Patriot Extreme International SM provides coverage
for US citizens traveling abroad for a minimum of 30 days up to a maximum
of six 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.
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ONE MONTH Rates US $50,000 Policy Maximum
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AGE |
One Month
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17 or younger
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$54 |
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18-39
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$64 |
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40-49
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$100 |
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Each Additional 15 Days US $50,000 Policy Maximum |
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AGE |
One Month
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17 or younger
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$27 |
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18-39
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$32 |
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40-49
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$50 |
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.
Refund of Premium
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
IMG 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
Please call IMG:
In the US 1-800-628-4664
Outside the US 01-317-655-4500
(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 to:
International Medical Group, Inc.
P.O. Box 88500
Indianapolis, IN 46208 U.S.A.
Please include Identification Number in all correspondence.
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