PATRIOT TRAVEL MEDICAL INSURANCE^sm
Enrollment ....

How to Enroll

Before you begin your travel, simply fill out the attached enrollment form and pay the premium for the time period you and your family will be traveling. Once you have completed the enrollment form, return it to your agent or mail it to IMG. You, your spouse and unmarried dependent children (over 14 days and under 18 years of age) on the enrollment form will be covered from the latest of the following dates:

1. The date IMG receives your Enrollment Form and the appropriate premium.
2. The date you depart from your country of citizenship.
3. The date requested on your Enrollment Form.

Patriot 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 Enrollment Form.
3. The date you return to your country of citizenship (see home country coverage).

IMG^sm normally processes enrollment forms within 24 hours of receipt. Once processing is complete we mail a fulfillment kit to the address listed on the enrollment form. The fulfillment kit includes an IMG^sm Identification Card, IMG^sm contact numbers, Claim Forms and complete Policy Wording.

| Patriot Home | Protection Package | Claim Management |
| Plan Administrator | Underwriter | Enrollment | Enrollment Form |
| Conditions and Exclusions |