Patriot Exchange Program Insurance

• Eligible medical expenses help	In-Network: 90% up to policy maximum Out-Network: 80% up to policy maximum International: 100% up to policy maximum
  Hospital room and board help	Average semi-private room rate, including nursing services In-Network: 90% up to policy maximum Out-Network: 80% up to policy maximum International: 100% up to policy maximum
  Surgery help	In-Network: 90% up to policy maximum Out-Network: 80% up to policy maximum International: 100% up to policy maximum
  Intensive care unit help	In-Network: 90% up to policy maximum Out-Network: 80% up to policy maximum International: 100% up to policy maximum
  Bedside visit help	$1,500 maximum limit. Not subject to deductible In-Network: 90% up to policy maximum Out-Network: 80% up to policy maximum International: 100% up to policy maximum
  Student Health Center help	$5 co-pay per visit. Not subject to deductible.
  Dental Treatment help	Period of Coverage Limit: $350 (Treatment due to Unexpected pain to sound, natural teeth) Period of Coverage Limit per Injury: $500 (Non-emergency Treatment at a Dental Provider due to an Accident) In-Network: N/A Out-of-Network: 90% International: 100%
  Traumatic Dental Injury help	Subject to Deductible and Coinsurance Up to the Maximum Limit Treatment at a Hospital Facility due to an Accident Additional Treatment for the same Injury rendered by a Dental Provider will be paid at 100% In-Network: 90% Out-of-Network: 80% International: 100%
  Mental/Nervous help	Not covered if incurred in student health center; Inpatient: $10K maximum limit; Outpatient: $50 maximum limit per day. $500 maximum limit In-Network: 90% up to policy maximum Out-Network: 80% up to policy maximum International: 100% up to policy maximum

• Interfacility ambulance transfer help	Company pays 100%
  Natural disaster help	$250 per day and maximum limit of five days for accommodations. Not subject to deductible.
  Political evacuation and repatriation help	$100,000 maximum limit. Not subject to deductible
  Emergency medical evacuation help	Up to the maximum limit
  Return of mortal remains or cremation/burial help	Up to the maximum limit for return of mortal remains or ashes to country of residence, or $5k maximum limit for cremation or local burial at the place of death. Not subject to deductible
  Emergency local ambulance help	Up to the maximum limit.
  Return of minor children help	$100,000 maximum limit. Not subject to deductible
  Natural disaster evacuation help	$25,000 maximum limit. Not subject to deductible
  Emergency reunion help	$100,000 maximum limit. Not subject to deductible
  Remote transportation help	$5,000 per certificate period / $20,000 maximum limit
  Terrorism help	Up to $50,000 maximum limit. Not subject to deductible
  Political Evacuation & Repatriation help	Maximum Limit: $10,000 Must be approved in advance by the Company In-Network: 100% Out-of-Network: 100% International: 100%

• Pre-Certification	50% reduction of eligible medical expenses if pre-certification provisions are not met
  Physician visits help	In-Network: 90% up to policy maximum Out-Network: 80% up to policy maximum International: 100% up to policy maximum
  Teladoc Consultation help	Company pays 100% within the U.S.; mental and nervous disorders not covered (Group plans only)
  Urgent Care Clinic help	$50 copay. Copay is not applicable when the $0 deductible is selected. Not subject to deductible In-Network: 90% up to policy maximum Out-Network: 80% up to policy maximum International: 100% up to policy maximum
  Walk-In Clinic help	$20 copay. Copay is not applicable when the $0 deductible is selected. Not subject to deductible In-Network: 90% up to policy maximum Out-Network: 80% up to policy maximum International: 100% up to policy maximum
  Physical Therapy help	In-Network: 90% up to policy maximum Out-Network: 80% up to policy maximum International: 100% up to policy maximum
  Prescription Drugs and Medications help	Period of Coverage limit: $250K per person Obtained through Retail Pharmacy, Inpatient and Outpatient Surgery, Emergency Room and Outpatient Office Visits.Dispensing maximum for Retail Pharmacy: 90 days per prescription In-Network: Not Covered Out-Network: 80% up to policy maximum International: 100% up to policy maximum

• Mental/Nervous help	Inpatient Mental or Nervous / Substance Abuse Maximum Limit: $10,000 Not covered if incurred at the Student Health Center Not covered if incurred at the Student Health Center In-Network: 90% Out-of-Network: 80% International: 100%
  Outpatient Mental or Nervous / Substance Abuse Maximum Limit per day: $50 Maximum Limit: $500 Not covered if incurred at the Student Health Center In-Network: 90% Out-of-Network: 80% International: 100%

• Pre-Existing Condition help

  After 12 months of continous coverage $500 per period of coverage; $1,500 lifetime maximum. Charges resulting directly or indirectly from or relating to any Pre-existing Condition that existed within 36 months prior to the Effective Date are excluded until the Insured Person has maintained 12 months of continuous coverage under this insurance.

Patriot Exchange international student insurance can purchase an optional rider at the time of application. The optional riders provide additional coverage for a minimal charge.