EXPATRIOT PLUS

PATRIOT TRAVEL MEDICAL INSURANCEsm
Expatriot Plus

ExPatriot Plussm: Coverage for those traveling outside their country of citizenship for a minimum of six months up to a maximum of two years.

Renewal of Coverage:
ExPatriot Plussm may be renewed for up to two years of total coverage by those traveling outside the US. For those traveling primarily within the US, ExPatriot Plussm may be renewed for up to one year of total coverage. A new Deductible and Coinsurance will apply for each 12 months of coverage.

Policy Premiums

ExPatriot Plus Policy Monthly Premiums for non U.S. Citizens traveling outside their country of citizenship.

EX-PATRIOT PLUS

  500,000 MAX 1,000,000 MAX 500,000 MAX 1,000,000 MAX
US CITIZEN US CITIZEN NON-US CITIZEN NON-US CITIZEN
option 7 option 8 option 9 option 10

AGE

TOTAL/MONTH

TOTAL/MONTH

TOTAL/MONTH TOTAL/MONTH

18-25

$40.00 $45.00 $60.00 $70.00

26-29

$45.00 $50.00 $70.00 $80.00

30-39

$65.00 $70.00 $75.00 $85.00

40-49

$70.00 $80.00 $120.00 $135.00

50-59

$120.00 $130.00 $200.00 $220.00

60-64

$135.00 $150.00 $230.00 $255.00

65-69

$160.00 $180.00 $235.00 $260.00

70-79*

$350.00 N/A $485.00 N/A

80 PLUS**

$420.00 N/A $550.00 N/A

DEP CHILD

$25.00 $30.00 $30.00 $35.00

CHILD ALONE

$55.00 $60.00 $60.00 $65.00

*50,000 limit

       

**10,000 limit

       

*For ages 70-79, policy maximum is $50,000.
A dependent child is your child shown on the Enrollment

Premiums effective through 12/31/99.

*See specific policy for age limit.

Benefit Period The Benefit Period is the period of time specified in the Policy Limits. It begins once an eligible incident occurs to the insured. While coverage is in effect under this policy, the Benefit Period does not apply. When coverage under this policy terminates, as defined, Patriot Travel Medical Insurance sm will pay eligible expenses for covered Injuries or Illnesses which commenced during the period of coverage for up to, but not exceeding the Benefit Period, subject to the Policy Limits.

Refund of Premium............................

IMG will refund premium only if a written request is received prior to the policy's effective date. The premium is non-refundable after that date.

For Precertification, Emergency Evacuation and Repatriation..............

Please call IMG
in the U.S. 1.800.628.4664
Outside the U.S. 01.317.655.4500
(collect if necessary).

IMG must be notified prior to treatment or within 48 hours of an emergency.

To Report Claims...............................
Please mail to IMG
International Medical Group, Inc.
407 North Fulton Street
Indianapolis, IN 46202 U.S.A.
Please include Identification Number in all correspondence.

This brochure is only a summary of coverage provided. Other conditions and exclusions may apply. Please consult the policy itself for a full description of the coverage. In support of Patriot Travel Medical Insurance sm, IMG has established the Group Health, Accident and Travel Insurance Trust, in Washington D.C. The trust owns a master group international travelers insurance policy. Individual certificates of insurance are issued from the master policy. Rates include 2% surplus lines tax.

Underwritten by: Sirius International Insurance Corporation

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