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Plan Information
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Maximum Limits:
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$ 50,000
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Deductible:
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$250 per Period of Coverage
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Coninsurance - For treatment received outside the U.S. & Canada:
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No Coinsurance
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Coninsurance - For treatment received within the U.S. & Canada:
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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
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Medical Benefits
Usual, reasonable and customary charges, subject to deductible and coinsurance
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Hospital Room and Board
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Up to the Maximum Limit for average semi-private room rate
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Intensive Care
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Up to the Maximum Limit
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Medical Expenses
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Up to the Maximum Limit
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Out-patient Medical Expenses
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Up to the Maximum Limit
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Local Ambulance
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Up to the Maximum Limit
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Emergency Room Accident
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Up to the Maximum Limit
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Emergency Room Illness with
In-patient Admission
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Up to the Maximum Limit
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Emergency Room Illness without
In-patient Admission
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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.
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Dental - Injury due to an accident:
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Each Patriot Adventure 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.
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Dental - Sudden dental pain
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Each plan will pay up to $100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.
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International Emergency Care
(when coordinated through the Plan administrator)
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Emergency Evacuation
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Up to the Maximum Limit
Patriot Adventure includes coverage for Emergency Medical Evacuations from a medical facility 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.
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Emergency Reunion
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Up to $10,000
Patriot Adventure also provides emergency reunion coverage, up to $10,000 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.
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Return of Mortal Remains
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Up to $15,000
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 $15,000.
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Political Evacuation
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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:
1. The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular affairs issues the travel advisory;
2. 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.
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Additional Benefits
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Benefit Period
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Three months
If a covered injury or illness has continuing treatment after the certificate expires, the three-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 three months before the certificate expired, benefits for the covered injury or illness will continue subject to the Maximum Limits until there has been three months of coverage for the covered injury or illness.
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Common Carrier Accidental Death
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$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 beneficiary to a maximum of $250,000 per family
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| Sports & Activities |
Up to the Maximum Limit for basic and Adventure sports as described below
Subject to the complete Certificate Terms and Conditions, Patriot Adventure covers injuries incurred during non-contact amateur athletic activities and the following activities: abseiling, BMX, bungee jumping, canyoning, caving, cave tubing, flying (private plane), hang gliding,heli-skiing, high diving, horseback riding, hot air ballooning, jet skiing, jungle zip lining, kayaking, inline skating, motorcycle/motorscooter riding, mountain biking, mountaineering (ropes and guides to 4500m from ground level), paragliding, parascending, rappelling, rock climbing (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snorkeling, snow skiing, snowboarding, snowmobiling, spelunking, surfing, trekking, wakeboarding, water skiing, whitewater rafting (to Class V), wildlife safaris, and windsurfing. These advenutre activities must be engaged in solely for leisure, recreation or entertainment purposes. Activities may be organized and include scheduled practices, games, and/or competitions.
Activities not covered include contact sports, professional sports and any athletic activities that are organized and/or sanctioned by the National Collegiate Athletic Association (or any other collegiate sanctioning body) or the International Olympic Committee.
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| Trip Cancellation |
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 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.
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Lost Luggage
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Up to $50 per item; maximum of $250
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