BROCHURE, RATES and APPLICATION
 atriot Executive
Travel Medical Insurance
SM
Underwritten by SIRIUS International
Insurance Corporation
Rates and Application are at the bottom of this
page.
Click here for Instant Quotes & Online Purchase
Patriot Executive is designed for:
U.S. citizens who:
- are under the age of 76,
- are covered by an individual or group medical plan,
and
- travel outside of the United States frequently
throughout the year.
Non-US citizens who:
- are under the age of 76,
- are covered by an individual or group medical plan,
and
- travel outside your country of citizenship frequently
throughout the year.
Although the Patriot Executive plan is not
renewable, it can be rewritten for succeeding or subsequent coverage periods. New
Deductible, Eligibility, Conditions of Coverage and Pre-Existing Condition Exclusions
apply to any succeeding or subsequent Period of Coverage. A new application also must be
completed.
 Scheduled
of Benefits
INTERNATIONAL
EMERGENCY CARE |
| Emergency
Evacuation |
Up
to US$25,000 for pre-existing conditions; up to policy maximum for covered incidents for
insured persons under age 66; up to US$50,000 for covered incidents for insured persons
from ages 66 to 75 |
| The Patriot Executive® plan includes
coverage for emergency medical evacuation 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. The plan pays up to US$25,000 for evacuations resulting from a
pre-existing condition; up to the policy maximum for covered incidents for insured persons
under age 66; and up to US$50,000 for covered incidents for insured persons from ages 66
to 75. |
| Emergency
Reunion |
To
US$15,000 when coordinated through the Plan Administrator |
| The Patriot Executive® 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
of the insured person: 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 Executive plan
will reimburse 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). |
SPECIAL COVERAGES |
| 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, the
Patriot Executive plan will reimburse the insured up to US$5,000 for the cost of returning
the insured to the area of principal residence. The plan will cover reimbursement 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 luggage; maximum of US$250 |
| 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 |
| 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.* |
| MEDICAL
BENEFITS |
usual,
reasonable and customary charges, subject to deductible |
| 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: The 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: The plan will pay up to US$100 for the necessary
treatment of sudden, unexpected pain to sound natural teeth. |
| Pre-existing
Conditions |
To US$5,000 per
period of coverage |
| The plan
will cover up to US$5,000 maximum, per insured person, per period of coverage (not per
trip), for the sudden and unexpected recurrence of a pre-existing condition, as defined in
the certificate wording. |
| Sports &
Activities Coverage |
To Policy
Maximum for basic sports as described below |
| The Patriot
Executive 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. |
| Accidental
Death & Dismemberment |
US$25,000
principal sum |
The Patriot
Executive 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 life which occurred during a hijacking,
kidnapping or attempted kidnapping - two times the 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 panel 9 of the Patriot Executive brochure.* |
BASIC PLAN INFORMATION |
| Deductible |
US$250 per each
covered Illness; deductible waived for claims incurred as a result of a covered accident |
| Coinsurance |
None |
| Policy Maximum |
US$1,000,000;
US$50,000 for travelers who are 70-75 years old |
| 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. |
| * Notwithstanding separate benefits, limits
and sublimits for Common Carrier Accidental Death benefit and Accidental Death &
Dismemberment benefits (above), no more than US$50,000 dollars per individual will be paid
to a beneficiary in the event of any death that occurs while covered by the Patriot
Executive plan. |
| This web page contains only a
consolidated and summary description of all current Patriot Executive benefits,
conditions, limitations and exclusions, and is subject to all of the terms and conditions
of the full Policy Wording. A certificate containing the complete Policy Wording with all
terms, conditions and exclusions will be included with the fulfillment kit. The Company
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. |
Exclusions:
Charges for the following services, treatments and/or
conditions, among others, are excluded from coverage under the Patriot Executive plan.
- Treatment for pre-existing conditions in excess of
US$5000, per Insured Person, per Period of Coverage (not per trip). 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 prior thereto, including any
subsequent, chronic or recurring complications or consequences relating thereto or arising
there from, whether or not previously manifested or known, diagnosed, treated, or
disclosed.
- 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 provided for in the Certificate of Coverage.
- Venereal disease, AIDS virus, AIDS related illness,
ARC Syndrome, or AIDS, 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 hereunder.
- . 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.
- . Treatment for Illness or Injury where the trip is
undertaken for the purpose of obtaining such treatment or advice for a pre-existing
condition.
- .Treatment incurred as a result of or arising from
exposure to nuclear radiation, and/or radioactive material(s).
Pre-Certification
All proposed hospital admissions and surgeries, whether inpatient or outpatient, will be
subject to Precertification. You or your attending physician must call the number listed
on your Confirmation of Coverage prior to admittance to a hospital or performance of a
surgery. In the event of an Emergency Admission, the Precertification call must be made
within 48 hours after the admission, or as soon as reasonably possible. In the event an
admission or surgery is not pre-certified, eligible expenses will be reduced by 50%.
Benefit Period
The Benefit Period is the period of time specified in the Policy Limits. It begins once an
eligible incident occurs to the insured. While coverage is in effect under this policy,
the Benefit Period does not apply. When coverage under this policy terminates as defined,
Patriot Executive InsuranceSM will pay eligible expenses for covered Injuries
or Illnesses which commenced during the period of coverage for up to, but not exceeding
the Benefit Period, subject to the Policy Limits.
Premiums
Patriot Executive Travel
Medical Insurance
Through age 75*
|
Maximum Trip Duration** |
30 Days |
U.S. CITIZENS |
| Annual
Premium |
US$200 |
| Spouse
& 2 children |
US$100 |
| Each
additional child |
US$40 |
NON-U.S. CITIZENS |
| Annual
Premium |
US$236 |
| Spouse
& 2 children |
US$118 |
| Each
additional child |
US$47 |
* The plan pays a policy maximum of US$50,000 for travelers who are
70-75 years old. Otherwise, the policy maximum is US$1,000,000.
** The maximum duration of any one trip is 30 days. |
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If you have any questions or concerns, please contact us
today.
info@internationalriskmanagement.com
877-211-3654 or
559-294-0316
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visiting our website.
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