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Patriot International Group Premiums
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New Rates Good Through March 31, 2006

Patriot InternationalSM provides coverage for US citizens traveling abroad for a minimum of 15 days up to a maximum of one year. Although the Patriot 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.

All premium rates are in US dollars and are effective through 12/31/2003. Rates include a 2.5% surplus lines tax. A dependent child is a child shown on the Enrollment Form over 14 days and under 18 years of age, travelling with the group as a dependent of a group member, and for whom premium has been paid.


ONE MONTH RATES
 
  Option 5 Option 6 Option 7 Option 8 Option 9
  $50,000
MAX
$100,000
MAX
$500,000
MAX
$1,000,000
MAX
$2,000,000
MAX
 
AGE One Month One Month One Month One Month One Month
18-29 $32.00 $37.00 $43.00 $48.00 $54.00
30-39 $37.00 $43.00 $57.00 $63.00 $72.00
40-49 $59.00 $66.00 $73.00 $81.00 $99.00
50-59 $95.00 $109.00 $122.00 $136.00 $153.00
60-64 $109.00 $129.00 $153.00 $180.00 $201.00
65-69 $129.00 $138.00 $158.00 $189.00 $243.00
70-79 $189.00 N/A N/A N/A N/A
80+* $378.00 N/A N/A N/A N/A
DEP CHILD $18.00 $23.00 $27.00 $28.00 $34.00
CHILD ALONE $32.00 $36.00 $41.00 $45.00 $52.00
 
* US$10,000 Maximum
 

DAILY RATE*
 
  Option 5 Option 6 Option 7 Option 8 Option 9
  $50,000
MAX
$100,000
MAX
$500,000
MAX
$1,000,000
MAX
$2,000,000
MAX
AGE Daily Rate* Daily Rate* Daily Rate* Daily Rate* Daily Rate*
18-29 $1.10 $1.20 $1.40 $1.60 $1.80
30-39 $1.20 $1.40 $1.90 $2.10 $2.40
40-49 $1.95 $2.20 $2.40 $2.70 $3.30
50-59 $3.15 $3.60 $4.10 $4.55 $5.10
60-64 $3.60 $4.30 $5.10 $6.00 $6.70
65-69 $4.30 $4.60 $5.30 $6.30 $8.10
70-79 $6.30 N/A N/A N/A N/A
80+** $12.60 N/A N/A N/A N/A
DEP. CHILD $.60 $.75 $.90 $.95 $1.15
CHILD ALONE $1.10 $1.20 $1.35 $1.50 $1.75
 
* Daily rate available if 15 day minimum is satisfied. All members must have same deductible.

** US$10,000 Maximum
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