Patriot America Plus

Plan Detail

Plan Administrator: International Medical Group | AM Best Rating: A "Excellent" | Underwriter: Sirius International

Benefits


Limit/Amount for Eligible Medical Expenses
Period of Coverage 5 day Minimum and 365 day Maximum Limit.
Maximum Limit per Period of Coverage $10,000, $50,000, $100,000, or $500,000per Insured Person, as indicated on the Declaration.
Area of Coverage Outside Home Country.
Deductible Per 12 month Period of Coverage $0, $100, $250, $500, $1,000 or $2,500 per Insured Person, as indicated on the Declaration. An additional Deductible of $250 will be applied for each Emergency Room visit for Treatment of an Illness which does not result in inpatient status.
Coinsurance
Per 12 month
Period of Coverage
For Treatment received outside the United States and Canada: 0%.
For Treatment received within the United States and Canada: If in the PPO Network, 10% of Eligible Medical Expenses until reaching $5,000, then 0%.
If outside the PPO Network 20% of Eligible Medical Expenses until reaching $5,000, then 0%.
Terrorism $50,000 Maximum Limit per lifetime and not subject to the Deductible.
Acute Onset of Pre-existing Condition prior to age 70 Up to the Maximum Limit per Period of Coverage; $25,000 Maximum Limit per lifetime for Emergency Medical Evacuation.

The following benefits are subject to the Deductible and Coinsurance, as described above and cannot exceed the Maximum Limit. When the Eligible Medical Expense criteria are met, the benefits offered under the insurance plan shown in the Declaration shall be as follows:

Charges for                                                                                                     Maximum Limits per Period of Coverage, or if indicated, per lifetime
Hospital Room & Board Up to the average semi-private room rate, including nursing service.
Intensive Care Unit Usual, Reasonable, & Customary.
Surgery Usual, Reasonable, & Customary.
Emergency Room Usual, Reasonable, & Customary.
Physician Visits Usual, Reasonable, & Customary.
Diagnostic Procedures Usual, Reasonable, & Customary.
Prescription Medication Usual, Reasonable, & Customary.
Home Nursing                       Care                     Usual, Reasonable, & Customary.
Local Ambulance Expense Usual, Reasonable, & Customary.
Durable Medical Equipment Usual, Reasonable, & Customary.
Dental Emergency $100 Maximum Limit for necessary Treatment of Unexpected pain to sound natural teeth or for necessary Treatment due to an Accident.
Continuation of Treatment Period Earlier of 6 months per Injury or Illness or upon return to Home Country.

The following benefits are not subject to a Deductible, but cannot exceed the Maximum Limit. The benefits offered under the insurance plan shown in the Declaration shall be as follows:

Benefit                                         Maximum Limits per Period of Coverage, or if indicated, per lifetime
Emergency Medical Evacuation $500,000 Maximum Limit per lifetime. Must be approved in advance and coordinated by the Company.
Emergency Reunion Up to $50,000 Maximum Limit per lifetime. Must be approved in advance and coordinated by the Company.
Return of Minor Children Up to $50,000 Maximum Limit per lifetime. Must be approved in advance and coordinated by the Company.
Return of Mortal Remains $50,000 Maximum Limit per lifetime for return of the Insured Person's Mortal Remains or ashes to Country of Residence or $5,000 Maximum Limit per Insured Person for preparation, local burial or cremation of the Insured Person’s mortal remains at the place of death. Must be approved in advance and coordinated by the Company.
Political Evacuation $10,000 Maximum Limit per lifetime. Must be approved in advance and coordinated by the Company.
Natural Disaster $100 per day and Maximum Limit of 5 days for accommodations.
Accidental Death & Dismemberment Accidental Death Principal Sum: $25,000; Dismemberment: See Schedule in AD&D Benefit section.
Common Carrier Accidental Death $50,000 per Insured Person and $250,000 Maximum Limit per lifetime and per Family.
Trip Interruption $5,000 Maximum Limit.
Lost Luggage $50 Maximum Limit per item and $250 Maximum Limit per Period of Coverage.
Hospital Indemnity $100 per overnight and Maximum Limit of 10 overnights .
Identity Theft $500 Maximum Limit.

 

Additional Provisions Requirements
Pre-certification 50% reduction of Eligible Medical Expenses if Pre-certification provisions are not met
Incidental Trips Up to 14 days