|
The Exchange Program Group Plan plan is designed for those who are:
- actively engaged or participating in an educational or cultural
exchange program in the country of assignment through a sponsoring
organization or school.
- traveling in a group to a destination that is not the home country
of any of the traveling members.
Obtaining coverage is as simple as:
- filling out the Enrollment Form with information on Sponsoring
Organization.
- filling out the Census Form with information on each Group Member.
- mailing or fax the above information to your independent agent or IMG.
|
benefit Description |
|
Plan Maximum |
US$10,000 per illness or injury with a lifetime
maximum of US$500,000 |
|
Coinsurance |
100% |
|
Deductible |
US$100 per illness or injury |
|
Treatment Period |
60 days per chronic illness |
|
Hospital Room & Board |
Up to semi-private room rate |
|
Hospital Intensive Care |
URC* |
|
Physical Therapy |
URC*, 1 visit per day |
|
Physician Visit |
URC* |
|
Student Health Center |
US$5 co-pay per visit |
|
Eligible Medical Expenses |
URC* |
|
Emergency Room |
URC* |
|
Emergency Illness with in-patient admission |
URC* |
|
Emergency Illness without in-patient
admission |
Additional US$250 |
|
Emergency Medical Evacuation |
US$25,000 lifetime maximum |
|
Emergency Reunion |
US$5,000 lifetime maximum |
|
Return of Mortal Remains |
US$7,500 |
|
Political Evacuation |
Up to US$10,000 |
|
Accidental Death |
US$5,000 |
|
Dismemberment |
US$5,000 two limbs; US$2,500 one limb |
|
Terrorism Coverage |
Up to US$50,000 lifetime maximum |
|
Sudden Recurrence of a Pre-existing Condition
(U.S. citizens) |
|
|
_Medical |
Up to US$5,000 of eligible expenses |
|
_Emergency Medical Evacuation |
Up to US$25,000 of eligible costs and
expenses |
|
Benefit Description |
|
Baggage |
|
|
_Loss/theft of Baggage |
US$250 |
|
_Loss/theft of Valuables |
US$250 |
|
_Loss/theft of Personal Papers |
US$250 |
|
Legal Assistance |
|
|
_Binder Fee |
US$500 when served with summons |
|
Personal liability |
|
|
_Injury to third party |
US$2,000 limit after US$100 deductible |
|
_Damage to third person property |
US$500 limit after US$100 deductible.
Secondary to any other insurance in force |
|
Limited high school sports coverage |
|
Benefit Description |
|
Plan Maximum |
Choice of US$50,000, US$250,000 or US$500,000 per
illness or injury with a lifetime maximum of US$500,000 |
|
Coinsurance |
100% |
|
Deductible |
US$100 per illness or injury |
|
Treatment Period |
60 days per chronic illness |
|
Hospital Room & Board |
Up to semi-private room rate |
|
Hospital Intensive Care |
URC* |
|
Physical Therapy |
URC*, 1 visit per day |
|
Physician Visit |
URC* |
|
Student Health Center |
US$5 co-pay per visit |
|
Eligible Medical Expenses |
URC* |
|
Dental |
|
|
_Injury due to accident |
US$500 |
|
_Sudden & unexpected pain |
US$350 |
|
Emergency Room |
URC* |
|
Emergency Illness with in-patient admission |
URC* |
|
Emergency Illness without in-patient admission |
Additional US$250 deductible |
|
Emergency Medical Evacuation |
US$50,000 |
|
Emergency Reunion |
US$15,000 |
|
Return of Mortal Remains |
US$25,000 |
|
Political Evacuation |
Up to US$10,000 |
|
Accidental Death |
US$25,000 |
|
Dismemberment |
US$25,000 two limbs; US$12,500 one limb |
|
Terrorism Coverage |
Up to US$50,000 lifetime maximum |
|
Sudden Recurrence of a Pre-existing Condition
(U.S. citizens) |
|
|
_Medical |
Up to US$5,000 of eligible expenses |
|
_Emergency Medical Evacuation |
Up to US$25,000 of eligible costs and expenses |
|
Schedule of Benefits |
Benefit Description |
|
Baggage |
|
|
_Loss/theft of Baggage |
US$250 |
|
_Loss/theft of Valuables |
US$250 |
|
_Loss/theft of Personal Papers |
US$250 |
|
Legal Assistance |
|
|
_Binder Fee |
US$500 when served with summons |
|
Personal liability |
|
|
_Injury to third party |
US$2,000 limit after US$100 deductible |
|
_Damage to third person property |
US$500 limit after US$100 deductible.
Secondary to any other insurance in force |
|
Limited high school sports coverage |
|
|
Benefit Description |
|
Maximum Limit |
US$1,000,000 |
|
Coinsurance |
100% |
|
Deductible |
Inpatient: US$100;
Outpatient: US$40 |
|
Treatment Period |
60 days per chronic illness |
|
Hospital Room & Board |
Up to semi-private room rate |
|
Hospital Intensive Care |
URC* |
|
Physical Therapy |
URC*, 1 visit per day |
|
Physician Visit |
URC* |
|
Student Health Center |
US$5 co-pay per visit |
|
Eligible Medical Expenses |
URC* |
|
Urgent Travel Expense |
US$500 |
|
Emergency Room |
URC* |
|
Emergency Illness-with in-patient admission |
URC* |
|
Emergency Illness-without in-patient admission |
Additional US$250 deductible |
|
Dental |
|
|
_Injury due to accident |
US$500 |
|
_Sudden & unexpected pain |
US$350 |
|
Emergency Medical Evacuation |
Maximum Limit |
|
Emergency Reunion |
US$15,000 |
|
Return of Mortal Remains |
US$25,000 |
|
Political Evacuation |
Up to US$10,000 |
|
Accidental Death |
US$25,000 (hazardous sports excluded) |
|
AD&D |
Dismemberment: US$25,000 two limbs; US$12,500
one limb |
|
Terrorism Coverage |
Up to US$50,000 lifetime maximum |
|
Sudden Recurrence of a Pre-existing Conditions
(U.S. Citizens) |
|
|
_Medical |
Up to US$5,000 of eligible expenses |
|
_Emergency Medical Evacuation |
Up to US$25,000 of eligible costs and
expenses |
|
TMJ |
US$5,000 lifetime maximum |
|
High School Sports coverage |
Organized sports coverage; Professional sports
excluded |
|
Baggage |
|
|
_Loss/theft of Baggage |
US$1,000 |
|
_Loss/theft of Valuables |
US$350 |
|
_Loss/theft of Personal Papers |
US$500 |
|
Schedule of Benefits |
Benefit Description |
|
Legal Assistance |
|
_Binder Fee
_Attorney Fees |
US$500 when served with summons
Up to US$20,000 |
|
Sports Coverage |
|
|
_Limited hazardous sports coverage |
No AD&D |
|
Personal liability |
|
|
_Injury to third party |
US$5,000 medical payment sub-limit
after US$100 deductible; Up to US$250,000 maximum with judgment |
|
_Damage to third person property |
US$1,000 sub-limit after US$100
deductible; Up to US$100,000 maximum with judgment |
|
Schedule of Benefits |
Benefit Description |
|
Sports Rider |
Up to Policy Maximum |
|
Chaperone / Faculty Leader Replacement Rider |
Up to US$3,000 for a round trip economy
airline ticket for a replacement Chaperone/ Faculty Leader |
Exclusions :
Charges for the following services, treatments and/or conditions,
among others, are excluded from coverage under the Patriot Group Exchange
Program.
-
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, whether or not
previously manifested or symptomatic, diagnosed, treated, or disclosed prior
to the effective date, including any subsequent, chronic or recurring
complications or consequences related thereto or arising therefrom.
-
Treatment or surgeries which are elective, investigational, experimental
or for research purposes.
-
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.
-
Immunizations and routine physical exams.
-
Treatment of Temporomandibular Joint or dental treatment, except as
expressly provided for in the certificate of insurance.
-
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.
-
Pregnancy, childbirth, birth control, artificial insemination, treatment
for infertility or impotency, sterilization or reversal thereof, or
abortion.
-
Injury sustained while participating in amateur or professional sports
or other athletic activity which is organized and/or sanctioned, or which
involves regular or scheduled practices, games or competition. The following
hazardous activities are excluded: racing of any kind, aviation (except when
traveling as a passenger in a commercial aircraft), BMX, BASE jumping,
bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding,
heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, luge,
motocross (moto-x), mountain biking, mountaineering, parachuting,
rappelling, rock climbing, rodeo, scuba diving, ski jumping, sky diving,
snow skiing, snowboarding, snowmobiling, spelunking, snorkeling, surfing,
wakeboarding, water skiing, wind-surfing and whitewater rafting.
-
Vision or ear tests and the provision of visual or hearing aids.
-
Vocational, recreational, speech or music therapy.
-
Treatment while confined primarily to receive custodial care,
educational or rehabilitative care, or nursing services.
-
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.
-
Treatment for, and injuries and/or illnesses resulting or arising from,
substance abuse or drug addiction.
-
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.
-
Willful self-inflicted injury or illness.
-
Treatment required as a result of or arising from complications from a
treatment or condition not covered under the certificate.
-
Any services or supplies performed or provided by a relative of the
Insured or provided at no cost to Insured.
-
Treatment for mental and nervous disorders.
-
Organ or tissue transplants or related services.
-
Illness or injury where the trip to the host country is undertaken for
treatment or advice for such Illness or injury, except as expressly provided
for in the certificate of insurance.
-
Treatment incurred as a result of or arising from exposure to nuclear
radiation, and/or radioactive material(s).
-
Charges for Treatment of a Chronic Illness incurred beyond sixty (60)
days from the date of initial Treatment thereof.
This web page contains only a consolidated and summary description of all
current Patriot Group Exchange Program benefits, conditions, limitations and
exclusions. A certificate containing the complete Certificate Wording with all
terms, conditions and exclusions will be included in the fulfillment kit. IMG
reserves the right to issue the most current Certificate 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 Certificate Wordings are
available upon request.
|
>
Are you an Insurance Agent looking for
International health coverage for your clients?
Click Here
and sign up to sell Int'l health insurance. Email us with any questions at
info@ciainsagency.com
|
|