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Benefits & Exclusions
Patriot Extreme
Benefits
Medical Benefits: Usual reasonable and customary charges,
subject to deductible and coinsurance
| Hospital Room
and Board |
To Policy Maximum for average semi-private room rate |
| Intensive Care |
To Policy Maximum |
| Medical Expenses |
To Policy Maximum |
| Outpatient Medical |
To Policy Maximum |
| Local Ambulance |
To Policy Maximum |
| Emergency
Room |
As Described Below |
Charges incurred for the use of the Emergency
Room due to an accident are covered up to the Policy Maximum.
Charges incurred for the use of the Emergency Room for treatment
of an illness are subject to an additional (extra) US$250 deductible
if treatment does not require admittance to the hospital. |
| Dental |
As
Described Below |
Injury due to an accident: Each Patriot
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 Policy Maximum.
Sudden dental pain:
Each plan will pay up to US$100 for the necessary treatment of sudden,
unexpected pain to sound natural teeth. |
| Coinsurance |
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For treatment received outside the U.S. & Canada: No coinsurance
For treatment received within the U.S. & Canada:
In the PPO Network: The plan pays 90% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum
Outside the PPO Network:
The plan pays 80% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum
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| International Emergency Care |
| Emergency Evacuation |
To
Policy Maximum When coordinated through Plan Administrator |
| Patriot Extreme 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 country
of residence or the country where the evacuation occurred up to
the policy limit. |
| Emergency Reunion |
To
US$10,000 when coordinated through Plan Administrator |
| Patriot Extreme also provides emergency reunion coverage,
up to US$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 country
of residence to be reunited with the insured. |
| Repatriation |
To
US$25,000 when coordinated through Plan Administrator |
| If a covered illness/injury results in death, expenses
for Repatriation of bodily remains or ashes to the country of residence
will be covered up to a maximum of US$15,000. |
| Political Evacuation |
To
US$10,000 when coordinated through Plan Administrator |
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 US$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: -
The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular affairs issues the travel advisory;
-
Political Evacuation and Repatriation is approved and coordinated by the Company.
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| Plan Information |
| Deductible |
US$250
Per Period of Coverage |
| Coinsurance |
As
Described Below |
| The plan pays 80% of eligible expenses up to US$5,000
then 100% up to the Policy Maximum. |
| Benefit Period |
Three
(3) Months |
| If a covered injury or illness has continuing treatment
after the certificate expires, the 3-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 Policy Limits until there has been three months of
coverage for the covered injury or illness. |
| Policy Maximum |
US$50,000 |
| The Patriot Extreme plan has a Policy Maximum of US$50,000. |
| Additional Benefits |
| Trip Cancellation |
To
US$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. |
| Lost Luggage |
To US$50 per item; maximum of US$250 |
| This benefit will be paid in the event that the Common
Carrier permanently loses an insured person's checked luggage. This
coverage is secondary to any other available coverage, including
the Carrier's. |
| Common Carrier
Accidental Death |
US$50,000
to Beneficiary; maximum of US$250,000 per family |
| If accidental death should occur while traveling on
a commercial Common Carrier, US$50,000 will be paid to the beneficiary
to a maximum of US$250,000 per family. |
| Sports & Activities |
To
Policy Maximum for basic and extreme sports as described below |
Subject to the terms of the complete
policy wording, Patriot Extreme covers injuries incurred during
non-contact amateur athletic activities and certain Extreme Sports
(see page 7 of the Patriot Extreme brochure). 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. |
Exclusions
Charges for the following services, treatments and/or conditions are excluded
from coverage under Patriot Extreme.
1. Pre-existing Conditions. A pre-existing condition is defined as any
injury, illness, sickness, disease, or other physical, medical, mental
or nervous condition, disorder or ailment that, with reasonable medical
certainty, existed at the time of application or at any time during the
three years prior to the effective date of the insurance, including any
subsequent, chronic or recurring complications or consequences related
thereto or arising therefrom whether or not previously manifested or known,
diagnosed, treated, or disclosed.
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
provided for herein.
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. Injury sustained while participating in professional sports or any
athletic activity that is sponsored or sanctioned by the National Collegiate
Athletic Association (or any collegiate governing body) or the International
Olympic Committee.
9. Injury sustained while participating in contact sports of any kind
as well as the following: mountaineering or climbing above 4500 meters
from ground level and without the proper use of ropes and guides; scuba
diving below 50 meters; whitewater rafting above Class V; BASE jumping;
luge; motocross or Moto-X; racing by horse, motor vehicle of any type,
or motorcycle; rodeo; ski jumping; and any Extreme Sport not listed as
covered on page 7 of the Patriot Extreme brochure.
10. Vision or hearing tests and the provision of visual or hearing aids.
11. Vocational, recreational, speech or music therapy.
12. Treatment while confined primarily to receive custodial care, educational
or rehabilitative care, or nursing services.
13. 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.
14. Treatment for, and injuries and/or illnesses resulting or arising
from, substance abuse or drug addiction.
15. Injury and/or illness resulting or arising from or sustained while
under the influence of or disablement of drugs or alcohol.
16. Willfull self-inflicted injury or illness, and injury due to reckless
endangerment or needless peril.
17. Treatment required as a result of or arising from complications from
a treatment or condition not covered hereunder.
18. Any services or supplies performed or provided by a relative of the
Insured or provided at no cost to Insured.
19. Treatment for mental and nervous disorders.
20. Organ or tissue transplants or related services.
21. Illness or injury where the trip to the host country is undertaken
for treatment or advice for such Illness or injury, except as provided
for herein.
22. Treatment incurred as a result of or arising from exposure to nuclear
radiation, and/or radioactive material(s).
This information is only a consolidated and
summary description of all current Patriot Extreme 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.
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