BROCHURE, RATES and APPLICATION
 atriot  xtremeSM
Hazardous Sport Insurance
Underwritten by SIRIUS International
Insurance Corporation
Rates and Application are at the bottom of this
page.
Click here for Instant Quotes & Online Purchase
Patriot Extreme Sport
Insurance is designed for the international traveler who engages in the extreme
sports listed below:
Abseiling |
BMX |
Bungee jumping |
Canyoning |
Caving |
Flying (private plan) |
| Hang gliding |
Heli-skiing |
| Hot air
ballooning |
High diving |
| Kayaking |
Inline skating |
| Mountain
biking |
Mountaineering (ropes and guides to 4500m from ground level) |
| Paragliding |
Parascending |
| Scuba diving
(to 50m) |
Rappelling |
| Skydiving |
Rock climbing (ropes and guides to 4500m from ground level) |
| Spelunking |
Whitewater rafting (to Class V) |
The listed sport activities must be engaged in
solely for leisure, recreation or entertainment purposes only.
Patriot Extreme International
SM
Patriot Extreme International provides coverage for U.S. citizens traveling
abroad for a minimum
of 30 days up to a maximum of three months. Although the Patriot Extreme International
plan is not renewable, it can be rewritten for succeeding or subsequent coverage periods.
New Deductible, Coinsurance, 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.
In addition to the benefits listed on the "Benefits" page, Patriot Extreme
International for U.S. citizens also provides three benefits outlined below, subject to
all Conditions of Coverage.
Sudden Recurrence of a Pre-Existing
Condition - Up to US$1,000 will be reimbursed for the eligible expenses of a
sudden and unexpected recurrence of a Pre-existing Condition while traveling outside of
the United States. In addition, up to US$25,000 will be reimbursed 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 page 8 of the Patriot Extreme brochure.
Dental Emergency - Patriot Extreme International will reimburse up
to US$100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.
Indemnity - Patriot Extreme International will pay directly to you
US$100 for each night of a required overnight stay in a hospital. The hospital stay must
be covered under this plan in order to receive this benefit.
Patriot Extreme AmericaSM
Patriot Extreme America provides coverage for non-U.S. citizens traveling
outside their country of citizenship for a minimum of 30 days up to a maximum of three
months. Although the Patriot Extreme America plan is not renewable, it can be rewritten
for succeeding or subsequent coverage periods. New Deductible, Coinsurance, 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.
SCHEDULE OF BENEFITS
& LIMITS
|
| INTERNATIONAL EMERGENCY CARE |
| Emergency
Evacuation |
To Policy Maximum when coordinated through the Plan
Administrator |
| Patriot Extreme includes coverage for Emergency Medical
Evacuations from a medical facility to the nearest qualified medical facility; expenses
for reasonable travel and accommodations resulting from the evacuation; and the cost of
returning to either the country of residence or the country where the evacuation occurred
up to the policy limit. |
| Emergency Reunion
|
To US$10,000 when coordinated through the Plan Administrator |
| Patriot Extreme also provides emergency reunion coverage, up
to US$10,000 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 country
of residence to be reunited with the insured. |
| Repatriation |
To US$15,000 when coordinated through the Plan Administrator |
| If a covered illness/injury results in death, expenses for
Repatriation of bodily remains or ashes to the country of residence will be covered up to
a maximum of US$15,000. |
| 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 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; 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 beneficiary to a maximum of
US$250,000 per family |
| 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 |
| Dental |
To Policy Maximum |
| Patriot Extreme covers the cost of emergency dental treatment
and dental procedures necessary to restore sound natural teeth lost or damaged in an
accident |
| Sports & Activities |
To Policy Maximum for basic and extreme sports as
described below |
Subject to the terms of the complete policy wording, Patriot
Extreme covers injuries incurred during non-contact amateur athletic activities and
certain Extreme Sports (see page 7 of the Patriot Extreme brochure). Activities may be
organized and include scheduled practices, games, and/or competitions.
Activities not covered include contact sports, professional sports and any athletic
activities that are organized and/or sanctioned by the National Collegiate Athletic
Association (or any other collegiate sanctioning body) or the International Olympic
Committee. |
| PLAN INFORMATION |
| Deductible |
US$250 per Period of Coverage |
| Coinsurance |
As described below |
The plan pays 80% of eligible
expenses up to US$5,000
then 100% up to the Policy Maximum. |
| Benefit Period |
Three months |
If a covered injury or illness has continuing treatment after
the certificate expires, the 3-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 three months before the certificate expired, benefits for the
covered injury or illness will continue subject to the Policy Limits until there has been
three months of coverage for the covered injury or illness. |
| Policy Maximum |
US$50,000 |
| The Patriot Extreme plan has a Policy Maximum of US$50,000. |
| The above outline is only a consolidated and summary
description of all current Patriot Extreme 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. |
 Exclusions:
Charges for the following services,
treatments and/or conditions are excluded from coverage under Patriot Extreme.
- 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 existed at the time of application or at any
time during the three years prior to the effective date of the insurance, including any
subsequent, chronic or recurring complications or consequences related 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 herein.
- 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 professional
sports or any athletic activity that is sponsored or sanctioned by the National Collegiate
Athletic Association (or any collegiate governing body) or the International Olympic
Committee.
- Injury sustained while participating in contact
sports of any kind as well as the following: mountaineering or climbing above 4500 meters
and without the proper use of ropes and guides; scuba diving below 50 meters; whitewater
rafting above Class V; BASE jumping; luge; motocross or Moto-X; racing by horse, motor
vehicle of any type, or motorcycle; rodeo; ski jumping; and any Extreme Sport not listed
as covered in the Patriot Extreme brochure.
- 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 or
sustained while under the influence of or disablement of drugs or alcohol.
- Willfull self-inflicted injury or illness, and injury
due to reckless endangerment or needless peril.
- 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.
- Illness or injury where the trip to the host country
is undertaken for treatment or advice for such Illness or injury, except as provided for
herein.
- Treatment incurred as a result of or arising from
exposure to nuclear radiation, and/or radioactive material(s).
This information is only a
consolidated and summary description of all current Patriot Extreme 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.
Patriot Extreme International
provides coverage for US citizens
traveling abroad for a minimum of 30 days up to
a maximum of three months. Although the Patriot Extreme International plan is not
renewable, it can be rewritten for succeeding or subsequent coverage periods. New
Deductible, Coinsurance, 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.
ONE MONTH RATES for US
citizens
US$50,000 POLICY MAXIMUM
|
| Age |
One Month |
| 17 or younger |
$54 |
| 18-39 |
$64 |
| 40-49 |
$100 |
EACH ADDITIONAL 15 DAYS
US$50,000 POLICY MAXIMUM |
| Age |
15 Days |
| 17
or younger |
$27 |
| 18-39 |
$32 |
| 40-49 |
$50 |
All premium rates are in US dollars. Rates include 2.5%
surplus lines tax. A dependent child is your child shown on the Enrollment Form over 14
days and under 18 years of age, traveling with you, and for whom premium has been paid.
Patriot Extreme America
provides coverage for non-US citizens
traveling outside their country of
citizenship for a minimum of 30 days up to a maximum of three months. Although the Patriot
Extreme America plan is not renewable, it can be rewritten for succeeding or subsequent
coverage periods. New Deductible, Coinsurance, 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.
ONE MONTH RATES for non-US citizens
US$50,000 POLICY MAXIMUM |
| Age |
One
Month |
| 17 or
younger |
$72 |
| 18-39 |
$94 |
| 40-49 |
$142 |
EACH ADDITIONAL
15 DAYS
US$50,000 POLICY MAXIMUM |
| Age |
15 Days |
| 17 or younger |
$36 |
| 18-39 |
$47 |
| 40-49 |
$71 |
All premium rates are in US dollars. Rates include 2.5%
surplus lines tax. A dependent child is your child shown on the Enrollment Form over 14
days and under 18 years of age, traveling with you, and for whom premium has been paid.
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 Extreme 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.
Refund of Premium
The Plan Administrator will refund premium only if a written request is received prior to
the policy's effective date. The premium is non-refundable after that date.
Click here for Instant Quotes & Online Purchase
If you have any questions or concerns, please contact us
today.
info@internationalriskmanagement.com
877-211-3654 or
559-294-0316
Thank you for
visiting our website.
www.InternationalRiskManagement.com
|
Experience
