Patriot GoTravel^SM Insurance

Plan Summary

Patriot GoTravel^SM Insurance for US citizen and Non-US citizen traveling abroad.

Policy Maximum	Maximum medical coverage is $50,000, $100,000, $500,000, $1,000,000 per each injury or sickness for age under 69. US$2,000,000(life of the policy) option is not for each injury. For ages 70 - 79 only $50,000 of coverage is available.
Deductible	US$0, $100, $250, $500, $1,000 or $2,500 per period of coverage.
Co-insurance	For treatment received within the US & Canada: In the PPO Network: Plan pays 90% of eligible expenses up to US$5,000 then 100% up to the Policy Maximum. Out of the PPO Network: Plan pays 80% of eligible expenses up to US$5,000 then 100% up to the Policy Maximum.	For treatment received Outside the US & Canada: No Coinsurance.
Coverage	- Home Country Coverage * Incidental Home Country Coverage * End of Trip Home Country Coverage - Accidental Death & Dismemberment - Common Carrier Accidental Death	- Sports & Activities Coverage - Terrorism Coverage - Identity Theft Assistance - Trip Interruption
Plan Life	10 days to 2 years
Underwriter	Underwritten by Sirius International Insurance Corporation (publ), Sirius International is a White Mountains Insurance Re company.
Buy - Online	Apply & purchase online Patriot GoTravel^SM Insurance
Brochure	Complete, mail/fax the Patriot GoTravel^SM Insurance Brochure along with payment

Patriot GoTravel^SM Insurance Benefits:

Home Country Coverage :

Incidental Home Country Coverage During the Period of Coverage an insured person may return to their home country for incidental visits up to a cumulative two weeks total, subject to: a. The insured person must have left their home country, b. The total Period of Coverage must be for a minimum of 30 days, and c. The return to the home country may not be taken to receive treatment for an illness or injury incurred while traveling.

End of Trip Home Country Coverage For every five months of continuous coverage you purchase, you can purchase one additional month of home country coverage as an accommodation and supplemental travel benefit, up to a maximum of two months. To purchase this special home country extension coverage, please check the appropriate box on the Application Form, and calculate your premium to include the additional month(s).

Trip Interruption : Up 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, each Patriot GoTravelSM plan will pay to return the insured to the area of principal residence. The plan will pay 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.

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, up to a maximum of US$250,000 per family.

Accidental Death & Dismemberment : US$25,000 principal sum :

It 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 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 in the Patriot GoTravelSM brochure.

Additional Benefits for U.S. Citizens :

Sudden Recurrence of a Pre-existing Condition :

Up to US$15,000 will be paid for the eligible expenses of a sudden and unexpected recurrence of a Pre-existing Condition while traveling outside of the US. For the definition of a Pre-existing Condition, please see Exclusion number 1 in the Patriot GoTravelSM brochure.

Indemnity :

Patriot GoTravel will pay directly to the insured person US$100 for each night of a required overnight stay in a hospital. However, the hospital stay must be covered under this plan in order to receive this benefit.

Exclusions:

Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under the Patriot plans.

1. Pre-existing Conditions. 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 during the three years prior to the effective date of the insurance, whether or not previously manifested or symptomatic, diagnosed, treated, or disclosed prior to the effective date, including any subsequent, chronic or recurring complications or consequences related thereto or arising therefrom.
2. Treatment or surgeries which are elective, investigational, experimental or for research purposes.
3. War, military action, terrorism, political insurrection, protest, or any act thereof.
4. Immunizations and routine physical exams.
5. Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.
6. 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.
7. Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
8. 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, windsurfing and whitewater rafting.
9. Vision or ear tests and the provision of visual or hearing aids.
10. Vocational, recreational, speech or music therapy.
11. Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
12. 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.
13. Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
14. Injury and/or illness resulting or arising from being under the influence of alcohol or drugs; and injury or illness resulting from operating any type of vehicle after consuming any alcohol or drugs.
15. Willful self-inflicted injury or illness.
16. Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.
17. Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
18. Treatment for mental and nervous disorders.
19. Organ or tissue transplants or related services.
20. Illness or injury where the trip to the host country is undertaken for treatment or advice for such Illness or injury, except as expressly provided for in the certificate of insurance.
21. Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).

This is only a summary description of Patriot GoTravel^SM 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.

Patriot GoTravelSM Insurance

Plan Summary