Patriot Platinum Travel

     
  • Best International health insurance with higher policy maximums.
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  • Provides 24-hour medical emergency availability.
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  • Obtain INSTANT ID CARDS by applying ONLINE!.
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  • Coverage is available from 5 days to 3 years.
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  • Renew online by phone, by email or by fax.
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  • Higher coverage for age 70 to 79.

Patriot Platinum Travel - As you expect first-rate protection when you travel, the two Patriot Platinum plans offer a complete package of international benefits available 24 hours a day. Patriot Platinum International provides coverage for US citizens traveling outside US; while Patriot Platinum America provides coverage for non us citizens traveling outside their home country for a minimum of five days up to a maximum of three years. These overseas travel medical insurance plans also provide optional coverage for Extreme Sports, Enhanced ADD benefit, Personal Liability (injury to third party or their property). The worldwide travel health insurance plans are administered by International Medical Group, Inc (IMG) and underwritten by Sirius International insurance Corporation.7


Benefits:

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.
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
Sudden and Unexpected Recurrence of a Pre-existing Condition
(Non U.S. citizens only) For those under age 65, the Plan will pay up to a $50,000 lifetime maximum for eligible medical expenses. For those ages 65 and older, the Plan will pay up to $2,500 lifetime maximum.

In addition, up to $25,000 will be paid to U.S. and non-U.S. citizens 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
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.
SCHEDULE OF BENEFITS (All amounts listed are in U.S. dollars)
MEDICAL BENEFITS Usual, reasonable and customary charges, subject to deductible and coinsurance
Hospital Room and Board Up to Policy Maximum
Intensive Care Up to Policy Maximum
Medical Expenses Up to Policy Maximum
Outpatient Medical Expenses Up to Policy Maximum
Local Ambulance Up to Policy Maximum
Emergency Room Accident Up to Policy Maximum
Emergency Room Illness with
In-patient Admission
Up to Policy Maximum
Emergency Room Illness without
In-patient Admission
Up to the Maximum Limit with
additional $250 deductible
Dental - Injury Due to Accident Up to the Maximum Limit
Dental - Sudden Dental Emergency Up to $250
Hospital Daily Indemnity Up to $250 per night for a
maximum of 10 days
Supplemental Accident Up to $300
INTERNATIONAL EMERGENCY CARE (when coordinated through the Plan administrator)
Political Evacuation Up to $100,000
If the United States Department of State, Bureau of Consular Affairs, or similar government organization of the Insured Person''s Home Country, orders the evacuation of all non-emergency government personnel from the Host Country, due to political unrest, that becomes effective on or after the Insured Person''s date of arrival in the Host Country, the Company will pay up to a $100,000 lifetime maximum for transportation to the nearest place of safety or for repatriation to the Insured Person''s home country or country of residence provided that:
  1. The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular Affairs, or similar government organization of the Insured Person''s Home Country, issuance of the evacuation order; and
  2. The evacuation order pertains to persons from the same Home Country as the Insured Person; and
  3. Political Evacuation and Repatriation is approved and coordinated by the Company; In no event will the Company pay for a Political Evacuation if there is a Travel Warning in effect on or within six (6) months prior to the Insured Person''s date of arrival in the Host Country.

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.

Emergency Evacuation Up to Policy Maximum
The Patriot Platinum plans offer coverage for Emergency Medical Evacuation to the nearest qualified medical facility; expenses for reasonable transportation resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred, up to the Maximum Limit.
Emergency Reunion Up to $100,000
Each Patriot Platinum plan also offers 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 or Cremation/
Burial
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 $50,000; or up to $5,000 for the preparation, local burial or cremation of your mortal remains at the place of death.
Hospital Daily Indemnity
Each plan pays $250 directly to the insured person for each night of a required overnight stay in a hospital up to a maximum of 10 days. The hospital stay must be covered under this plan in order to receive this benefit.
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).
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:

  1. The insured person must have left their home country,
  2. The total Period of Coverage must be for a minimum of 30 days, and
  3. 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 one month
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 one month. 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.
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 Assistanc 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.
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. Some of these sports and activities include, but are not limited to, motor cycle/motorscooter riding, scuba diving (to 10m), snorkeling, wakeboarding, and water skiing. 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 Adventure Sports Rider is purchased: abseiling, BMX, bobsleigh, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, horseback riding, hot air ballooning, inline skating, jet skiing, jungle zip lining, kayaking, mountain biking, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snow boarding, snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), and wildlife safaris. To be covered under the Adventure Sports Rider, these adventure activities must be engaged in solely for leisure, recreation, or entertainment purposes.

Injury sustained while participating in contact sports of any kind, racing of any kind, BASE jumping, kiteboarding, mountaineering or 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, scuba below 50 meters; and/or adventure sports not expressly covered hereunder are excluded regardless of which plan or rider is selected.
Adventure Sports Rider (available to insured up to age 65)
Age Lifetime Maximum
0 - 49 $50,000
50 - 59 $30,000
60 - 64 $15,000
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.
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.

Exclusions:

Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under the Patriot Platinum plans.

  1. A Pre-existing Condition which is 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, whether or not previously manifested or known, diagnosed, treated, or disclosed.
  2. Treatment or surgeries which are elective, investigational, experimental or for research purposes.
  3. 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.
  4. Immunizations and routine physical exams.
  5. Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.
  6. 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.
  7. Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
  8. Any illness or injury sustained while taking part in: Amateur Athletics, Professional Athletics, or other athletic activity that is sponsored or sanctioned by the National Collegiate Athletic Association (and/or any other collegiate sanctioning or governing body), or the International Olympic Committee. The following Adventure Sports are excluded unless the Adventure Sports Rider is purchased: abseiling, BMX, bobsledding, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, hot air bal-looning, inline skating (with proper use of helmet and pads), jet skiing, jungle zip lining, kayaking, mountain biking, parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snowboarding, snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), wildlife safaris, and windsurfing. All such activities must be carried out in strict accordance wit the rules, regulations and guidelines of the applicable Governing Body or Authority of each such activity.

    Injury sustained while participating in contact sports of any kind, racing of any kind, any rodeo activity, BASE jumping, kiteboarding, mountaineering or climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, ski jumping, sub-aquatic activities below 50 meters, whitewater rafting exceeding Class V difficulty; and/or adventure sports activity not expressly covered hereunder are excluded regardless of which plan or rider is selected.
  9. Vision or ear tests and the provision of visual or hearing aids.
  10. Vocational, recreational, speech or music therapy.
  11. Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
  12. 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.
  13. Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
  14. 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.
  15. Willful self-inflicted injury or illness.
  16. Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.
  17. Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
  18. Treatment for mental and nervous disorders.
  19. Organ or tissue transplants or related services.
  20. 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.
  21. Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).
  22. Any infection of the urinary tract (or Illness arising there from), that occurs within ninety (90) days of the Effective Date of coverage and that requires Treatment of the Insured Person in a Hospital; provided that any such Illness will be deemed by the Company to be a Pre-existing Condition. See Sudden and Unexpected Recurrence of a Pre-existing Condition, on brochure page 11.
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.

IMPORTANT NOTICE REGARDING PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA): This insurance is not subject to, and does not provide benefits required by, PPACA. On January 1, 2014, PPACA will require U.S. citizens and certain U.S. residents to obtain PPACA compliant insurance coverage unless they are exempt from PPACA. Penalties may be imposed on U.S. citizens and U.S. residents who are required to maintain PPACA compliant coverage but do not do so. Please note that it is solely your responsibility to determine if PPACA is applicable to you.



Nationwide PPO Network:

Click here to ACCESS THE PPO DIRECTORY

You may seek treatment under Patriot Platinum Medical Insurance Plan worldwide, including in the United States, with the hospital or doctor of your choice. When seeking treatment in the U.S., you may use the independent Preferred Provider Organization (PPO) contracted by IMG, a separately organized network (First Health Group) of approximately 500,000 physicians and 4,700 privately owned and operated hospitals. * This PPO network includes a large number of hospitals including some of the most well recognized university medical centers and transplant facilities.

Using this provider network could significantly reduce your out-of-pocket expenses.

When a U.S. hospital outside the network is used, a co-payment of US $250 is required in addition to the regular deductible and coinsurance. This co-payment is waived, however, if there is not a network provider within 50 miles of the location of treatment.

Each proposed hospital admission, inpatient or outpatient surgery, and certain other medical procedures must be Pre-certified for medical necessity. This means the insured person or their attending physician must call the number listed on the IMG identification card prior to admittance to a hospital or performance of a surgery, or medical procedure. In the case of an emergency hospital admission, the Pre-certification call must be made within 48 hours of the admission, or as soon as reasonably possible. For a complete list of procedures requiring Pre-certification, please refer to your certificate wording.

If Pre-certification guidelines are not followed, eligible claims and expenses will be reduced by 50%.


Options: Other lower and Higher deductible options available as follows to improve the deductible or reduce the cost. please use these rate factors.
Deductible Rate Factors. Deductible Rate Factors.
US $ Zero 1.25 US $500 .90
US $100 1.10 US $1,000 .80
US $250 1.00 US $2,500 .70

ONE MONTH RATES
(Four Policy Maximum options. Maximums are per insured per certificate period.)

Option 1 Option 2 Option 3 Option 4
$50,000 $100,000 $500,000 $1,000,000
Age One Month
18-29 $42 $49 $63 $74
30-39 $55 $66 $82 $95
40-49 $82 $94 $123 $139
50-59 $118 $144 $174 $202
60-64 $139 $171 $203 $243
65-69 $159 $204 $221 $265
70-79 $215 N/A N/A N/A
80+* $373 N/A N/A N/A
Dep. Child $36 $43 $55 $62
Child Alone $38 $45 $58 $65
DAILY RATES (5 day minimum)
(Four Policy Maximum options. Maximums are per insured per certificate period.)

Option 1 Option 2 Option 3 Option 4
$50,000 $100,000 $500,000 $1,000,000
Age Daily
18-29 $1.42 $1.72 $2.16 $2.50
30-39 $1.86 $2.21 $2.79 $3.19
40-49 $2.79 $3.19 $4.17 $4.70
50-59 $3.97 $4.85 $5.88 $6.76
60-64 $4.70 $5.73 $6.81 $8.18
65-69 $5.34 $6.86 $7.45 $8.87
70-79 $7.20 N/A N/A N/A
80+* $12.50 N/A N/A N/A
Dep. Child $1.20 $1.45 $1.85 $2.10
Child Alone $1.32 $1.57 $1.96 $2.21


Riders:

DESCRIPTION OF OPTIONAL RIDERS
ADVENTURE SPORTS RIDER:
The Adventure Sports Rider is available on both Patriot Platinum plans for those up to the age of 65. The following activities are covered to the lifetime maximum amounts listed on page four: abseiling, BMX, bobsleigh, bungee jumping, canyoning, caving, hang gliding, heliskiing, high diving, horseback riding, hot air ballooning, inline skating, jet skiing, jungle zip lining, kayaking, mountain biking, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snow boarding, snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), and wildlife safaris. These adventure activities must be engaged in solely for leisure, recreation, or entertainment purposes.
Adventure Sports Rider
(Age Lifetime Maximum)
Age Lifetime Maximum
0 - 49 $50,000
50 - 59 $30,000
60 - 64 $15,000
ENHANCED AD&D RIDER:
This optional coverage is available for the primary insured person only. This coverage is in addition to the Accidental Death and Dismemberment already included in the Patriot Platinum plans. This rider is available with a minimum purchase of one month of medical and AD&D rider coverage.
CITIZENSHIP RETURN RIDER:
When purchased at the time of application, the Citizenship Return Rider provides temporary medical coverage for non-U.S. citizens returning to their country of citizenship. For U.S. citizens, the rider provides up to 60 days of coverage for brief returns to the U.S. provided you have a current health plan in force and have resided outside the U.S. continuously for the past six months. Coverage for sudden recurrence of pre-existing conditions is excluded if the rider is selected. For premium information, please see the back of the Application Form.
PERSONAL LIABILITY RIDER:
This optional coverage provides for the reimbursement of legal costs associated with a personal liability event by a covered insured. This includes legal costs incurred arising from the determination and/or settlement of such legal liability associated with the injury of a third person or damage to a third person's property during the period of coverage. Personal Liability - Injury to third party $2,000 limit after $100 deductible
EVACUATION PLUS RIDER:
This optional rider is available to insureds up to age 65 and provides coverage for medical evacuations for medical conditions that are non life-threatening and evacuations as a result of a natural disaster. This rider must be purchased for a minimum of one month regardless of the minimum number of days being traveled. Up to age 65. Non Life threatening Medical Evacuation - Up to a maximum of $50,000; Natural Disaster Evacuation - Up to a maximum of $10,000