PATRIOT TRAVEL MEDICAL INSURANCEsm
Expatriot Plus
ExPatriot Plussm:
Coverage for those traveling outside their country of citizenship for a minimum of six
months up to a maximum of two years.
Renewal of Coverage:
ExPatriot Plussm may be renewed for up to
two years of total coverage by those traveling outside the US. For those traveling
primarily within the US, ExPatriot Plussm may be renewed for up to one year of
total coverage. A new Deductible and Coinsurance will apply for each 12 months of
coverage.
Policy Premiums
ExPatriot Plus Policy Monthly Premiums for non U.S.
Citizens traveling outside their country of citizenship.
EX-PATRIOT PLUS |
| |
500,000 MAX |
1,000,000 MAX |
500,000 MAX |
1,000,000 MAX |
| US
CITIZEN |
US
CITIZEN |
NON-US
CITIZEN |
NON-US
CITIZEN |
| option 7 |
option 8 |
option 9 |
option 10 |
AGE |
TOTAL/MONTH |
TOTAL/MONTH |
TOTAL/MONTH |
TOTAL/MONTH |
18-25 |
$40.00 |
$45.00 |
$60.00 |
$70.00 |
26-29 |
$45.00 |
$50.00 |
$70.00 |
$80.00 |
30-39 |
$65.00 |
$70.00 |
$75.00 |
$85.00 |
40-49 |
$70.00 |
$80.00 |
$120.00 |
$135.00 |
50-59 |
$120.00 |
$130.00 |
$200.00 |
$220.00 |
60-64 |
$135.00 |
$150.00 |
$230.00 |
$255.00 |
65-69 |
$160.00 |
$180.00 |
$235.00 |
$260.00 |
70-79* |
$350.00 |
N/A |
$485.00 |
N/A |
80 PLUS** |
$420.00 |
N/A |
$550.00 |
N/A |
DEP CHILD |
$25.00 |
$30.00 |
$30.00 |
$35.00 |
CHILD ALONE |
$55.00 |
$60.00 |
$60.00 |
$65.00 |
*50,000 limit |
|
|
|
|
**10,000 limit |
|
|
|
|
*For ages 70-79, policy maximum is $50,000.
A dependent child is your child shown on the Enrollment
Premiums effective through 12/31/99.
*See specific policy for age limit.
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 Travel Medical Insurance sm
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............................
IMG 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.
For Precertification, Emergency Evacuation
and Repatriation..............
Please call IMG
in the U.S. 1.800.628.4664
Outside the U.S. 01.317.655.4500
(collect if necessary).
IMG must be notified prior to treatment or
within 48 hours of an emergency.
To Report
Claims...............................
Please mail to IMG
International Medical Group, Inc.
407 North Fulton Street
Indianapolis, IN 46202 U.S.A.
Please include Identification Number in all correspondence.
This brochure is only a summary of coverage provided. Other
conditions and exclusions may apply. Please consult the policy itself for a full
description of the coverage. In support of Patriot Travel Medical Insurance sm,
IMG has established the Group Health, Accident and Travel Insurance Trust, in Washington
D.C. The trust owns a master group international travelers insurance policy. Individual
certificates of insurance are issued from the master policy. Rates include 2% surplus
lines tax.
Underwritten by: Sirius International
Insurance Corporation |