriot America®
Patriot America provides coverage for non-US citizens traveling
outside their country of citizenship for a minimum of 5 days up to a maximum of one
year. 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 two years. See the "Extension of Coverage" section on page
16 of the brochure for more information. If you or other family
members applying for coverage are age 65 or older, please see the Eligibility
in the Patriot brochure for additional information.
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INTERNATIONAL EMERGENCY CARE |
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Emergency Evacuation
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To Policy Maximum when coordinated through
IMG
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Each Patriot Travel Medical Insurance®
plan also provides for Emergency Medical Evacuations to the
nearest qualified medical facility or the country of residence
(as determined by IMG®)expenses for
reasonable travel and accommodations resulting from the evacuation;
and the cost of returning to either the country of residence
or the country where the evacuation occurred up to the policy
limit.
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Emergency
Reunion |
To
US$15,000 when coordinated through IMG |
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Each Patriot®
plan includes emergency reunion coverage, up to US$15,000 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 country of residence to
be united with the insured. |
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Repatriation
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To US$25,000 when coordinated through IMG
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If a covered illness/injury results in death,
expenses for Repatriation of bodily remains or ashes to the
country of citizenship will be covered up to a maximum of US$25,000.
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Returning Minor Children
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To US$5,000 when coordinated through IMG
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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 US$5,000 for one way economy fare to their
home country, including a chaperone, if necessary, for the safety
of the child(ren).
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SPECIAL COVERAGES |
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Home Country Coverage
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As described below
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Incidental
Home Country Coverage - During the period of coverage an
insured person may return to their country of citizenship for
incidental visits of up to two weeks total, subject to: a. The
insured person must have left their country of citizenship,
b. The Total Period of Coverage must be for a minimum of 30
days, and c. The return to the country of citizenship may not
be taken to receive treatment for a condition incurred while
traveling.
End of Trip Home Country Coverage-For every five (5) months
of coverage you purchase, you can purchase one (1) month of
home country coverage up to a maximum of 2 months.
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Trip Interruption
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To US$5,000
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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,
the plan will pay to return the insured to the area of principal
residence. The plan will pay 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.
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Lost Luggage
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To US$50 per item; maximum of US$250
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This benefit will be paid in the event that
the Common Carrier permanently loses an insured person's checked
luggage. This coverage is secondary to any other available coverage,
including the Carrier's.
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Common Carrier Accidental Death
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US$50,000 to Beneficiary; maximum
of US$250,000 per family
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If accidental death should occur while traveling
on a commercial Common Carrier, US$50,000 will be paid to the
beneficiary to a maximum of US$250,000 per family
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MEDICAL BENEFITS |
Usual reasonable and customary charges, subject to deductible
and coinsurance |
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Hospital Room and Board
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To Policy Maximum for average semi-private
room rate
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Intensive Care
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To Policy Maximum
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Medical Expenses
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To Policy Maximum
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Outpatient
Medical |
To
Policy Maximum |
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Local Ambulance
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To Policy Maximum
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Dental
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To Policy Maximum
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Each Patriot
plan covers the cost of emergency dental treatment and dental
procedures necessary to restore sound natural teeth lost or
damaged in an accident |
| Sports & Activities
Coverage |
To Policy Maximum for
basic sports Coverage as described below |
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Each Patriot plan covers injuries incurred
during amateur athletic activities which are non-contact and
engaged in by an 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: racing of any
kind, aviation (except when traveling as a passenger in a commercial
aircraft), BMX, BASE jumping, bobsleigh, bungee jumping, canyoning,
caving, high diving, hang gliding, heli-skiing, hot air ballooning,
inline skating, jet skiing, kayaking, luge, motocross (moto-x),
mountain biking, mountaineering, parachuting, rappelling, rock
climbing, rodeo, scuba diving, ski jumping, sky diving, snow
skiing, snowboarding, snowmobiling, spelunking, snorkeling,
surfing, wakeboarding, water skiing, windsurfing and whitewater
rafting.
Optional Leisure Sports Rider: This
rider adds coverage for amateur non-motorized racing, jet skiing,
snow skiing, snowboarding, snowmobiling, snorkeling, surfing,
wakeboarding, water skiing and windsurfing. For more sports
coverage, please review IMG's Patriot ExtremeSM plan
or the Extreme Sports Rider below.
Extreme Sports Rider: The Extreme
Sports Rider is available on both Patriot plans and adds up
to 12 months of coverage for those under the age of 49.
This rider provides up to US$50,000 lifetime maximum for the
following activities: abseiling, BMX, bungee jumping, canyoning,
caving, flying (private plane), hang gliding, heli-skiing, high
diving, hot air ballooning, kayaking, inline skating, mountain
biking, mountaineering (ropes and guides to 4500m from ground
level), paragliding, parascending, rappelling, rock climbing
(ropes and guides to 4500m from ground level)), sky-diving,
spelunking, whitewater rafting (to Class V). These extreme activities
must be engaged in solely for leisure, recreation, or entertainment
purposes.
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Accidental
Death&Dismemberment |
US$25,000
principal sum |
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Each Patriot
plan includes US$25,000 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. For more
information see the Conditions of Coverage section in the Patriot
Travel Medical brochure. |
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PLAN INFORMATION |
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Deductible
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Your choice of US$100, $250, $500, $1,000
or $2,500
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Coinsurance
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As described below
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For treatment received outside the US &
Canada: No coinsurance
For treatment received within the US &
Canada: The plan pays 80% of eligible expenses up to US$5,000
then 100% up to the Policy Maximum.
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Benefit Period
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Six months
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If a covered
injury or illness has continuing treatment after the policy
expires, the Benefit Period may provide continued coverage.
When the policy expires, IMG will review the date of initial
treatment for the covered injury or illness. If treatment began
less than six months before the policy expired, benefits for
the covered injury or illness will continue subject to the Policy
Limits until there has been six months of coverage. The Benefit
Period serves as an extension of benefits and does not limit
the treatment time during the Policy Period. |
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Additional Benefits for U.S.
Citizens |
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Sudden
Recurrence of a Pre-existing Condition |
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Sudden Recurrence
of a Pre-existing Condition - Up to US$15,000 will be paid for
the eligible expenses of a sudden and unexpected recurrence
of a Pre-existing Condition while traveling outside of the US.
In addition, up to US$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 Travel Medical brochure.
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Dental
Emergency |
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This plan will
pay up to $100 for the necessary treatment of sudden, unexpected
pain to sound natural teeth. |
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Indemnity |
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Patriot International
will pay directly to you US$100 for each night of a required
overnight stay in a hospital. The hospital stay must be covered
under this plan in order to receive this benefit. |
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The above outline
is only a consolidated and summary description of all current
Patriot Travel Medical Insurance benefits, conditions, limitations
and exclusions. A certificate containing the complete Policy
Wording with all terms, conditions and exclusions will be included
with the fulfillment kit. |
TOP^
Coverage for US citizens traveling abroad
from 10 days to one year. If you are traveling for three months or more,
review the ExPatriot Plus plan for additional coverage options. Once
the Period of Coverage expires, Patriot International can be rewritten
but is not renewable. This means new Deductible, Coinsurance, Eligibility,
Conditions of Coverage and Pre-existing Condition Exclusions apply to
any subsequent Period of Insurance.
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PATRIOT INTERNATIONAL POLICY PREMIUMS |
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50,000
MAX |
100,000
MAX |
500,000
MAX |
1,000,000
MAX |
2,000,000
MAX |
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option 5 |
option 6 |
option7 |
option 8 |
option 9 |
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AGE
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One Month |
One Month |
One Month |
One Month |
One Month |
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18-29
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$32.00
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$37.00
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$43.00
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$48.00
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$54.00
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30-39
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$37.00
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$43.00
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$57.00
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$63.00
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$72.00
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40-49
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$59.00
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$66.00
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$73.00
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$81.00
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$99.00
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50-59
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$96.00
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$109.00
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$122.00
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$136.00
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$153.00
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60-64
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$109.00
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$129.00
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$153.00
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$180.00
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$201.00
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65-69
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$129.00
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$138.00
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$158.00
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$189.00
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$243.00
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70-79
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$189.00
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N/A
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N/A
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N/A
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N/A
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80 PLUS*
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$378.00
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N/A
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N/A
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N/A
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N/A
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DEP CHILD
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$18.00
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$23.00
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$27.00
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$28.00
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$34.00
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CHILD ALONE
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$32.00
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$36.00
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$41.00
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$46.00
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$52.00
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*US$10,000 limit
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Daily rates are also available.
All premium rates are in US dollars and are effective
through 12/31/2006. Rates include 2.5% surplus lines tax. A dependent
child is your child shown on the Enrollment Form over 14 days and under
18 years of age, traveling with you, and for whom premium has been paid.
TOP^
Patriot America provides coverage for non-US citizens
traveling outside their country of citizenship for a minimum of
10 days up to a maximum of one year. Although the Patriot America
plan is not renewable, it can be rewritten for succeeding or subsequent
coverage periods. New Deductible, Coinsurance, Eligibility, Conditions
of Coverage and Pre-Existing Condition Exclusions apply to any succeeding
or subsequent Period of Coverage. A new application also must be
completed. If you or other family members applying for coverage
are age 65 or older, please see the Eligibility section of the Patriot
brochure for additional information.
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PATRIOT AMERICA POLICY PREMIUMS |
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50,000 MAX |
100,000 MAX |
500,000 MAX |
1,000,000
MAX |
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option 1 |
option 2 |
option 3 |
option 4 |
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AGE
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One Month |
One Month |
One Month |
One Month |
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18-29
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$45.00
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$50.00
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$64.00
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$76.00
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30-39
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$56.00
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$67.00
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$84.00
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$97.00
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40-49
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$84.00
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$96.00
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$126.00
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$142.00
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50-59
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$120.00
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$147.00
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$178.00
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$206.00
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60-64
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$142.00
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$174.00
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$207.00
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$248.00
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65-69
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$162.00
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$208.00
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$226.00
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$300.00
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70-79
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$219.00
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N/A
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N/A
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N/A
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80 PLUS*
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$381.00
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N/A
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N/A
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N/A
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DEP CHILD
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$26.00
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$28.00
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$36.00
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$44.00
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CHILD ALONE
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$39.00
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$46.00
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$59.00
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$74.00
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*US$10,000 limit |
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All premium rates are in US dollars and
are effective through 12/31/2006. Rates include 2.5% surplus lines tax.
A dependent child is your child shown on the Enrollment Form over 14
days and under 18 years of age, traveling with you, and for whom premium
has been paid.
TOP^
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LifeLine Plus, Inc.
Marketing Dept.
169 S. Main Street
Suite 422
New City, NY 10956
Email:insure@lifelineplus.com
Tel:
001-888-975-5888
Fax: 001-501-694-6176
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