MULTI-TRIP FOR

EMPLOYEES

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MULTI-TRIP FOR EMPLOYEES

Gateway Patriot Multi-Trip ℠

Many travelers are required to travel worldwide throughout the year. While concentrating on their business projects, they may forget the various risks that can be encountered while traveling abroad. The prudent executive will not wait for an accident or sickness to occur before seeking medical coverage for international travel.

COVERAGE OVERVIEW

Anticipating the needs of busy executives is one of the top priorities of Gateway Patriot Multi-Trip Insurance. Our plan offers a complete set of medical benefits to those working or living abroad. With Gateway multi-trip insurance plan you get a 24-hour access to:
• International, multilingual customer service centers and claims administrators specializing in worldwide claims
• Qualified coordinators of emergency medical treatment and international health services
• International Provider Access ℠ (IPA) to more than 17,000 providers outside of the U.S.

Getting multi-trip travel insurance for personal or business travel is a must if you are going abroad. The convenience of getting a single annual plan that will provide medical coverage for multiple trips makes Gateway Patriot Multi-Trip ℠ the top choice of frequent travelers. For additional information about the Gateway Patriot Multi-Trip ℠ plan, visit the Highlights tab.

PLAN INFORMATION

Your reasons to travel abroad may be many and varied which is why our services are designed to provide you with the security you need no matter where you are. Our goal is to make the medical process smooth and efficient by providing global products and services to those working or living abroad for short or extended periods.

Maximum Limit  | $1,000,000
Maximum Limit for travelers who are 70-75 years old | $50,000
Deductible | $250 per each covered Illness; deductible waived for claims incurred as a result of a covered accident

Coinsurance
For treatment received outside the U.S. & Canada | No Coinsurance
For treatment received within the U.S. & Canada:
In the PPO Network | The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Maximum Limit
Outside the PPO Network | The plan pays 80% of eligible expenses up to $5,000, then 100% up to the Maximum Limit

MEDICAL BENEFITS

USUAL, REASONABLE, AND CUSTOMARY CHARGES
Hospital Room and Board
| Up to the Maximum Limit for average semi-private room rate
Intensive Care | Up to the Maximum Limit Medical Expenses | Up to the Maximum Limit
Out-patient Medical Expenses | Up to the Maximum Limit
Local Ambulance | Up to the Maximum Limit

Emergency Room Accident | Up to the Maximum Limit
Charges incurred for the use of the Emergency Room due to an accident are covered up to the Maximum Limit.
Emergency Room Illness with In-patient Admission | Up to the Maximum Limit
Emergency Room Illness without In-patient Admission | Up to the Maximum Limit with additional $250 deductible
Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional (extra) $250 deductible if treatment does not require admittance to the hospital.

DENTAL
Injury due to an accident
| The plan covers the cost of emergency dental treatment and dental procedures necessary to restore sound natural teeth lost or damaged in an accident up to the Maximum Limit.
Sudden dental pain | The plan will pay up to $100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.

PRE-EXISTING CONDITIONS
The plan will cover up to $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.

HOSPITAL DAILY INDEMNITY
(U.S. citizens only) Patriot Multi-Trip International pays $100 directly to the insured person for each night of a required overnight stay in a hospital up to a maximum of 10 days. The hospital stay must be covered under this plan in order to receive this benefit.

BENEFIT PERIOD
If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the thirty day Benefit Period may offer continued coverage for that injury or illness. When the Certificate expires, the Company will review the date of initial treatment for the covered injury or illness. If treatment began less than thirty days before the Period of Coverage expired, benefits for the covered injury or illness continues. This is subject to the $5,000 Maximum Limit, proof of current medical insurance and the other terms of the plan, until there have been thirty days of continuous coverage for the covered injury or illness.

INTERNATIONAL EMERGENCY CARE

Emergency Evacuation | Up to the Maximum Limit The Patriot Multi-Trip 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. The plan will pay up to the Maximum Limit for covered incidents for insured persons under age 66; up to $50,000 for covered incidents for insured persons from ages 66 to 75; and up to $25,000 for evacuations resulting from a pre-existing condition.

Emergency Reunion | Up to $50,000
The Patriot Multi-Trip plan also provides emergency reunion coverage, up to $50,000 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 | Up to $50,000
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 $50,000.

Return of Minor Children | Up to $50,000
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 Multi-Trip plan will reimburse up to $50,000 for one way economy fare to their home country, including a chaperone, if necessary, for the safety of the child(ren).

Political Evacuation | Up to $10,000
If the United States Department of State, Bureau of Consular Affairs issues a travel advisory that becomes effective on or after the Insured Person’s date of arrival in the Host Country, the Company will pay up to $10,000 for transportation to the nearest place of safety or for repatriation to the Insured Person’s home country or country of residence provided that:
• The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular affairs issues the travel advisory
• Political Evacuation and Repatriation is approved and coordinated by the Company.

To be eligible for the Evacuation, Reunion and Return benefits, these must be recommended by the attending physician in critical medical situations, and approved in advance and coordinated by IMG.

TERRORISM COVERAGE

$50,000 lifetime maximum
The Patriot Multi-Trip plan provides coverage for injuries and illness incurred as a result of an act of Terrorism, subject to one $50,000 lifetime maximum. If an insured person is injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims subject to a $50,000 lifetime maximum.

Claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered.

Terrorism is the systematic or planned use of violence, fear, or threat of violence in order to intimidate a population or government, especially as a means of coercion or to obtain a granting of any demand.

This benefit does not cover an act of Terrorism in a country or location where the United States government has issued a travel advisory that has been in effect within the 6 months prior to the insured person’s date of arrival. This benefit does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person’s arrival date, and the insured person unreasonably fails or refuses to depart the country or location.

 

IDENTITY THEFT ASSISTANCE

Up to $500/Period of Coverage
If an imposter obtains key personal information such as a Social Security or Driver’s License number, or other method of identifying an insured person in order impersonate or obtain credit, merchandise or services in the insured person’s name, the Patriot Multi-Trip plans will provide coverage for the reasonable, customary and necessary costs incurred by the insured for: re-filing a loan or other credit application that is rejected solely as a result of the stolen indentity event; notarization of legal documents, long distance telephone calls, and postage that has resulted solely as a result of reporting, amending and /or rectifying records as a result of the stolen identity event; up to three credit reports obtained within one year of the insured person’s knowledge of the stolen identity event; and stop payment orders placed on missing or unauthorized checks as a result of the stolen identity event.

The identity theft event must occur during the Period of Coverage and must be reported within six months of the termination of coverage date.

ADDITIONAL BENEFITS

Trip Interruption | Up to $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, the Patriot Multi-Trip plan will reimburse the insured up to $5,000 for the cost of returning the insured to the area of principal residence. The plan will cover reimbursement 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.

Lost Luggage | Up to $50 per item of luggage; maximum of $250

Sports & Leisure Activities | Up to the Maximum Limit for basic sports
The Patriot Multi-Trip plan covers injuries incurred during amateur athletic activities which are non-contact and engaged in by the insured person solely for leisure, recreation, entertainment or fitness purposes. However, activities not covered include 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.

Accidental Death & Dismemberment  |  $25,000 principal sum
The Patriot Multi-Trip plan includes $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 life which occurred during a hijacking, kidnapping or attempted kidnapping – two times the 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 Additional Coverage Information page.*

Common Carrier Accidental Death | $50,000 to Beneficiary; maximum of $250,000 per family If accidental death should occur while traveling on a commercial Common Carrier, $50,000 will be paid to the designated beneficiary, to a maximum of $250,000 per family.* * Notwithstanding separate benefits, limits and sublimits for Common Carrier Accidental Death benefit and Accidental Death & Dismemberment benefits (above), no more than $50,000 dollars per individual will be paid to a beneficiary in the event of any death that occurs while covered by the Patriot Multi-Trip plan.

DESCRIPTION OF OPTIONAL RIDERS
Adventure Sports Rider

The Adventure Sports Rider is available on both Patriot Multi- Trip plans for those up to the age of 65. The following activities are covered to the lifetime maximum amounts listed on page four as long as they are engaged solely for leisure, recreation, or entertainment purposes: abseiling, BMX, bobsledding, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, hot air ballooning, inline skating, jet skiing, jungle zip lining, kayaking, mountain biking, mountaineering or rock climbing (to elevation 4500 meters from ground level), parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, scuba diving (to 50M), skydiving, snorkeling, snow skiing, snowboarding, snowmobiling, spelunking, surfing, trekking, whitewater rafting (to Class V), wildlife safaris, and windsurfing. All such activities must be carried out in strict accordance with the rules, regulations and guidelines of the applicable Governing Body or Authority of each such activity. Certain sports activities are never covered, regardless of whether or not you purchase the Adventure Sports Rider. Please see page 12, exclusion 8. Please note this is only a summary of Adventure Sports and exclusions. For additional information, please refer to the Certificate of Insurance.

Evacuation Plus Rider
This optional rider is available to insureds up to age 65. It offers coverage for medical evacuations for sudden and unexpected medical conditions that are not life-threatening, and where hospitalization is medically necessary. It also offers coverage for evacuations as a result of a natural disaster.

EXCLUSIONS

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

Treatment for Pre-existing Conditions in excess of $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. 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 provided for in the Certificate of Coverage.

Venereal disease, AIDS virus, AIDS related illness, ARC Syndrome, or AIDS, 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, skijumping, 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 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.

Treatment for illness or injury where the trip is undertaken for the purpose of obtaining such treatment or advice for a Pre-existing Condition.

Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).

ADDITIONAL INFORMATION

CONDITIONS OF COVERAGE
• The Period of Coverage is for one year from the effective date of the Certificate of Coverage.
• Coverage and benefits are subject to the applicable deductible, and the other terms of the plan as contained in the complete Certificate Wording and Master Policy.
• Coverage under the Patriot Multi-Trip plan is secondary to any other coverage or contractual benefits.
• Coverage and benefits are for medically necessary, usual, reasonable and customary charges only. Benefits under the plan are available only for injuries and illnesses for which treatment is first obtained during the first 30 days of the trip.
• Charges must be administered or ordered by a physician.
• Charges must be incurred during the Period of Coverage.
• Claims must be presented to IMG for payment within the Period of Coverage, or during the three months immediately following the Period of Coverage.

ELIGIBILITY
(U.S. citizens)
You, your spouse and children are eligible for Patriot Multi-Trip International while traveling outside the United States if you: 1) are under the age of 76, 2) are covered by an individual or group medical plan, and 3) travel outside the United States frequently throughout the year.

(Non-U.S. citizens) You, your spouse and children are eligible for Patriot Multi-Trip America while traveling outside your home country if you: 1) are under the age of 76, 2) are covered by an individual or group medical plan, and 3) travel outside your home country frequently throughout the year.

RENEWAL OF COVERAGE
If your plan is purchased for a minimum of three months, coverage may be renewed (unless there is a break in coverage) for a total of up to two years. Renewals are available in whole month or daily increments and may be completed online or by using a paper application, however, renewals of less than one month are available only online. For each renewal of less than one month completed online, you will be charged an additional $5 processing fee. Each insured person must only satisfy one deductible and coinsurance within each 12 month coverage period. Please note: Renewal rates may differ from initial rates.

CONTACT US

If you have any questions regarding IMG or the products located on this website, please contact us. We are available to provide support to our producers and prospective clients. Our contact information is below. Additionally, you may use the online inquiry form. An IMG representative will review your questions or comments, and respond in a timely manner.

International Medical Group
2960 North Meridian Street Indianapolis, IN USA 46208-4715
Telephone: 1.317.655.4500 or 1.877.808.7434
Fax:1.317.655.4505
Email: insurance@imglobal.com

For all claims correspondence, please use the following address:
International Medical Group Claims Department
PO Box 88500 Indianapolis, IN 46208-0500

To submit applications, underwriting information or premium, please use the following address:
International Medical Group
PO Box 88509
Indianapolis, IN 46208-0509

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QUALITY GUARANTEE

Your satisfaction is very important to IMG and the plan underwriter. If you are not pleased with this product for any reason, you may submit a written request, prior to the effective date, for cancellation and refund of your premium.