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Patriot America Insurance is designed for the international traveler. Patriot America Insurance provides coverage for non-US citizens traveling outside their country of citizenship for a minimum of 10 days up to a maximum of one year. Patriot America Insurance is ideal visitor health insurance for parents visiting usa and tourists to the United States.
Patriot AmericaSM provides coverage for non-US citizens traveling outside their country of citizenship for a minimum of 10 days up to a maximum of one year.
Although the Patriot America Insurance plan is not renewable, it can be rewritten for succeeding or subsequent coverage periods. New deductible, coinsurance, eligibility, conditions of coverage and pre-existing condition exclusions apply to any succeeding or subsequent Period of Coverage. A new application also must be completed. If you or other family members applying for coverage are age 65 or older, please see the eligibility section of the Patriot brochure for additional information.
If you are a non-US citizen traveling for three (3) months or
more and under age 70, please review the ExPatriot Plus® plan, which offers
a 10% discount on rates and is renewable for up to two years.
ONE MONTH RATES (four Policy Maximum options)
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Option 1
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Option 2
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Option 3
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Option 4
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$50,000
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$100,000
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$500,000
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$1,000,000
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AGE
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One Month |
One Month |
One Month |
One Month |
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18-29
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$48
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$56
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$72
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$84
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30-39
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$62
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$74
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$94
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$108
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40-49
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$94
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$106
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$140
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$158
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50-59
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$134
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$164
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$198
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$228
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60-64
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$158
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$194
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$230
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$276
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65-69
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$180
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$232
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$252
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$300
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70-79
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$244
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N/A
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N/A
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N/A
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80+*
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$424
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N/A
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N/A
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N/A
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DEP. CHILD
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$28
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$32
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$40
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$44
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CHILD ALONE
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$44
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$52
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$66
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$74
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*US$10,000 limit
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DAILY RATES (MINIMUM COVERAGE IS 10 DAYS)
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Option 1
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Option 2
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Option 3
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Option 4
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$50,000
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$100,000
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$500,000
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$1,000,000
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AGE
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Daily |
Daily |
Daily |
Daily |
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18-29
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$1.60
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$1.90
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$2.40
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$2.80
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30-39
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$2.10
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$2.50
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$3.15
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$3.60
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40-49
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$3.15
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$3.55
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$4.70
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$5.30
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50-59
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$4.50
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$5.50
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$6.60
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$7.60
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60-64
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$5.30
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$6.50
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$7.70
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$9.20
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65-69
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$6.00
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$7.75
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$8.40
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$10.00
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70-79
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$8.15
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N/A
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N/A
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N/A
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80+*
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$14.15
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N/A
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N/A
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N/A
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DEP. CHILD
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$0.95
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$1.10
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$1.35
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$1.50
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CHILD ALONE
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$1.50
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$1.75
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$2.20
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$2.50
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*US$10,000 limit
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All premium rates are in US dollars and are effective through
12/31/2004. Rates include 2.5% surplus lines tax. A dependent child is your
child shown on the Application Form over 14 days and under 18 years of age,
traveling with you, and for whom premium has been paid.
Refund of Premium
IMG will refund premium only if a written request is received prior to the
certificate's effective date. The premium is non-refundable after that date.
Precertification, Emergency Evacuation and Repatriation
For precertification, emergency evacuation and repatriation please call IMG
in the U.S. 1-800-628-4664 (toll free) or 1-317-655-4500. Call IMG outside
the US: 001-317-655-4500 (collect if necessary). This information will
also be provided on your ID card.
IMG must be notified prior to treatment or within 48 hours of an emergency.
To Report Claims
Please mail completed claim forms to International Medical Group, 407 Fulton
Street, Indianapolis, IN 46202 USA. All IMG contact numbers, claim forms
and Policy Wordings will be included in the fulfillment kit. IMG may also
be contacted by fax: 317-655-4505 or email: insurance@imglobal.com.
This web page contains only a consolidated and summary description of all
current Patriot Travel Medical Insurance benefits, conditions, limitations and
exclusions. A certificate containing the complete Policy Wording with all
terms, conditions and exclusions will be included with the fulfillment kit. IMG
reserves the right to issue the most current Policy Wording for this insurance
plan in the event this application and/or brochure has expired, is modified, or
is replaced with a newer version. Current Policy Wordings are available upon
request.
 
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