We are Your "Global Travel Companions"
Patriot Platinum Visitors Insurance
Why Consider International Travel Medical Insurance?
Exploring the Grand Canal in Venice by gondola, discovering the breathtaking lakes of Ticino in Switzerland from the foothills of the Alps, taking in the opera at Prague’s prestigious National Theatre, admiring some of the greatest masterpieces in the world at the Louvre in Paris, or sending family members on an adventurous vacation backpacking through Europe- whatever your travel destination, you expect and deserve firstclass protection and service. But what would happen if you or one of your family members became ill or injured while away from home? International travel can quickly turn frightening if you’re not prepared for a medical emergency.
Most travelers assume they will be covered by their standard medical plan. The truth is, while traditional plans may offer adequate domestic coverage, they are not designed for international travel. Without even realizing it, you may be putting your health - and that of your family - at risk.
You have enough to worry about when you’re traveling. Don’t letyour medical coverage be an uncertainty. International Medical Group® (IMG®) has developed two Patriot Platinum Travel Medical Insurance plans to provide you and your family superior protection so you can spend more time enjoying your international experience, and less time worrying about your medical coverage. Why Patriot PlatinumSM?
As you expect first-rate protection when you travel, the two Patriot Platinum plans 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 10 days up to a maximum of three years, in accordance with the terms of the Certificate of Insurance. Additionally, the plans offer enhanced benefits and services to meet your global travel needs. You can choose from an extensive range of deductibles and Maximum Limits, you have exclusive access to our Global Concierge and Assistance Services and you have access to more than 17,000 providers through our International Provider Access SM IPA) when seeking treatment outside the U.S. You can also reduce your out-of-pocket costs when seeking treatment in the U.S. by locating providers through the independent Preferred Provider Organization.
ENHANCED AD&D RIDER MONTHLY RATES*
Up to $100,000 additional coverage $8
Up to $200,000 additional coverage $16
Up to $300,000 additional coverage $24
Up to $400,000 additional coverage $32
*Available to the primary insured only. Available with a minimum purchase of 3 months of medical and AD&D rider coverage. Premium is charged in whole month increments.
EVACUATION PLUS RIDER MONTHLY RATE*
Premium per covered insured per month $70
*Must be purchased for a minimum of 3 months regardless of the minimum number of days being traveled. Premium is charged in whole month increments.
*EVERY INSURANCE POLICY COMES WITH OUR EXCLUSIVE MAESTRO TRAVEL COMPANION
ENHANCED AD&D RIDER MONTHLY RATES*
Up to $100,000 additional coverage $8
Up to $200,000 additional coverage $16
Up to $300,000 additional coverage $24
Up to $400,000 additional coverage $32
*Available to the primary insured only. Available with a minimum purchase of 3 months of medical and AD&D rider coverage. Premium is charged in whole month increments.
EVACUATION PLUS RIDER MONTHLY RATE*
Premium per covered insured per month $7*Must be purchased for a minimum of 3 months regardless of the minimum number of days being traveled. Premium is charged in whole month increments. All premium rates are effective as of 4/1/2013. IMG reserves the right to issue the most current rates in the event these expire, are modified or replaced with a newer version. Rates include surplus lines tax where applicable. 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. The maximum amount of coverage for applicants who are 70-79 years of age is $100,000. The maximum amount of coverage for applicants 80 years of age or older is $20,000.
CONDITIONS OF COVERAGE
1. Coverage and benefits are subject to the deductible and coinsurance, and all terms of the Certificate of Insurance and Master Policy.
2. Coverage under a Patriot Platinum plan is secondary to any other coverage.
3. Coverage and benefits are for medically necessary, usual, reasonable and customary charges only.
4. Charges must be administered or ordered by a physician.
5. Charges must be incurred during the Period of Coverage or the Benefit Period.
6. Claims must be presented to IMG for payment within ninety (90) days from the date the claim was incurred.
ELIGIBILITY
The following conditions apply to all persons applying for and/or enrolling in Patriot Platinum Travel Medical Insurance. n 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 65 years of age 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.
ENROLLMENT PROCESS & APPLICATION FORM
You should read the following important information prior to completing the Application Form.
HOW TO ENROLL
Before you begin your travel, simply fill out the Application Form and calculate the premium for the time period you and/or your family will be traveling. Once you have completed the Application Form, return it to your insurance agent or broker, and/or mail it to IMG. You, your spouse and unmarried dependent children (over 14 days and under 18 years of age) listed on the Application Form and for whom premiums have been paid will be covered from the latest of the following dates:
1. the date IMG receives your completed Application Form and the appropriate premium;
2. the date you depart from your home country; or
3. the date requested on your Application Form.
Patriot Platinum Travel Medical Insurance coverage ends on the earliest of the following dates:
1. the end of the period for which premium has been paid;
2. the date requested on your Application Form; or
3. the date you return to your home country (however, see End of Trip Home Country Coverage on page 12).
ENROLLMENT PROCESSING & FULFILLMENT KITS
IMG normally processes Application Forms within 24 hours of receipt. Once processing is complete, IMG will mail a fulfillment kit to the mailing address listed on the application form. The fulfillment kit will include an IMG Identification Card, IMG contact numbers, claim forms and your insurance certificate providing a complete description of your coverage under the contract. Please note: If you require express mail delivery, there is an additional charge listed on the Application Form.
ONLINE FULFILLMENT KIT
For convenience, approved applicants may choose to communicate electronically and download their fulfillment kit from the IMG website for immediate access. To do this, you must check the appropriate box listed in Section 2 of the application form. We must have your correct email address to complete this process. If IMG has processed and approved your application form, you will receive an email from IMG that contains all of the hyperlinks to easily obtain the fulfillment information through the Internet.
CLAIMS PROCEDURE
PRECERTIFICATION
Each proposed hospital admission, in-patient or out-patient surgery, and other procedures as noted in the Certificate of Insurance must be Precertified for medical necessity, which means the insured person or their attending physician must communicate with an IMG representative at the number listed on the IMG identification card prior to admission to a hospital or performance of a surgery. In case of an emergency admission, the Precertification call must be made within 48 hours of the admission, or as soon as reasonably possible. If a hospital admission or a surgery is not Precertified, eligible claims and expenses will be reduced by 50%. It is important to note that Precertification is only a determination of medical necessity, not an assurance of coverage, verification of benefits or a guarantee of payment. All medical expenses eligible for reimbursement must be medically necessary and will be paid or reimbursed at usual, reasonable, and customary rates. Please refer to the Certificate of Insurance for full details of the Precertification requirements. For Precertification, emergency evacuation, and return of mortal remains, please call: IMG in the U.S.: 1.800.628.4664 (toll free) or 1.317.655.4500. Call IMG outside the U.S.: 001.317.655.4500 (collect if necessary). This information will also be provided on your ID card.
Note: An insured person may begin the Precertification process through MyIMG or the Client Resources section of our website, www.imglobal.com. Simply look for the Precertification option. You will be asked to provide the required information, which can then be submitted electronically to IMG. Once we have confirmed receipt of your request, our utilization management and review team will review the information provided and respond to the insured person or the provider within two business days. Please note that this online service will only initiate the Precertification process, and it should not be used to Precertify emergency admissions, procedures, or evacuations.
SUMMARY OF BENEFITS
The following is a summary of benefits and terms that are available to eligible insureds on the Patriot Platinum plans.
EMERGENCY ROOM:
Charges incurred for the use of the Emergency Room due to an accident or illness are covered up to the Maximum Limit. 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 admission to the hospital.
DENTAL:
Injury due to an accident - Each Patriot Platinum plan covers the cost of emergency dental treatment and dental surgical procedures necessary to restore or replace sound natural teeth lost or damaged in an accident up to the Maximum Limit.
Sudden dental emergency - Each plan will pay up to $250 for the necessary treatment of sudden, unexpected pain to sound natural teeth.
SUPPLEMENTAL ACCIDENT:
Each Patriot Platinum plan provides up-front, additional protection for unexpected injuries. This benefit provides up to $300 of firstdollar benefits for treatment of an injury.
SUDDEN AND UNEXPECTED RECURRENCE OF A PRE-EXISTING CONDITION:
(U.S. citizens only) For those up to age 65 with a primary health plan, Patriot Platinum International will pay the Usual, Reasonable and Customary charges of a sudden and unexpected recurrence of a Pre-existing Condition (defined on page 16) up to the plan maximum. For those without a primary health plan, Patriot Platinum International will pay up to a $20,000 lifetime maximum. For those age 65 and older, with or without a primary health plan, Patriot Platinum International will pay up to a $2,500 lifetime maximum. The primary health plan must have existed prior to the effective date and during coverage of the Patriot Platinum plan, and the Pre-existing Condition must be covered under the primary health plan.
(Non-U.S. citizens only) For those under age 65, Patriot Platinum America will pay up to a $50,000 lifetime maximum for eligible medical expenses. For those age 65 and older, Patriot Platinum America will pay up to $2,500 lifetime maximum. In addition, up to $25,000 will be paid to U.S. and non-U.S. citizens for the eligible costs and expenses of an Emergency Medical Evacuation arising or resulting from a sudden and unexpected recurrence of a Pre-existing Condition.
HOSPITAL DAILY INDEMNITY: Each plan pays $250 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 twelve-month Benefit Period may offer continued coverage for that injury or illness. When the Certificate expires, the Company will review the date of initial treat-ment for the covered injury or illness. If treatment began less than six months before the Period of Coverage expired, benefits for the covered injury or illness continues. This is subject to the Maximum Limits and the other terms of the plan until there have been six months of continuous coverage for the covered injury or illness.
*EVERY INSURANCE POLICY COMES WITH OUR EXCLUSIVE MAESTRO TRAVEL COMPANION
INTERNATIONAL EMERGENCY CARE POLITICAL EVACUATION:
If the United States Department of State, Bureau of Consular Affairs, or similar government organization of the insured person’s home country, orders the evacuation of all non-emergency government personnel from the host country, due to political unrest, that becomes effective on or after the insured person’s date of arrival in the host country, the Company pays up to a $100,000 lifetime maximum 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, or similar government organization of the insured person’s home country, issuance of the evacuation order; and 2. The evacuation order pertains to persons from the same home country as the insured person; and 3. Political Evacuation and Repatriation is approved and coordinated by the Company; In no event will the Company pay for a political evacuation if there is a travel warning in effect on or within six (6) months prior to the insured person’s date of arrival in the host country.
REMOTE TRANSPORTATION:
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 provides 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).
EMERGENCY EVACUATION:
The Patriot Platinum plans offer coverage for Emergency Medical Evacuation to the nearest qualified medical facility; expenses for reasonable transportation 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:
Each Patriot Platinum plan also offers 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 OR CREMATION/BURIAL:
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; or up to $5,000 for the preparation, local burial or cremation of your mortal remains at the place of death.
RETURN OF MINOR CHILDREN:
If a covered illness/injury results in a hospitalization and/or death of the insured person, and he/she is traveling alone with child(ren) 19 or under that otherwise would be left unattended, the Patriot Platinum plans will pay up to $100,000 for one way economy fare to their home country, including a chaperone, if necessary, for the safety of the child(ren). To be eligible for the Remote Transportation, Evacuation, Reunion and Return benefits, these must be recommended by the attending physician in lifethreatening medical situations, and approved in advance and coordinated by IMG.
INCIDENTAL HOME COUNTRY COVERAGE:
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:
1. The insured person must have left their home country,
2. The total Period of Coverage must be for a minimum of 30 days, and
3. 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:
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 calculate your premium on the Application Form, and include the additional month(s).
SPORTS AND ACTIVITIES COVERAGE:
Each Patriot Platinum plan covers injuries incurred during athletic activities which are non-organized, non-contact and engaged in by the insured person solely for leisure, recreation, entertainment or fitness purposes. Some of these sports and activities include, but are not limited to, motor cycle/motorscooter riding, recreational downhill and/or cross country snow skiing, horseback riding, subaquatic activities (to 10m), wakeboarding, and water skiing. However,activities not covered include amateur or professional sports or other athletic activity which is organized and/or sanctioned by the National Collegiate Athletic Association (and/or any other collegiate sanctioning or government body), or the International Olympic Committee, and or Adventure Sports. Please note this is only a summary of sports and activities and exclusions. For additional information, please refer to the Certificate of Insurance.
ACCIDENTAL DEATH AND DISMEMBERMENT:
Each Patriot Platinum plan offers a $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.
*EVERY INSURANCE POLICY COMES WITH OUR EXCLUSIVE MAESTRO TRAVEL COMPANION
COMMON CARRIER ACCIDENTAL DEATH:
If accidental death should occur while traveling on a commercial Common Carrier, $100,000 per adult and $25,000 per child is payable to the designated beneficiary, to a maximum of $250,000 per family.
NATURAL DISASTER:
This benefit is available in the event an insured person is required to depart his/her destination due to an evacuation order issued byprevailing authorities in connection with a Natural Disaster. Natural Disaster is defined as widespread disruption of human lives by disasterssuch as flood, drought, tidal wave, fire, hurricane, earthquake, windstorm, or other storm, landslide, or other natural catastrophe or event resulting in migration of the population for its safety.
TRIP INTERRUPTION:
If, during a covered trip, there is an uexpected death of an immediate family member (spouse, child, parent or sibling), a break-in at the insured’s principle residence, or the substantial destruction of the insured’s principal residence due to a fire or natural disaster, each Patriot Platinum plan pays to return the insured to the area of principal residence. The plan pays for a one way air or ground transportation ticket of the same class as the unusedtravel ticket, less the value of the unused return ticket.
TERRORISM COVERAGE:
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 reimburses eligible medical claims up to the maximum limit. Terrorism includes criminal acts, including against civilians, committed with the intent to cause death or serious bodily injury, or taking of hostages, with the purpose to provide a state of terror in the general public or in a group of persons or particular persons, intimidate a population, or compel a government of international organization to do or to abstain from doing an act. However, this benefit does not cover an act of Terroris in any country or location where the United States government has issued a travel advisory that has been in effect within the sixmonths prior to the insured person’s date of arrival. In addition ,claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered. 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 to heed such warning or depart the country or location.
IDENTITY THEFT ASSISTANCE:
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 servicesin the insured person’s name, the Patriot Platinum plans provide coverage for up to $500 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 thestolen identity event; notarization of legal documents, long distanctelephonecalls, 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 resultof the stolen identity event. The identity theft event must occur during the Period of Coverage.
FELONIOUS ASSAULT:
If you are Injured as a result of a Felonious Assault while traveling out- side of your home country, each plan pays up to $10,000. This benefit is in addition to any other benefit available under Patriot Platinum.
LOST / THEFT:
A benefit of up to $500 is payable in the event that there is damage to, loss of, or theft of your checked or stored baggage or personal tems by a common carrier or while stored with your hotel. It will also include coverage for the replacement costs of travel documents.
SMALL PET COMMON AIR CARRIER ACCIDENTAL DEATH:
A benefit of up to $500 is payable in the event of loss of life to a small pet while traveling with a covered insured on a common air carrier. This covers the pet while on the insured’s originating flight from his/her home country, and returning flight to the insured’s home country only. A small pet is a cat or dog up to 30 pounds in weight.
DESCRIPTION OF OPTIONAL RIDERS
ADVENTURE SPORTS RIDER:
The Adventure Sports Rider is available on both Patriot Platinum 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, parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snorkeling, snowboarding, snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), and 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 SportsRider. Please see page 16, exclusion 8. Please note this is only a summar of Adventure Sports and exclusions. For additional information, please refer to the Certificate of Insurance.
ENHANCED AD&D RIDER:
This optional coverage is available for the primary insured person only. This coverage is in addition to the Accidental Death and Dismemberment already included in the Patriot Platinum plans. This rider is available with a minimum purchase of three months of medical and AD&D rider coverage.
CITIZENSHIP RETURN RIDER:
When purchased at the time of application, the Citizenship Return Rider provides temporary medical coverage for non-U.S. citizens returning to their country of citizenship. For U.S. citizens, the rider provides up to 60 days of coverage for brief returns to the U.S. provided you have a current health plan in force and have resided outside the U.S. continuously for the past six months. Coverage for sudden recurrence of pre-existing conditions is excluded if the rider is selected. For premium information, please see the back of the Application Form.
PERSONAL LIABILITY RIDER:
This optional coverage provides for the reimbursement of legal costs associated with a personal liability event by a covered insured. Thisincludes legal costs incurred arising from the determination and/or settlement of such legal liability associated with the injury of a third person or damage to a third person’s property during the period of coverage.
EVACUATION PLUS RIDER:
This optional rider is available to insureds up to age 65. It offers coverage for medical evacuations for sudden and unexpected medicalconditions that are non life-threatening and where hospitalization is medically necessary. It also offers coverage for evacuations as a result of a natural disaster. This rider must be purchased for a minimum of three months regardless of the minimum number of days being traveled.
EXCLUSIONS
Charges for certain services, treatments and/or conditions, among others, are excluded from coverage under the Patriot Platinum plans and include but are not limited to:
1. A Pre-existing Condition which is any injury, illness, sickness, disease, or other physical, medical, mental or nervous disorder, condition or ailment that, with reasonable medical certainty, existed a 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, symptomatic or known, diagnosed, treated, or disclosed to the Company prior to the effective date, and including any and all subsequent, chronic or recurring complications or consequences related thereto or resulting or arising therefrom.
2. Treatment or surgeries which are elective, investigational, experimental or for research purposes.
3. 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.
4. Immunizations and routine physical exams.
5. Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the Certificate of Insurance.
6. 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.
7. Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
8. Any illness or injury sustained while taking part in: Amateur Athletics, Professional Athletics, or other athletic activity that is sponsored or sanctioned by the National Collegiate Athletic Association (and/or any other collegiate sanctioning or governing body), or the International Olympic Committee. The following Adventure Sports are excluded unless the Adventure Sports Rider is purchased: abseiling, BMX, bobsledding, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, hot air ballooning, inline skating (with proper use of helmet and pads), jet skiing, junglezip lining kayaking, mountain biking, parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snowboarding, snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), wildlife safaris, and windsurfing. All such activities must be carried out in strict accordance wit the rules, regulations and guidelines of the applicable Governing Body or Authority of each such activity. Injury sustained while participating in contact sports of any kind, racing of any kind, any rodeo activity, BASE jumping, kiteboarding, mountaineering or climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, ski jumping, subaquatic activities below 50 meters, whitewater rafting exceeding Class V difficulty; and/or adventure sports activity not expressly covered hereunder are excluded regardless of which plan or rider is selected.
9. Vision or ear tests and the provision of visual or hearing aids.
10. Vocational, recreational, speech or music therapy.
11. Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
12. 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.
13. Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
14. 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.
15. Willful self-inflicted injury or illness.
16. Treatment required as a result of or arising from complica- tions from a treatment or condition not covered under the certificate.
17. Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
18. Treatment for mental and nervous disorders.
19. Organ or tissue transplants or related services.
20. Illness or injury where the trip to the host country is under- taken for treatment or advice for such illness or injury, except as expressly provided for in the certificate of insurance.
21. Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).
22. Any infection of the urinary tract (or Illness arising therefrom), that occurs within ninety (90) days of the Effective Date of coverage and that requires Treatment of the Insured Person in a Hospital; provided that any such Illness will be deemed by the Company to be a Pre-existing Condition. See “Sudden and Unexpected Recurrence of a Pre-existing Condition,” on page 11. This brochure contains only a brief summary of current Patriot Platinum Medical Insurance benefits, conditions, limitations and exclusions, and is subject to all the terms and conditions of the full Certificate of Insurance. The complete Certificate of Insurance with all terms, conditions and exclusions will be included in the fulfillment kit sent to approved applicants.
The Patriot Travel Medical Insurance plans are amended, modified or replaced from time to time, and IMG reserves the right to issue the most current Certificate of Insurance for this insurance plan in the event this application and/or brochure has expired, is modified, or is replaced with a newer version. Samples of current Certificate wordings are available upon request.
IMPORTANT NOTICE REGARDING PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA):
This insurance is not subject to, and does not provide benefits required by, PPACA. On January 1, 2014, PPACA will require U.S. citizens and certain U.S. residents to obtain PPACA compliant insurance coverage unless they are exempt from PPACA. Penalties may be imposed on U.S. citizens and U.S. residents who are required to maintain PPACA compliant coverage but do not do so. Please note that it is solely your responsibility to determine if PPACA is applicable to you.
*EVERY INSURANCE POLICY COMES WITH OUR EXCLUSIVE MAESTRO TRAVEL COMPANION
For More Info:
Global Visitors Insurance
3410 Midcourt Rd
Carrollton, TX 75006
877-856-1411
