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Patriot Extreme® Insurance
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Patriot Extreme® Insurance is designed for the international traveler who engages in extreme sports. Patriot Extreme® Insurance provides coverage for a large array of adventure sports while providing up to US$50,000 of medical coverage. Patriot Extreme® Insurance International provides coverage for US citizens while Patriot Extreme® America provides coverage for non-US citizens.
Patriot Extreme® SUMMARY OF BENEFITS
| SCHEDULE OF BENEFITS |
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| INTERNATIONAL EMERGENCY CARE |
| Emergency Evacuation |
To Policy Maximum when coordinated through the 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 the 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$15,000 when coordinated through the Plan Adminstrator |
If a covered illness/injury results in death, expenses for Repatriation of bodily remains or ashes to the country of residence will be covered upto a maximum of US$15,000. |
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| SPECIAL COVERAGES |
| 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 |
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| 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 |
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| Intensive Care |
To Policy Maximum |
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| Medical Expenses |
To Policy Maximum |
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| Outpatient Medical |
To Policy Maximum |
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| Local Ambulance |
To Policy Maximum |
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| Emergency Roon |
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 a hospital. |
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| 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. |
| 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. |
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| PLAN INFORMATION |
| Deductible |
US$250 per Period of Coverage |
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| 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 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. |
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| The above outline is only a consolidated and summary description of all current Patriot Extreme® Travel Medical Insurance 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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| Patriot Extreme® EXCLUSIONS |
Charges for the following services, treatments and/or conditions are excluded from coverage under Patriot Extreme® .
- 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.
- Treatment or surgeries which are elective, investigational, experimental or for research purposes.
- War, military action, terrorism, political insurrection, protest, or any act thereof.
- Immunizations and routine physical exams.
- Treatment of Temporomandibular Joint or dental treatment, except as provided for herein.
- 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 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.
- 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.
- Vision or hearing 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 or sustained while under the influence of or disablement of drugs or alcohol.
- Willfull self-inflicted injury or illness, and injury due to reckless endangerment or needless peril.
- Treatment required as a result of or arising from complications from a treatment or condition not covered hereunder.
- 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 provided for herein.
- 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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