PLATINUM HEALTH INSURANCE
Gateway Patriot Platinum Travel Medical Insurance
The Gateway Patriot Platinum plan provides a complete package of international benefits available 24 hours a day. Coverage is available for U.S. citizens traveling outside of the country with coverage for brief returns. Coverage is also available for non-U.S. citizens traveling outside of their home country. These plans are available for a minimum of 10 days up to a maximum of three years.
• An exclusive range of deductibles and Maximum Limits.
• Access to our Global Concierge and Assistance Services ℠ and over 17,000 providers through our International Provider Access ℠ (IPA) network.
• Reducing your out-of-pocket costs when seeking treatment within the U.S. by using providers through the independent Preferred Provider Organization.
You have enough to worry about when you’re traveling. Don’t let your medical coverage be an uncertainty. IMG has developed two Patriot Platinum Travel Medical Insurance plans to provide you and your family superior protection and offer a complete package of international benefits available 24 hours a day. Patriot Platinum International ℠ provides coverage for U.S. citizens traveling outside the U.S. with coverage for brief returns to the U.S., while Patriot Platinum America ℠ provides coverage for non-U.S. citizens traveling outside their home country. Both plans are available for a minimum of five days to a maximum of three years.
• Short-term travel medical coverage
• Coverage for individuals and dependents
• Two plan designs – one for U.S. citizens and one for non-U.S. citizens traveling outside their home country
• Maximum Limits from $1,000,000 to $8,000,000
• Deductible options from $0 to $25,000
• Available in monthly and daily rates
• Renewable up to 36 months if three months is initially purchased
• Access to Global Concierge & Assistance Services – extended services handled by a dedicated service team
• Access to board-certified physicians, licensed psychologists, pharmacist, dentists, dieticians and trainers to assist you with any routine health related questions you have
• Freedom to seek treatment with hospital or doctor of your choice
• Trip cancellation, travel delay and baggage delay benefits available
• Universal Rx pharmacy discount savings
• 12 month benefit period
• 24 hour secure access from anywhere in the world to manage your account at any time
Maximum Limits | $1,000,000, $5,000,000, $8,000,000
Individual Deductible | Your choice of $0, $100, $250, $500, $2,500, $5,000, $10,000, $25,000
On the Application Form, you will be asked to circle your choice of a deductible. Your premium rate is dependent on the deductible you choose. Please see the Application Form for more information.
Family Deductible | Three times the individual deductible
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 100% of eligible expenses up to the Maximum Limits.
Outside the PPO Network | The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Maximum Limits.
12 MONTH BENEFIT PERIOD
If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the twelve-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 twelve months before the Period of Coverage expired, benefits for the covered injury or illness will continue subject to the Maximum Limit and the other terms of the plan until there have been twelve months of continuous coverage for the covered injury or illness.
GLOBAL CONCIERGE AND ASSISTANCE SERVICES
• Access to a dedicated service team for assistance services.
• MyIMG ℠ | 24 hour secure access from anywhere in the world to manage your account at anytime.
• eDocAmerica | Access to board-certified physicians, licensed psychologists, pharmacists, dentists, dieticians and fitness trainers to assist with any routine health related questions.
• World-class Medical Benefits | Premium coverage available for in-patient and out-patient medical expenses.
• International Emergency Care | A wide range of international emergency benefits available including emergency evacuation, emergency reunion, return of mortal remains, return of minor children and more.
USUAL, REASONABLE, AND CUSTOMARY CHARGES
Hospital Room and Board | Up to the Maximum Limit
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
Charges incurred for the use of the Emergency Room for treatment of an illness are covered up to the Maximum Limit if treatment requires admittance to the hospital.
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.
Injury due to an accident | Each Patriot Platinum 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 | Each plan will pay up to $250 for the necessary treatment of sudden, unexpected pain to sound natural teeth.
Hospital Daily Indemnity | Up to $250
Supplemental Accident | Up to $300
Each Patriot Platinum plan provides up-front, additional protection for unexpected injuries. This benefit provides up to $300 of first-dollar benefits for treatment of an injury.
INTERNATIONAL EMERGENCY CARE
Emergency Evacuation | Up to the Maximum Limit
Each Patriot Platinum plan includes coverage for Emergency Medical Evacuations 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 Maximum Limit.
Emergency Reunion | Up to $100,000
Each Patriot Platinum plan also provides emergency reunion coverage, up to $100,000 for a maximum of 15 days, for the reasonable travel and lodging expenses of a relative or friend during an Emergency Medical Evacuation: 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 $100,000
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 $100,000.
Return of Minor Children | Up to $100,000
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 plans will pay 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 $100,000
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 $100,000 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.
Natural Disaster | $250 per day for five days
This benefit is available in the event an insured person is required to depart his/her destination due to an evacuation order issued prevailing authorities in connection with a Natural Disaster. Natural Disaster is defined as widespread disruption of human lives disasters such as flood, drought, tidal wave, fire, hurricane, earthquake, windstorm, or other storm, landslide, or other natural catastrophe event resulting in migration of the population for its safety.
Remote Transportation | $5,000 per certificate period, $20,000 lifetime maximum
In the event of a diagnosis of a critical medical condition which is not necessarily immediately life-threatening, but severe enough to result in death or a permanent disability if not treated right away, Remote Transportation will provide for eligible charges arising out of the transportation of an insured person to a qualified facility for further treatment (if the current facility is unable to provide such treatment).
To be eligible for the Transportation, 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.
Identity Theft | Up to $500
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 to impersonate or obtain credit, merchandise or services in the insured person’s name, the Patriot Platinum 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 identity 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.
Lost / Theft (luggage, valuables, personal papers) | Up to $500
This benefit will be paid in the event that damage to, loss of, or theft of your checked or stored baggage or personal items by a common carrier or while stored with your hotel and the replacement costs of travel documents.
Felonious Assault | Up to $10,000
If you are injured as a result of a Felonious Assault while traveling outside of your Home Country, each plan will pay up to $10,000. This benefit is in addition to any other benefit available under Patriot Platinum.
Covered Up to the Maximum Limit
Each Patriot Platinum plan provides coverage for injuries and illness incurred as a result of an act of Terrorism, limited in amount and by circumstances. 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 up to the Maximum Limit. However, claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered.
Terrorism is defined as 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 orf any demand. However, this benefit does not cover an act of Terrorism in any 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 also 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.
Sports & Leisure Activities | Up to the Maximum Limit for basic sports
Each Patriot Platinum 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 unless the Adventure Sports Rider is purchased: abseiling, aviation (except when traveling as a passenger in a commercial aircraft), BMX, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, mountain biking, paragliding, parascending, rappelling, rock climbing, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, surfing, trekking, wind-surfing and whitewater rafting.
Racing of any kind, BASE jumping, mountaineering, climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, rodeo activity, ski jumping, whitewater rafting exceeding Class V difficulty, scuba below 10 meters; and/or adventure sports not expressly covered here under are excluded regardless of which plan or rider is selected.
Incidental Home Country Coverage | Up to a cumulative two weeks
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 One month for every four months of travel coverage, up to a maximum of three months
For every four 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 three 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 $10,000
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 Platinum plan will pay to return the insured to the area of principal residence. The plan will play 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 | $100,000 per adult, $25,000 per child, maximum of $250,000 per family If accidental death should occur while traveling on a commercial Common Carrier, $100,000 per adult and $25,000 per child will be paid to the designated beneficiary, to a maximum of $250,000 per family.
Accidental Death & Dismemberment | $50,000 principle sum
Each Patriot Platinum plan includes $50,000 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.
Small Pet Common Air Carrier Accidental Death | Up to $500
Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under the Patriot Platinum plans.
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 unless the Adventure Sports Rider is purchased: abseiling, aviation (except when traveling as a passenger in a commercial aircraft), BMX, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, mountain biking, paragliding, parascending, rappelling, rock climbing, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, surfing, trekking, wind-surfing and whitewater rafting.
Racing of any kind, BASE jumping, mountaineering, climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, rodeo activity, ski jumping, whitewater rafting exceeding Class V difficulty, scuba below 10 meters; and/or adventure sports not expressly covered hereunder are excluded regardless of which plan or rider is selected.
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).
CONDITIONS OF COVERAGE
• Coverage and benefits are subject to the deductible and coinsurance, and all terms of the certificate of coverage and Master Policy.
• Coverage under this plan is secondary to any other coverage.
• Coverage and benefits are for medically necessary, usual, reasonable and customary charges only.
• Charges must be administered or ordered by a physician.
• Charges must be incurred during the Period of Coverage or the Benefit Period.
• Claims must be presented to IMG for payment within the Period of Coverage, Benefit Period or during the three months immediately following the Period of Coverage.
The following conditions apply to all persons applying for and/or enrolling in Patriot Platinum Travel Medical Insurance.
• Patriot Platinum Travel Medical Insurance is travel insurance for U.S. citizens traveling outside the United States with coverage for brief returns to the U.S., and for non-U.S. citizens traveling outside their home country.
• For those under the age of 65 and visiting the U.S., your initial Period of Coverage must begin within six months of arrival in the U.S. For those 65 years of age and older, it must begin within 30 days of arrival. These requirements will be waived with proof of previous valid international travel insurance. Prior U.S. domestic health care coverage does not meet this eligibility requirement. Please provide the name of your international insurance carrier on the Application Form. If you are not in the U.S. at the time of application, please indicate your expected date of arrival on your Application Form.
RENEWAL OF COVERAGE
If your plan is purchased for a minimum of three months, coverage may be renewed (without break in coverage) for a total of up to three 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.
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 your effective date, for cancellation and refund of your premium. 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 $50 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.
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
For all claims correspondence, please use the following address:
International Medical Group
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
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.