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PatriotAmericaPlusTravelInsurance
Pleaseusethishighlevelinformationasaguideonlyanddonotmakeanydecisionssolelybasedonthiscomparison.If
youhaveanyconcerns,doubtsorquestions,pleaserefertotheindividualpolicydetailsforcompleteinformationasitisnot
possibletoaccuratelyrepresentallthedetailsinconciseinformationsuchasfollows.Please call us for further details. If
thereisanydiscrepancybetweenthiscomparisonandtheactualpolicydetails,thepolicydetailswilloverride.
AlltheamountsareinU.S.dollars.
Routinephysicalsandvision(eyeglassesetc.)arenotcoveredinanyoftheplans.

Purchase
Plantype

Coinsurance

Comprehensive
InU.S./Canada:Afterdeductible,youpay10%(20%outsidenetwork)ofthefirst
$5,000incoveredexpenses,restcoveredat100%uptoselectedpolicy
maximum.
OutsideU.S./Canada:Afterdeductible,coveredat100%uptoselectedpolicy
maximum.

MEDICALOUTPATIENT
Doctor/urgentcarevisits

Topolicymaximum
Topolicymaximum.

Hospitalemergencyroom(all
expensesincurredtherein)

Extra$250penalty/visitifERvisitforasickness(notinjury/accident)doesnot
resultindirecthospitaladmission.

Prescriptiondrugs

Topolicymaximum,maximumsupplyof90daysperprescription

Diagnosticxrayslabservices

Topolicymaximum

Surgicaltreatment

Topolicymaximum

Anesthetist

Topolicymaximum

Assistantsurgeon

20%ofprimarysurgeoncharge.Nostandbyavailabilitycoverage

Outpatientsurgicalfacility

Topolicymaximum

MEDICALINPATIENT
Hospitalroomandboardincluding
miscellaneous

Topolicymaximum,averagesemiprivateroom

Intensivecareunit

Topolicymaximum

Surgicaltreatment

Topolicymaximum

Anesthetist

Topolicymaximum

Assistantsurgeon

20%ofprimarysurgeoncharge.Nostandbyavailabilitycoverage

Physician'snonsurgicalvisits

Topolicymaximum

Consultphysician,whenrequested
byattendingphysician

Topolicymaximum

Preadmissiontestswithin7days
beforehospitaladmission

Topolicymaximum

MEDICALOTHERTREATMENTANDSERVICES
Cardiovascularevent

Sameasanyothereligiblemedicalexpense

Localambulance

Topolicymaximumforcoveredillnessthatresultsinhospitalizationasinpatient
orforcoveredinjury

Initialorthopedicprosthesis/brace

Topolicymaximum

Chemotherapyand/orradiation
therapy

Topolicymaximum

Mental&nervousdisorder&
substanceabuse

Maternity

Physicaltherapy

Topolicymaximum

Preexistingconditions

Acuteonsetonly.Medicaltopolicymaximumand$25,000medicalevacuation
forpersonsunderage70

PPOwithinUSA

Yes.Coventry/FirstHealthPPO

PPOoutsideUSA

Yes

Hazardoussports

Optional

Benefitperiodforcontinued
treatmentfollowingtermination
dateofpolicy

6months

DENTAL
DentalAcute,unexpectedpain

$100

DentalAccidentrelated
emergency

Topolicymaximum

TRAVEL
Emergencymedical
evacuation/repatriation

$500,000

Returnofmortalremains

$50,000

Localburial/cremation

$5,000

Emergencyreunion

$50,000

Returnofminorchild(ren)

$50,000

Tripcancellation

Tripinterruption

$5,000

Lossofcheckedluggage

$50peritem,$250max

LIFE

AccidentalDeath&
Dismemberment(AD&D)

$25,000

Commoncarrieraccidentaldeath

$50,000perperson.Max$250,000perfamily

OTHER
Homecountrycoverage

IncidentalandOptionalEndofTrip

Terrorismcoverage

$50,000

Identitytheftassistance

$500

Hospitalindemnity

$100/night,max10nights

Naturaldisasterbenefit

$100/day,5days

PLANFEATURES

Details

Brochure
HowPlanWorks
CertificateWording
ProviderDirectory
5daysRenewable
RxDiscountCard
OptionalCoverages

Renewable

Yes,renewableformin.5daysifpurchasedmin.1monthinitially

Cancellationpolicy

Beforeeffectivedate,fullrefund.Aftereffectivedate,proratedrefundminus$50
cancellationfeeaslongasnoclaimshavebeenfiledsincetheeffectivedate.

Policydurations

multiplesofdays(min5days)max2years

Applicationfee

$0

Membershipfee

$0

Creditcardsaccepted

Availabledeductibles
ByAge

Annual
$0
$100
$250
$500
$1,000
$2,500

Policymaximumoptions
ByAge

lifetimemaximum
$10,000Age80+
$50,000Upto79
$100,000Upto69
$500,000Upto69

Claimsadministrator

InternationalMedicalGroup(IMG)

Insurancecompany/Carrier/
Underwriter

SiriusInternational

A.M.Bestrating

A"Excellent"

A.M.Bestrating
Remarks

A"Excellent"
$5renewalfee(<1month)

Topolicymaximumabovereferstotheusual,reasonableandcustomarycharges(URC).
Coveragesshownaboveareperpersonunlessnotedotherwise.

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