Patriot Executive Insurance

Plan Summary

Patriot Executive Insurance has 2 plan options available: Patriot Executive^® International and Patriot Executive^® America.

Policy Maximum	Patriot Executive plan offers a maximum coverage of US$1,000,000. For travelers 70-75, the maximum coverage is US$50,000.
Deductible	US$250 per each covered Illness; deductible waived for claims incurred as a result of a covered accident.
Eligibility	- US citizens and Non-US citizens who are under the age of 76.
Pre-Existing Condition Definition	- A pre-existing condition is defined as any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that, with reasonable medical certainty, existed at the time of application or at any time prior thereto, including any subsequent, chronic or recurring complications or consequences relating thereto or arising therefrom, whether or not previously manifested or known, diagnosed, treated, or disclosed.
Pre-Existing Condition 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.
Coverage	- Hospital Room and Board - Local Ambulance - Emergency Room Accident	- Outpatient Medical - Intensive Care - Sudden dental pain
Benefit Period	Six Months
Underwriter	Underwritten by Sirius International Insurance Corporation (publ), Sirius International is a White Mountains Insurance Re company.
Buy - Online	Apply & purchase online Patriot Executive Insurance
Brochure	Complete, mail/fax the Patriot Executive Insurance Brochure along with payment

Patriot Executive^® Insurance benefits

Eligibility

For US citizens and Non-US citizens who:

are under the age of 76
are covered by an individual or group medical plan
and travel outside of the United States frequently throughout the year.

Benefit Period

The Benefit Period is 6 months.

Schedule of Benefits

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.

Deductible	US$250 per Period of Coverage
Benefit Period	6 Months
Policy Maximum	US$1,000,000

Trip Interruption	US$5,000
Lost Luggage	US$50 per item of luggage; maximum of US$250
Common Carrier Accidental Death	US$50,000 to Beneficiary; maximum of US$250,000 per family

All premium rates are in US dollars and are effective through 12/31/2008. 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.

Emergency Evacuation

Patriot Executive® plan includes coverage for emergency medical evacuation to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country 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; up to the policy maximum for covered incidents for insured persons under age 66; and up to US$50,000 for covered incidents for insured persons from ages 66 to 75.

Emergency Reunion

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 home country to be reunited with the insured.

Return of Mortal Remains

If a covered illness/injury results in death, expenses for repatriation of bodily remains or ashes to the home country will be covered up to a maximum of US$25,000.

Returning Minor Children

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).

Patriot Executive^® Insurance - Exclusions

No benefits will be paid for loss or expense caused by, contributed to, or resulting from:

PTreatment for pre-existing conditions in excess of US$5000, per Insured Person, per Period of Coverage (not per trip). A pre-existing condition is defined as any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that, with reasonable medical certainty, existed at the time of application or at any time prior thereto, including any subsequent, chronic or recurring complications or consequences relating thereto or arising therefrom, whether or not previously manifested or known, diagnosed, treated, or disclosed.
Treatment or surgeries which are elective, investigational, experimental or for research purposes.
War, military action, terrorism, political insurrection, protest, or any act thereof.
Immunizations and routine physical exams.
Treatment of Temporomandibular Joint or dental treatment, except as provided for herein.
Venereal disease, AIDS virus, AIDS related illness, ARC Syndrome, or AIDS, and the cost of testing for these conditions, and charges for treatment or surgeries which are incurred by any Insured who was HIV+ at time of enrollment into this insurance.
Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
Injury sustained while participating in 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 excluded: racing of any kind, aviation (except when traveling as a passenger in a commercial aircraft), BMX, BASE jumping, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, luge, motocross (moto-x), mountain biking, mountaineering, parachuting, rappelling, rock climbing, rodeo, scuba diving, ski jumping, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, wind-surfing and whitewater rafting.
Vision or hearing tests and the provision of visual or hearing aids.
Vocational, recreational, speech or music therapy.
Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
Charges, injuries and/or illnesses resulting or arising from or occurring during the commission or continuing perpetration of a violation of law by the insured, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
Injury and/or illness resulting or arising from or sustained while under the influence of or disablement of drugs or alcohol.
willful self-inflicted injury or illness, and injury due to reckless endangerment or needless peril.
Treatment required as a result of or arising from complications from a treatment or condition not covered hereunder.
Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
Treatment for mental and nervous disorders.
Organ or tissue transplants or related services.
Illness or injury where the trip to the host country is undertaken for treatment or advice for such Illness or injury, except as provided for herein.
Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).

Refund of Policy (Quality Guarantee)

Your satisfaction is very important to the plan underwriter, and to IMG as the plan administrator. If, for any reason, you are not pleased with this product, you may submit a written request for cancellation and refund of your premium. In order to be considered for a full refund, your request for cancellation must be received by IMG prior to your effective date. If you do not have any claims filed with IMG, you may cancel your plan after your effective date, however, the following conditions will apply: 1) you will be required to pay a US$25 cancellation fee and 2) only full month premiums will be considered for refunds (e.g., if you choose to cancel your coverage two months and two weeks prior to the date your coverage ends, IMG will only consider the two full months for a refund). If you have filed claims, your premium is non-refundable.

Precertification, Emergency Evacuation and Repatriation

For precertification, emergency evacuation and repatriation please call IMG in the U.S. 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 Certificate Wordings will be included in the fulfillment kit. IMG may also be contacted by fax: 317-655-4505 or e-mail: insurance@imglobal.com.