Patriot Platinum International

Plan Detail

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

Benefits


 

Benefit LIMITS
Maximum Limits $1,000,000, $5,000,000, $8,000,000
Individual Deductible $0, $100, $250, $500, $1,000, $2,500, $5,000, $10,000, $25,000
Family Deductible Three times the individual deductible
Coinsurance - for treatment received outside the U.S. & Canada No Coinsurance
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 Maximum 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 Services Access to a dedicated service team for assistance services
MyIMGSM 24 hour secure access from anywhere in the world to manage your account at anytime
eDocAmerica Access to board-certified physicians, licensed psychologists, pharmacists, dentists, dieticians and fitness trainers 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
MEDICAL BENEFITS (Usual, reasonable and customary charges. Subject to deductible and coinsurance when applicable.)
Hospital Room and Board Up to the Maximum Limit
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
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
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.
Dental - Injury Due to Accident Up to the Maximum Limit

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 Maximum Limit.
Dental - Sudden Dental Pain Up to $250

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 per night for a maximum of 10 days

Patriot Platinum will pay directly to the insured person $250 for each night of a required overnight stay in a hospital up to a maximum of 10 days. However, the hospital stay must be covered under this plan in order to receive this benefit.
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
Emergency Medical Evacuation Up to the Maximum Limit

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 Maximum Limit.
Emergency Reunion Up to $100,000

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 Maximum Limit.
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.
Return of 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 Platinum plans will pay up to $100,000 for one way economy fare to their home country, including a chaperone,
if necessary, for the safety of the child(ren).

To be eligible for the Remote Transportation, Evacuation, Reunion and Return benefits, these must be recommended by the attending physician in life-threatening medical situations, and approved in advance and coordinated by IMG.
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.
Natural Disaster $250 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.
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).
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, 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 six 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 there is 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.   It will also include coverage for 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 up to $10,000. This benefit is in addition to any other benefit available under Patriot Platinum.
ADDITIONAL BENEFITS
Terrorism Up to the Maximum Limit

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 Maximum Limit. 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 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, 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
Sudden and Unexpected Recurrence of a Pre-existing
Condition - Medical (for U.S. citizens only)
Up to age 65 with primary health plan - URC up to plan maximum.
Up to age 65 without primary health plan - $20,000 lifetime maximum.  Age 65+ with or without primary health plan -$2,500 lifetime maximum.
Sudden and Unexpected Recurrence of a Pre-existing
Condition - Emergency Medical Evacuation (for U.S. citizens only
Up to $25,000 of eligible costs and expenses
Sudden and Unexpected Recurrence of a Pre-existing
Condition - Medical (for non-U.S. citizens only)
Up to age 65.  $20,000 lifetime maximum for eligible medical expenses.  $20,000 lifetime
maximum for Emergency Medical Evacuation.
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 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), 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 Platinum 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 $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.
Small Pet Common Air Carrier Accidental Death Up to $500

A benefit of up to $500 will be paid in the event of loss of life to a small pet while traveling with a covered insured on a common air carrier. This covers the pet while on the insured’s originating flight from his/her home country, and returning flight to the insured’s home country only.  A small pet is a cat or dog up to 30 pounds in weight.
OPTIONAL RIDERS
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 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, 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 Platinum 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.
Personal Liability - Injury to third party $2,000 limit after $100 deductible

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 - Damage to third person
property
$500 limit after $100 deductible

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.
Evacuation Plus Rider
(available to insureds up to age 65)
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

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 three months regardless of the minimum number of days being traveled.

This brochure 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.  The Patriot Platinum Travel Medical Insurance 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.