BROCHURE, RATES and APPLICATION
 atriot  r
oup
Travel Medical InsuranceSM
Underwritten by
SIRIUS International Insurance Corp.
Worldwide Medical Coverage for Groups of U.S.
Citizens and
non-US Citizens of 5 or More Traveling Outside Their Country of Citizenship
 Click here for Instant Quotes & Online Purchase
 Patriot Group Travel Medical Insurance is designed for
organizations who:
 have a group of 5 or
more that will be traveling together, and
are traveling to a
destination that is not the home country of any of the traveling
members.
| MEDICAL BENEFITS |
Usual, reasonable and
customary charges, subject to deductible and coinsurance |
| Hospital Room and
Board |
To Policy Maximum
for average semi-private room rate |
| Intensive Care |
To Policy Maximum |
| Medical Expenses |
To Policy Maximum |
| Outpatient Medical |
To Policy Maximum |
| Local Ambulance |
To Policy Maximum |
| Emergency Room |
As described
below |
Charges
incurred for the use of the Emergency Room due to an accident are covered up to the Policy
Maximum.
Charges incurred for the use of the Emergency Room for treatment of an illness are subject
to an additional (extra) US$250 deductible if treatment does not require admittance to the
hospital. |
| Dental |
As described below |
Injury
due to an accident: Each Patriot Group 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 Policy Maximum.
Sudden dental pain: Each plan will pay up to US$100 for the necessary
treatment of sudden, unexpected pain to sound natural teeth. |
INTERNATIONAL EMERGENCY CARE |
| Emergency Evacuation |
To Policy Maximum
when coordinated through the Plan Administrator |
| Each
Patriot Group 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 policy limit. |
| Emergency Reunion |
To US$15,000 when
coordinated through the Plan Administrator |
| Each
Patriot Group plan also provides 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 home country to be reunited with the insured. |
| Return of Mortal
Remains |
To US$25,000 when
coordinated through the Plan Administrator |
| 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 US$25,000. |
| Returning Minor
Children |
To US$5,000 when
coordinated through the Plan Administrator |
| 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 Group 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). |
PLAN INFORMATION |
| Deductible |
Your
choice of US$0, $100, $250, $500, $1,000 or $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 |
As
described below |
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 |
| 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 Policy Limits and
the other terms of the plan until there have been six months of continuous coverage for
the covered injury or illness. |
SPECIAL COVERAGES |
| Home Country
Coverage |
As described below |
Incidental
Home Country Coverage - 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.
End of Trip Home Country Coverage - 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 |
To US$5,000 |
| 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 Group 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. |
| Lost Luggage |
To US$50 per item of
personal property; maximum of US$250 per Period of Coverage |
| 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. |
| Common
Carrier Accidental Death |
US$50,000
to Beneficiary; maximum of US$250,000 per family of group |
| If accidental death should occur while traveling on a commercial Common
Carrier, US$50,000 will be paid to the designated beneficiary, to a maximum of US$250,000
per family of group. |
| Sports
& Activities Coverage |
To
Policy Maximum for basic sports as described below |
Each Patriot Group 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. 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 or Extreme Sports Riders: Please see the brochure for more
information. |
| Accidental Death
& Dismemberment |
US$25,000 principal
sum |
| Each
Patriot Group 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 on page 14 of the Patriot
Group brochure. |
Additional Benefits for U.S. Citizens |
| 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 on pages 11
of the Patriot Group brochure. |
| Indemnity |
| Patriot
International will pay directly to the insured person US$100 for each night of a required
overnight stay in a hospital. However, the hospital stay must be covered under this plan
in order to receive this benefit. |
Exclusions:
Charges for the following services,
treatments and/or conditions, among others, are excluded from coverage under the Patriot
Group plans.
- Pre-existing Conditions. A
pre-existing condition is
defined as 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 there
from.
- Treatment or surgeries which are elective,
investigational, experimental or for research purposes.
- War, military action, terrorism, political
insurrection, protest, or any act thereof.
- Immunizations and routine physical exams.
- Treatment of Temporomandibular Joint or dental
treatment, except as expressly provided for in the certificate of insurance.
- 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.
- Pregnancy, childbirth, birth control, artificial
insemination, treatment for infertility or impotency, sterilization or reversal thereof,
or abortion.
- Injury sustained while participating in 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, wind-surfing and whitewater rafting.
- Vision or ear tests and the provision of visual or
hearing aids.
- Vocational, recreational, speech or music therapy.
- Treatment while confined primarily to receive
custodial care, educational or rehabilitative care, or nursing services.
- 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.
- Treatment for, and injuries and/or illnesses
resulting or arising from, substance abuse or drug addiction.
- 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.
- Willful self-inflicted injury or illness.
- Treatment required as a result of or arising from
complications from a treatment or condition not covered under the certificate.
- Any services or supplies performed or provided by a
relative of the Insured or provided at no cost to Insured.
- Treatment for mental and nervous disorders.
- Organ or tissue transplants or related services.
- Illness or injury where the trip to the host country
is undertak en for treatment or advice for such Illness or injury, except as expressly
provided for in the certificate of insurance.
- Treatment incurred as a result of or arising from
exposure to nuclear radiation, and/or radioactive material(s).
This web page contains only a consolidated and
summary description of all current Patriot Group 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. We reserves the right to issue the most current Policy 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 Policy Wordings are available upon request.
Click here for Instant Quotes & Online Purchase
For custom quotes, please contact us
today.
info@internationalriskmanagement.com
877-211-3654 or
559-294-0316
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visiting our website.
www.InternationalRiskManagement.com
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