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
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 and are effective through
12/31/2003. 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
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 US 1-800-628-4664
Outside the US 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:
International Medical Group, Inc.
407 Fulton Street
Indianapolis, IN 46202 U.S.A.
Please include Identification Number in all correspondence.
This web site contains 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. In support of Patriot
Extreme, IMG has established the Global Medical Services Group Insurance Trust,
in Indiana. The trust owns a master group international travelers insurance
policy. Individual certificates of insurance are issued from the master policy.
Underwritten by: Sirius International Insurance Corporation
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