International travel medical and health insurance

Patriot America provides coverage for non-US citizens traveling outside their country of citizenship for a minimum of 10 days up to a maximum of one year. Although the Patriot 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. If you or other family members applying for coverage are age 65 or older, please see the Eligibility section on page 16 of the Patriot Travel Medical Insurance brochure.

If you are a non-US citizen traveling for three (3) months or more and under age 80, please review the ExPatriot Plus® plan, as described on page 10 of the Patriot Travel Medical Insurance brochure, which offers a 10% discount on rates and is renewable for up to two years. Details on optional riders can be found on page 11 of the Patriot Travel Medical Insurance brochure, and more information on calculating your rates can be found on page 17.

All premium rates are in US dollars and are effective through 12/31/05. 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. Rates shown represent US$250 annual deductible. To determine other deductibles, multiple premiums below by the following deductible factors: $100 deductible = 1.10; $250 = 1.00; $500 = .90; $1000 = .80; $2500 = .70


AGE	Monthly Rates
18-29	$48.00	$56.00	$72.00	$84.00
30-39	$62.00	$74.00	$94.00	$108.00
40-49	$94.00	$106.00	$140.00	$158.00
50-59	$134.00	$164.00	$198.00	$228.00
60-64	$158.00	$194.00	$230.00	$276.00
65-69	$180.00	$232.00	$252.00	$300.00
70-79	$244.00	N/A	N/A	N/A
80+*	$424.00	N/A	N/A	N/A
DEP. CHILD	$28.00	$32.00	$40.00	$44.00
CHILD ALONE	$44.00	$52.00	$66.00	$74.00

	Daily Rates (Minimum length of coverage is 5 days)
18-29	$1.60	$1.90	$2.40	$2.80
30-39	$2.10	$2.50	$3.15	$3.60
40-49	$3.15	$3.55	$4.70	$5.30
50-59	$4.50	$5.50	$6.60	$7.60
60-64	$5.30	$6.50	$7.70	$9.20
65-69	$6.00	$7.75	$8.40	$10.00
70-79	$8.15	N/A	N/A	N/A
80+*	$14.15	N/A	N/A	N/A
DEP. CHILD	$0.95	$1.10	$1.35	$1.50
CHILD ALONE	$1.50	$1.75	$2.20	$2.50

* US$10,000 Maximum

Quality Guarantee

Your satisfaction is very important to IMG. If, for any reason, you are not pleased with this product you may submit a written request for cancellation and refund of your premium. The request must be received by IMG prior to your effective date of coverage.

Precertification, Emergency Evacuation and Repatriation

For precertification, emergency evacuation and repatriation, please call: IMG in the US: 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 46208-0500 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 e-mail: insurance@imglobal.com.

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.