Patriot GoTravel America

Plan Detail

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

Benefits


 

Benefit Limit
Maximum Limits $50,000, $100,000, $500,000, $1,000,000, $2,000,000
Individual Deductible $0, $100, $250, $500, $1,000, $2,500

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 - for treatment received within the U.S. & Canada In the PPO Network - The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Maximum Limit.
Out of the PPO Network - The plan pays 80% of eligible expenses up to $5,000, then 100% up to the Maximum Limit.
Benefit Period Six months

If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the six-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 six months before the Period of Coverage expired, benefits for the covered injury or illness will continue subject to the Maximum Limits and the other terms of the plan until there have been six months of continuous coverage for the covered injury or illness.
MyIMGSM 24 hour secure access from anywhere in the world to manage your account at anytime
World-class Medical Benefits Coverage available for in-patient and out-patient medical expenses
MEDICAL BENEFITS -Usual, reasonable and customary charges. Subject to deductible and coinsurance when applicable
Hospital Room and Board Up to the Maximum Limit for average semi-private room rate
Intensive Care Up to the Maximum Limit
Medical Expenses Up to the Maximum Limit
Out-patient Medical Expenses Up to the Maximum Limit
Local Ambulance Up to the Maximum Limit
Prescription Drugs Up to the Maximum Limit
Emergency Room Accident Up to the Maximum Limit

Charges incurred for the use of the Emergency Room due to an accident or illness are covered up to the Maximum Limit.
Emergency Room Illness with In-patient Admission Up to the Maximum Limit

Charges incurred for the use of the Emergency Room due to an accident or illness are covered up to the Maximum Limit.
Emergency Room Illness without In-patient Admission Up to the Maximum Limit with additional $250 deductible

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.
ADDITIONAL BENEFITS
Terrorism Up to $50,000 lifetime maximum

Each Patriot GoTravel 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 subject to a $50,000 lifetime 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 of 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 six 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 & Activities Coverage Up to the Maximum Limit for basic sports

Each Patriot GoTravel 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.
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 five months of travel coverage purchased, up to a maximum of two months

For every five 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 two 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 $5,000

If, during a covered trip, there is a death of an immediate family member (spouse, child, parent or sibling), a break-in at the insured’s principle residence, or the substantial destruction of the insured’s principal residence due to a fire or natural disaster, each Patriot GoTravel 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.
Common Carrier Accidental Death $50,000 to beneficiary; maximum of $250,000 per family

If accidental death should occur while traveling on a commercial Common Carrier, $50,000 will be paid to the designated beneficiary, to a maximum of $250,000 per family.
Accidental Death & Dismemberment $25,000 principle sum

Each Patriot GoTravel plan includes $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.
Identity Theft Assistance Up to $500 per Period of Coverage

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 GoTravel 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 six months of the termination of coverage date.
Natural Disaster $100 per day for five days

This benefit is available in the event an insured person is required to depart his/her destination due to an evacuation order issued by prevailing authorities in connection with a Natural Disaster. Natural Disaster is defined as widespread disruption of human lives by disasters such as flood, drought, tidal wave, fire, hurricane, earthquake, windstorm, or other storm, landslide, or other natural catastrophe or event resulting in migration of the population for its safety.
OPTIONAL RIDERS - With the exception of the Enhanced AD&D Rider, optional riders apply to all individuals listed on the Application Form.
Adventure Sports Rider
(available to insureds up to age 65)
Age                                             Lifetime Maximum
0 - 49                                               $50,000
50 - 59                                            $30,000
60 - 64                                            $15,000

The Adventure Sports Rider is available on both Patriot GoTravel plans for those up to the age of 65. The following activities are covered to the lifetime maximum amounts listed on page 4: 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. These adventure activities must be engaged in solely for leisure, recreation, or entertainment purposes.
Enhanced AD&D Rider
(available to the primary insured only)
Up to an additional $400,000

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 GoTravel plans. This rider is available with a minimum purchase of three months of medical and AD&D rider coverage.
Citizenship Return Rider Up to the Maximum Limit

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.

This web page contains only a consolidated and summary description of all current Patriot GoTravel 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. The Patriot GoTravel plans are amended, modified or replaced from time to time, and 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.