Patriot Group Exchange Insurance

Plan Summary

Patriot Group Exchange plan is designed for groups of students studying abroad or participants of a group cultural exchange program. Traveling in a group to a destination that is not the home country of any of the traveling members.This plan may be purchased in monthly increments and can include coverage for the students or participants, their spouses and unmarried dependent children travelling with them. If the plan is purchased for a minimum for a minimum of three months, coverage may be renewed for a total of up to 2 years without break in coverage.

Plan Maximum:	Basic Plan: $10,000 per illness or injury with a lifetime maximum of $500,000 Standard Plan: $50,000, $250,000 or $500,000 per illness or injury with a lifetime maximum of $500,000 Long-Term Annual Plan: Maximum up to $1,000,000
Deductible	Basic and Standard Plan: $100 per illness or injury	Long-Term Annual Plan Inpatient: $100 Outpatient: $40
Eligibility	The group member must be actively engaged or participating in an educational or cultural exchange program in the ocuntry of assignment through a sponsoring organization or school. The group member and his/her travelling dependents must have legally departed the Home Country and entered the Host Country and must not be a citizen of the Host Country.
Pre-Existing Condition Coverage (U.S.citizens)	Medical: Up to $5,000 of eligible expenses	Emergency Medical Evacuation: Up to $25,000 of eligible costs and expenses
Coverage	- Hospital Room & board - Emergency Medical Evacuation - Emergency Reunion - Return of Mortal Remains	- AD&D - Terrorism Coverage - Intensive Care
Co-insurance	100%
Plan Life	3 months, can be extended up to 2 years with no breakage period.
Underwriter	Patriot Group Exchange^SM is underwritten by Sirius International Insurance Corporation (publ)
Buy - Online	Apply & purchase online Patriot Group Exchange^SM Insurance
Brochure	Complete, mail/fax the Patriot Group Exchange^SM Insurance Brochure along with payment.

Patriot Group Exchange^SM Insurance Benefits

Patriot Group Exchange^SM provides coverage is for groups of students studying abroad or participants of a group cultural exchange program.
There are 3 plans which he can choose from. They are

Basic Plan
Standard Plan
Long-term Annual plan

Schedule of Benefits

All coverages and plan costs listed here are in U.S. dollar amounts

Coverages	Basic Plan	Standard Plan	Long-term Annual Plan
Hospital Room & Board:	Up to semi-private room rate	Up to semi-private room rate	Up to semi-private room rate
Hospital Intensive Care:	URC*	URC*	URC*
Student Health Center:	$5 co-pay per visit	$5 co-pay per visit	$5 co-pay per visit
Emergency Illness: With hospitalization Without hospitalization	URC* Additional $250 deductible	URC* Additional $250 deductible	URC* Additional $250 deductible
Emergency Medical Evacuation:	$25,000 lifetime maximum	$50,000	Maximum Limit
Repatriation:	$7,500	$25,000	$25,000
Dental: Injury due to accident Sudden & unexpected pain		$500 $350	$500 $350
Accidental Death:	$5,000	$25,000	$25,000 (hazardous sports excluded)
Emergency Reunion:	$5,000 lifetime maximum	$15,000	$15,000
Terrorism Coverage:	$50,000 lifetime maximum	$50,000 lifetime maximum	$50,000 lifetime maximum
Optional Add-on Plan
Legal Assistance: Binder Fee Attorney Fees		$500 when served with summons	$500 when served with summons Up to $20,000
Personal liability: Injury to third party Damage to third person property		$2,000 limit after $100 deductible $500 limit after $100 deductible. Secondary to any other insurance in force	$5,000 medical payment sub-limit after $100 deductible; Up to $250,000 maximum with judgment $1,000 sub-limit after $100 deductible; Up to $100,000 maximum with judgment
Optional Riders
Sports Rider:			Up to Policy Maximum
Chaperone / Faculty Leader Replacement Rider:			Up to $3,000 for a round trip economy airline ticket for a replacement Chaperone/ Faculty Leader

*Usual, Reasonable and Customary Charges

Eligibility Requirements

The following conditions apply to all persons applying for and/or enrolling in Patriot Group Exchange^SM Program Plan:

The group member must be actively engaged or participating in an educational or cultural exchange program in the ocuntry of assignment through a sponsoring organization or school.
The group member and his/her travelling dependents must have legally departed the Home Country and entered the Host Country and must not be a citizen of the Host Country.

Exclusions

Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under the Patriot Group Exchange Program^SM.:

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.
Treatment or surgeries which are elective, investigational, experimental or for research purposes.
War, military action, terrorism, political insurrection, protest, or any act thereof. The Company will not pay for a Political Evacuation if there is a travel advisory in effect on or within six (6) months prior to the Insured Person's date of arrival in the Host Country.
Immunizations and routine physical exams.
Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.
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 ear 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 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.
Willful self-inflicted injury or illness.
Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.
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 expressly provided for in the certificate of insurance.
Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).
Charges for Treatment of a Chronic Illness incurred beyond sixty (60) days from the date of initial Treatment thereof.