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Patriot Travel Medical Insurance Schedule Of Benefits
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Designed for the International Traveler
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Overview • Benefits • Exclusions • Free Quote
/ Apply Online
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Premiums:
Patriot International® • Patriot AmericaSM
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Patriot America® provides coverage for
non-US citizens traveling outside their country of citizenship for a minimum of
5 days up to a maximum of two years. If the plan is purchased for
a minimum of three months, coverage may be renewed (without break in coverage) for
a total of up to two years. If you or other family members applying for coverage are age
70 or older, please see the Eligibility section of the Patriot brochure for additional
information.
| ONE MONTH RATES (Four Policy Maximum Options) |
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Option 1
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Option 2
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Option 3 |
Option 4
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$50,000
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$100,000
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$500,000
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$1,000,000
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AGE |
One Month
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One Month
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One Month
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One Month
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18-29 |
$43 |
$50 |
$64 |
$76 |
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30-39
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$56 |
$67 |
$84 |
$97 |
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40-49
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$84 |
$96 |
$126 |
$142 |
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50-59
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$120 |
$147 |
$178 |
$206 |
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60-64
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$142 |
$174 |
$207 |
$248 |
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65-69
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$162 |
$208 |
$226 |
$270 |
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70-79
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$219 |
N/A |
N/A |
N/A |
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80+*
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$318 |
N/A |
N/A |
N/A |
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Dep. Child
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$26 |
$28 |
$36 |
$39 |
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Child Alone
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$39 |
$46 |
$59 |
$66 |
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*US $10,000 Limit
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| DAILY RATES (Minimum Coverage Is 5 Days) |
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Option 1
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Option 2
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Option 3
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Option 4
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$50,000
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$100,000
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$500,000
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$1,000,000
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AGE
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Daily
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Daily
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Daily
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Daily
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18-29
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$1.45
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$1.75
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$2.20
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$2.55
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30-39
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$1.90
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$2.25
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$2.85
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$3.25 |
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40-49
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$2.85 |
$3.25 |
$4.25 |
$4.80 |
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50-59
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$4.05 |
$4.95 |
$6.00 |
$6.90 |
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60-64
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$4.80 |
$5.85 |
$6.95 |
$8.35 |
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65-69
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$5.45 |
$7.00 |
$7.60 |
$9.05 |
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70-79
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$7.35 |
N/A |
N/A |
N/A |
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80+*
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$12.75 |
N/A |
N/A |
N/A |
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Dep. Child
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$0.90 |
$1.00
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$1.25 |
$1.35
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Child Alone
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$1.35 |
$1.60 |
$2.00 |
$2.25 |
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*US $10,000 Limit
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All premium rates are in US dollars and are effective through 12/31/2007. Rates include 2.5% surplus lines tax. A dependent child is your child shown on the Application Form over 14 days and under 18 years of age, traveling with you, and for whom premium has been paid.
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Refund of Premium
911Abroad will refund premium only if a written request is received prior to the
certificate's effective date. The premium is non-refundable after that date.
Precertification, Emergency Evacuation and Repatriation
For precertification, emergency evacuation and repatriation please call IMG in the
U.S. 1-800-628-4664 (toll free) or 1-317-655-4500. Call IMG outside the US: 001-317-655-4500
(collect if necessary). This information will also be provided on your ID card.
IMG must be notified prior to treatment or within 48 hours of an emergency.
To Report Claims
Please mail completed claim forms to International Medical Group, P O Box 88500, Indianapolis, IN 46208 USA. All IMG contact numbers, claim forms and Policy Wordings
will be included in the fulfillment kit. IMG may also be contacted by fax: 317-655-4505
or email: insurance@IMGlobal.com.
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This web page contains only a consolidated and summary description of all current
Patriot 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. IMG 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.
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