SCHEDULE OF BENEFITS
INTERNATIONAL EMERGENCY CARE
Emergency Evacuation	To US$25,000 for pre-existing conditions, to US$50,000 for covered incidents when coordinated through the Plan Administrator
The Patriot® Executive plan includes coverage for emergency medical evacuation to the nearest qualified medical facility or the country of citizenship; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the country of citizenship 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 and up to US$50,000 for evacuations resulting from other covered incidents.
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 country of residence to be reunited with the insured.
Repatriation	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 country of citizenship 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), when coordinated through the Plan Administrator.
SPECIAL COVERAGES
Trip Cancellation	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 certain amateur athletic activities which are non-contact and engaged in by an 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 likewise excluded: Scuba diving, mountain climbing (up to 4500 meters or where ropes or guides are normally used), jet, snow and water skiing and snowboarding, sky diving, amateur racing, piloting an aircraft, bungee jumping and spelunking.
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.