Medical Insurance
  Home   Contact Us   Guide   Send to Friend  

Source Id:
bai


US/Canada: (866) INSU-BUY, International: (972) 985-4400
Patriot GoTravelSM International - Travel Medical Insurance
US citizens. 5 days-2 years.
Instant Quotes & Purchase
Paper Application

Printer Friendly     PDF Brochure
Why Consider Travel Insurance?
Traveling abroad can be an exciting experience. But what would happen if you or one of your family members became ill or injured while away from home? International travel can quickly turn frightening if you’re not prepared for a medical emergency.

Most travelers assume they will be covered by their standard medical plan. The truth is, while traditional plans may offer adequate domestic coverage, they are not designed for international travel. Without even realizing it, you may be putting your health - and that of your family - at risk.

You have enough to worry about when you’re traveling. Don’t let your medical coverage be an uncertainty. International Medical Group® (IMG®) has developed two Patriot GoTravelSM plans to provide you and your family Coverage Without Boundaries®. Each plan offers a complete package of international benefits available 24 hours a day. Simply select the one that best fits your needs.

INTRODUCTION
Patriot GoTravel International provides coverage for U.S. citizens traveling outside the U.S. for a minimum of 10 days up to a maximum of two years. If the plan is purchased for a minimum of three months, coverage may be renewed (without break in coverage) for a total of up to two years. See the “Renewal of Coverage” section on page 8 for more information.

A Unique, Full-Service Approach
At IMG, we know that the reasons to travel abroad are many and varied - that’s why our services are designed to provide you with the security you need no matter where you are. Our goal is to make the medical process smooth and efficient. By providing global products and services to vacationers, those working or living abroad for short or extended periods, people traveling frequently between countries, and those who maintain multiple countries of residence, IMG is the single resource for all your international travel needs.

How we service and support your needs is what sets us apart. Since 1990, we’ve served more than a million people around the globe - always focused on the specific needs of each individual. We’ve set the benchmark for industry service levels by integrating independent credentialing services with in-house, fully owned and operated service divisions. At IMG, we’re with you, wherever you go - bringing support for all your insurance needs around the globe - providing you Global Peace of Mind®.

MyIMGSM
MyIMG is our proprietary online service that lets you access a wealth of information and manage routine areas of your account 24 hours a day, seven days a week, from anywhere in the world. You can check the status of your claims submissions, retrieve explanation of benefits, obtain certificate documents, initiate precertification and access a list of physicians within the Preferred Provider Organization (PPO) as well as through the International Provider AccessSM (IPA), a database of over 16,000 providers outside the United States!

Locating a Provider
With the Patriot GoTravel plan, you may seek treatment with the hospital or doctor of your choice. When seeking treatment in the U.S., you can reduce your out-of-pocket costs by using the independent PPO, a separately organized network of hundreds of thousands of established, highly qualified health care physicians and many well-recognized hospitals in the U.S. contracted by IMG.

IMG also provides its International Provider Access (IPA) database online that can be used to locate health care providers outside the U.S. as needed.

(Note: Use of this service is subject to the terms and conditions specified online. These terms must be agreed to prior to using the service.) You may access these services at provider directory ).

Akeso Care Management® (ACM ®)
The ability to access quality health care is of paramount importance when a medical emergency arises abroad. To coordinate care and provide U.S. and internationally based medical management services, IMG formed ACM, a URAC accredited, on-site specialized division devoted entirely to medical management. ACM’s clinical members are experts at assessing the need for services and ensuring those services are delivered in a timely, cost-effective manner.

From routine medical care to complex case management, from check-ups to emergency medical evacuations, ACM is there for you. They are committed to consumer protection and empowerment, quality operations and regulatory compliance. This translates into better care for you - around the world, around the clock.

Schedule of Benefits

All coverages, benefits and premium amounts shown in this brochure are in U.S. dollars

PLAN INFORMATION
Deductible
Your choice of $0, $100, $250, $500, $1,000 or $2,500
Coinsurance
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 $5,000, then 100% up to the Policy Maximum
  Out of the PPO Network
The plan pays 80% of eligible expenses up to $5,000, then 100% up to the Policy Maximum

MEDICAL BENEFITS
Usual, reasonable and customary charges, subject to deductible and coinsurance
Hospital Room and Board
Up to Policy Maximum for average semi-private room rate
Intensive Care
Up to Policy Maximum
Medical Expenses
Up to Policy Maximum
Outpatient Medical
Up to Policy Maximum
Local Ambulance
Up to Policy Maximum
Prescription Drugs
Up to Policy Maximum
Emergency Room Accident
Up to Policy Maximum
Emergency Illness- with in-patient admission
Up to Policy Maximum
Emergency Illness- without in-patient admission
Up to Policy Maximum with additional $250 deductible

This is a summary of benefits only. Please see below for a list of benefit descriptions.

ADDITIONAL BENEFITS
Benefit Period
Six months
Incidental Home Country Coverage
Up to a cumulative two weeks
End of Trip Home Country Coverage
One month for every five months of travel coverage purchased, up to maximum of two months
Common Carrier Accidental Death
$50,000 to beneficiary; maximum of $250,000 per family
Sports & Activities Coverage
Up to Policy Maximum for basic sports
Accidental Death & Dismemberment
$25,000 principal sum
Terrorism Coverage
Up to $50,000 lifetime maximum
Identity Theft Assistance
Up to $500 per Period of Coverage
Natural Disaster
$100 per day for five days
Trip Interruption
Up to $5,000

ADDITIONAL BENEFITS FOR U.S. CITIZENS ONLY
Indemnity
Up to $100 per night
Sudden Recurrence of a Pre-existing Condition
 
  Medical
Up to $15,000 of eligible expenses

This is a summary of benefits only. Please see below for a list of benefit descriptions.

RATES

ONE MONTH RATES
 
$50,000
$100,000
$500,000
$1,000,000
$2,000,000
Age
One Month
One Month
One Month
One Month
One Month
18-29
$29
$34
$40
$44
$50
30-39
$34
$40
$53
$58
$66
40-49
$54
$61
$67
$75
$91
50-59
$88
$100
$112
$125
$141
60-64
$100
$119
$141
$166
$185
65-69
$119
$127
$146
$174
$224
70-79
$174
N/A
N/A
N/A
N/A
80+*
$348
N/A
N/A
N/A
N/A
Dep. Child
$17
$21
$25
$26
$31
Child Alone
$29
$33
$38
$42
$48
*$10,000 Maximum

DAILY RATES (5 day Minimum)
 
$50,000
$100,000
$500,000
$1,000,000
$2,000,000
Age
Daily
Daily
Daily
Daily
Daily
18-29
$1.00
$1.15
$1.35
$1.50
$1.65
30-39
$1.15
$1.35
$1.75
$1.95
$2.20
40-49
$1.80
$2.05
$2.25
$2.50
$3.05
50-59
$2.95
$3.35
$3.75
$4.20
$4.70
60-64
$3.35
$3.95
$4.70
$5.55
$6.20
65-69
$3.95
$4.25
$4.85
$5.80
$7.50
70-79
$5.80
N/A
N/A
N/A
N/A
80+*
$11.60
N/A
N/A
N/A
N/A
Dep. Child
$.55
$.70
$.85
$.90
$1.05
Child Alone
$1.00
$1.10
$1.25
$1.40
$1.60
*$10,000 Maximum

Premiums shown above are for $250 annual deductible. If you would like to choose different deductible, the following deductible factors apply.
Deductible
Factor
$0
+25%
$100
+10%
$500
-10%
$1000
-20%
$2500
-30%

ENHANCED AD&D RIDER
Monthly Rates - Coverage must be purchased for a minimum of three months
Up to $100,000 additional coverage    $8
  Up to $200,000 additional coverage    $16
  Up to $300,000 additional coverage    $24
  Up to $400,000 additional coverage    $32

All premium rates are effective through 12/31/09. Rates include surplus lines tax where applicable. A dependent child is your child shown on the Application Form over 14 days and under 18 years of age, traveling with you, and for whom premium has been paid. The maximum amount of coverage for applicants who are 80 years of age or older is $10,000.

 

OPTIONAL RIDERS
With the exception of the Enhanced AD&D Rider, optional riders apply to all individuals listed on the Application Form.
Extreme Sports Rider
(available to the primary insured only)
Age
Lifetime Maximum
0-49
$50,000
50-59
$30,000
60-64
$15,000
Enhanced AD&D Rider
(available to the primary insured only)
Up to an additional $400,000

This is a summary of optional rider benefits only. Please see below for a list of optional rider descriptions.

UNIVERAL RX PHARMACY DISCOUNT SAVINGS
This is a discount savings program available to every certificate holder of the Patriot GoTravel plans. This program allows card members to purchase prescriptions at one of over 35,000 participating pharmacies in the U.S. and receive the lower of 1) Universal Rx contract price or 2) the pharmacy regular retail price.

This discount program is not insurance coverage. It is purely a discount program to purchasers of the Patriot GoTravel plans. Use of the discount card does not guarantee that prescribed medication is covered under the insurance benefit plan.

QUALITY GUARANTEE
Your satisfaction is very important to IMG and the plan underwriter. If you are not pleased with this product for any reason, you may submit a written request, prior to your effect date for cancellation and refund of your premium. If you do not have any claims filed with IMG, you may cancel your plan after your effective date, however, the following conditions will apply: 1) you will be required to pay a $50 cancellation fee and 2) only full month premiums will be considered for refunds (e.g., if you choose to cancel your coverage two months and two weeks prior to the date your coverage ends, IMG will only consider the two full months for a refund). If you have filed claims, your premium is nonrefundable.

CONDITIONS OF COVERAGE
1. Coverage and benefits are subject to the deductible and coinsurance, and all terms of the certificate of coverage and Master Policy.
2. Coverage under a Patriot GoTravel plan is secondary to any other coverage.
3. Coverage and benefits are for medically necessary, usual, reasonable and customary charges only.
4. Charges must be administered or ordered by a physician.
5. Charges must be incurred during the Period of Coverage or the Benefit Period.
6. Claims must be presented to IMG for payment within the Period of Coverage, Benefit Period or during the three months immediately following the Period of Coverage.

ELIGIBILITY REQUIREMENTS
The following conditions apply to all persons applying for and/or enrolling in Patriot GoTravel.
  • Patriot GoTravel International is travel insurance for U.S. citizens traveling outside the United States.
RENEWAL OF COVERAGE
If Patriot GoTravel International is purchased for a minimum of three months, coverage may be renewed (without break in coverage) for a total of up to two years. Renewals are available in whole month or daily increments and may be completed online or by using a paper application, however, renewals of less than one month are available only online. For each renewal of less than one month completed online, you will be charged an additional $5 processing fee. Each insured person must only satisfy one deductible and coinsurance within each 12 month coverage period. Please note: Renewal rates may differ from initial rates.

ENROLLMENT PROCESS & APPLICATION FORM
You should read the following important information prior to completing the Application Form.

HOW TO ENROLL
You may either apply online for Instant Quotes & Purchase or make Paper Application

If you are applying online, no papers are required to be mailed or faxed. If you are making paper application, you can either fax the credit card applications to (972) 767-4470 or mail all applications to

BuyAmericanInsurance.com
3105 Broken Bow Way,
Suite 100
Plano, TX 75093 USA

You can apply over the phone as well by calling toll-free (866) INSU-BUY.

You, your spouse and unmarried dependent children (over 14 days and under 18 years of age) listed on the Application Form and for whom premiums have been paid will be covered from the latest of the following dates:
  1. the date IMG receives your completed Application Form and the appropriate premium;
  2. the date you depart from your home country; or
  3. the date requested on your Application Form.
Patriot GoTravel 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 Application Form; or
  3. the date you return to your home country (however, see Home Country Coverage for incidental coverage).
ENROLLMENT PROCESSING & FULFILLMENT KITS
IMG normally processes Application Forms within 24 hours of receipt. Once processing is complete, IMG will mail a fulfillment kit to the mailing address listed on the Application Form. The fulfillment kit will include an IMG Identification Card, IMG contact numbers, Claim Forms and your insurance certificate providing a complete description of your rights and benefits under the contract. Please note: If you require express mail delivery, there is an additional charge listed on the Application Form.

ONLINE FULFILLMENT KIT
For your convenience, you may choose to download your fulfillment kit from the our website rather than having it mailed to you. To do this, you must check the appropriate box listed in Section 2 of the Application Form. We must have your correct email address to complete this process. Once IMG has received and processed your Application Form, you will receive an email from IMG that contains all of the hyperlinks to easily obtain the fulfillment information through the Internet.

CLAIMS PROCEDURE
PRECERTIFICATION
Each proposed hospital admission, inpatient or outpatient surgery, and other procedures as noted in the Certificate Wording must be Precertified for medical necessity, which means the insured person or their attending physician must call the number listed on the IMG Identification Card prior to admittance to a hospital or performance of a surgery. In case of an Emergency Admission, the Precertification call must be made within 48 hours of the admission, or as soon as reasonably possible. If a hospital admission or a surgery is not Precertified, eligible claims and expenses will be reduced by 50%. It is important to note that Precertification is only a determination of medical necessity, not an assurance of coverage, verification of benefits or a guarantee of payment. All medical expenses must meet usual, reasonable, customary, and eligible payment guidelines. Please refer to the Certificate Wording for full details of the Precertification requirements.

For precertification, emergency evacuation, and return of mortal remains, please call: IMG in the U.S.: 1.800.628.4664 (toll free) or 1.317.655.4500. Call IMG outside the U.S.: 001.317.655.4500 (collect if necessary). This information will also be provided on your ID card.

Note: An insured person may begin the precertification process at IMG's web site. Simply click the "Current Clients" title, then click the "Initiate Precertification" option. You will be asked to provide the required information, which can then be submitted electronically to IMG. The Medical Department at IMG will notify you upon receipt of the email, and once IMG has received the request, IMG's utilization management and review team will review the information provided and respond to the insured person or the provider within 2 business days. Please note that this online service will only initiate the precertification process, and it should not be used to precertify emergency admissions, procedures, or evacuations.

CLAIM PAYMENT
All benefits payable under Patriot GoTravel are subject to the provisions described in this brochure and as contained in the Certificate Wording and certificate of coverage. To make claim processing efficient, claims may be paid in two ways.
  1. Eligible claims that have been paid by or on behalf of the Insured Person will be reimbursed by check directly to the Insured Person.
  2. Eligible claims that have not yet been paid by the Insured Person will, at the option of IMG, be paid either to the Insured Person or directly to the provider.
Please mail completed claim forms to International Medical Group, P.O. Box 88500, Indianapolis, IN 46208-0500 USA. All IMG contact numbers, claim forms and Certificate Wordings will be included in the fulfillment kit. IMG may also be contacted by fax: 317-655-4505

DESCRIPTION OF BENEFITS
The following is a partial list of benefits and terms that are offered on the Patriot GoTravel plans.

DEDUCTIBLE:
On the Application Form, you will be asked to circle your choice of a deductible. Your premium rate is dependent on the deductible you choose. Please see the Application Form for more information.

EMERGENCY ROOM:
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) $250 deductible if treatment does not require admittance to the hospital.

SUDDEN RECURRENCE OF A PRE-EXISTING CONDITION:
(U.S. citizens only) Up to $15,000 will be paid for the eligible expenses of a sudden and unexpected recurrence of a Pre-existing Condition (defined below) while traveling outside of the U.S. In addition, up to $25,000 will be paid for the eligible costs and expenses of an Emergency Medical Evacuation arising or resulting from a sudden and unexpected recurrence of a Pre-existing Condition.

INDEMNITY:
(U.S. citizens only) Patriot GoTravel International will pay directly to the insured person $100 for each night of a required overnight stay in a hospital. However, the hospital stay must be covered under this plan in order to receive this benefit.

BENEFIT PERIOD:
If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the six-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 six months before the Period of Coverage expired, benefits for the covered injury or illness will continue subject to the Policy Limits and the other terms of the plan until there have been six months of continuous coverage for the covered injury or illness.

INCIDENTAL HOME COUNTRY COVERAGE:
During the Period of Coverage an insured person may return to their home country for incidental visits up to a cumulative two weeks total, subject to:
  1. The insured person must have left their home country,
  2. The total Period of Coverage must be for a minimum of 30 days, and
  3. The return to the home country may not be taken to receive treatment for an illness or injury incurred while traveling.
END OF TRIP HOME COUNTRY COVERAGE:
For every five months of continuous coverage you purchase, you can purchase one additional month of home country coverage as an accommodation and supplemental travel benefit, up to a maximum of two months. To purchase this special home country extension coverage, please check the appropriate box on the Application Form, and calculate your premium to include the additional month(s).

SPORTS AND ACTIVITIES COVERAGE:
Each Patriot GoTravel plan covers injuries incurred during amateur athletic activities which are non-contact and engaged in by the insured person solely for leisure, recreation, entertainment or fitness purposes. However, activities not covered include 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 unless the Extreme Sports Rider is purchased: abseiling, aviation (except when traveling as a passenger in a commercial aircraft), BMX, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, mountain biking, paragliding, parascending, rappelling, rock climbing, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, surfing, trekking, windsurfing and whitewater rafting.

Racing of any kind, BASE jumping, mountaineering, climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, rodeo activity, ski jumping, whitewater rafting exceeding Class V difficulty; and/or extreme sports not expressly covered hereunder are excluded regardless of which plan or rider is selected.

ACCIDENTAL DEATH AND DISMEMBERMENT:
Each Patriot GoTravel plan includes $25,000 principal sum benefit for Accidental Death and Dismemberment occurring during the Period of Coverage: • Accidental Loss of life - principal sum; • Accidental Loss of two Members - principal sum; • Accidental Loss of one Member - 50% of principal sum. "Member" means hand, foot or eye.

COMMON CARRIER ACCIDENTAL DEATH:
If accidental death should occur while traveling on a commercial Common Carrier, $50,000 will be paid to the designated beneficiary, to a maximum of $250,000 per family.

NATURAL DISASTER:
This benefit is available in the event an insured person is required to depart his/her destination due to an evacuation order issued by prevailing authorities in connection with a Natural Disaster. Natural Disaster is defined as widespread disruption of human lives by disasters such as flood, drought, tidal wave, fire, hurricane, earthquake, windstorm, or other storm, landslide, or other natural catastrophe or event resulting in migration of the population for its safety.

TRIP INTERRUPTION:
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, each Patriot GoTravel 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.

TERRORISM COVERAGE:
Each Patriot GoTravel plan provides coverage for injuries and illness incurred as a result of an act of Terrorism, limited in amount and by circumstances. If an insured person is injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims subject to a $50,000 lifetime maximum. However, claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered.

Terrorism is defined as the systematic or planned use of violence, fear, or threat of violence in order to intimidate a population or government, especially as a means of coercion or to obtain a granting of any demand. However, this benefit does not cover an act of Terrorism in any country or location where the United States government has issued a travel advisory that has been in effect within the 6 months prior to the insured person's date of arrival.

This benefit also does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location.

IDENTITY THEFT ASSISTANCE:
If an imposter obtains key personal information such as a Social Security or Driver's License number, or other method of identifying an insured person in order to impersonate or obtain credit, merchandise or services in the insured person’s name, the Patriot GoTravel plans will provide coverage for the reasonable, customary and necessary costs incurred by the insured for: re-filing a loan or other credit application that is rejected solely as a result of the stolen identity event; notarization of legal documents, long distance telephone calls, and postage that has resulted solely as a result of reporting, amending and/or rectifying records as a result of the stolen identity event; up to three credit reports obtained within one year of the insured person’s knowledge of the stolen identity event; and stop payment orders placed on missing or unauthorized checks as a result of the stolen identity event.

The identity theft event must occur during the Period of Coverage and must be reported within 6 months of the termination of coverage date.

DESCRIPTION OF OPTIONAL RIDERS
EXTREME SPORTS RIDER:
The Extreme Sports Rider is available on both Patriot GoTravel plans for those up to the age of 65. The following activities are covered to the lifetime maximum amounts listed on page 7: abseiling, aviation, BMX, bobsleigh, bungee jumping, canyoning, caving, flying (private plane), hang gliding, heli-skiing, high diving, hot air ballooning, inline skating, jet skiing, kayaking, mountain biking, paragliding, parascending, rappelling, rock climbing (ropes and guides to 4500m from ground level), skydiving, snow boarding, snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), wind-surfing. These extreme activities must be engaged in solely for leisure, recreation, or entertainment purposes.

ENHANCED AD&D RIDER:
This optional coverage is available for the primary insured person only. This coverage is in addition to the Accidental Death and Dismemberment already included in the Patriot GoTravel plans. Coverage must be purchased for a minimum of three months.


EXCLUSIONS
Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under the Patriot GoTravel plans.
1. 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.
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.
4. Immunizations and routine physical exams.
5. Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.
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 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 unless the Extreme Sports Rider is purchased: abseiling, aviation (except when traveling as a passenger in a commercial aircraft), BMX, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, mountain biking, paragliding, parascending, rappelling, rock climbing, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, surfing, trekking, wind-surfing and whitewater rafting.

Racing of any kind, BASE jumping, mountaineering, climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, rodeo activity, ski jumping, whitewater rafting exceeding Class V difficulty; and/or extreme sports not expressly covered hereunder are excluded regardless of which plan or rider is selected.
9. Vision or ear tests and the provision of visual or hearing aids.
10. Vocational, recreational, speech or music therapy.
11. Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
12. 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.
13. Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
14. 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.
15. Willful self-inflicted injury or illness.
16. Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.
17. Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
18. Treatment for mental and nervous disorders.
19. Organ or tissue transplants or related services.
20. 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.
21. Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).

This brochure contains only a consolidated and summary description of all current Patriot GoTravel 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.



PROTECTING YOUR TRAVEL INVESTMENT
You can spend a great deal of time planning your trip and it is exciting getting everything ready. But what would happen if the airline you selected should go out of business or you’re prevented from taking your trip? Your hard-earned payments could be lost. To help protect you from losing the money you’ve spent to travel, IMG works with iTravelInsured® (iTI®) to bring you the Patriot T.R.I.P Lite program.

PATRIOT T.R.I.P. LITE
This iTI program is designed to provide peace of mind so you can enjoy your travels. The benefits are outlined below and program cost information can be found on the back of the Application Form.

SCHEDULE OF BENEFITS
Trip cancellation
Trip cost up to $20,000
Travel delay
$500 ($100 per day after 24 hours or up to $500 for missed connection)
Baggage delay
$100

Trip Cancellation - Provides coverage for the loss of non-refundable, unused payments when a trip is cancelled prior to departure due to: emergency illness, injury or death to you, a family member or travel companion; financial default; a terrorist incident; jury duty; home made uninhabitable by fire, wind, storm, flood, or vandalism; quarantine; auto accident on way to airport; job termination; cancelled leave for active duty military, police or fire fighters.

Travel Delay - Reimburses you up to $100 per day for reasonable additional accommodations and traveling expenses, not otherwise paid by a travel supplier or common carrier, when your trip is delayed for more than 24 hours caused by: travel supplier delay, lost or stolen passport, medical quarantine, natural disaster, or emergency illness or injury to you or a travel companion.

Baggage Delay - Reimburses you for the costs you incur to buy reasonable additional clothing and essential personal items when your checked baggage is delayed by a common carrier for more than 24 hours from the actual time of arrival at a destination.

NSBTHA
When you purchase a Patriot T.R.I.P. Lite program you automatically become a member of the National Small Business Travel & Health Association (NSBTHA). Through this association members may access travel insurance, emergency travel assistance services, and information about events, legislation, and other matters that affect travel. Information about NSBTHA is available at www.NSBTHA.org.

Certificate Form No. iTI100-11

T.R.I.P. LITE EXCLUSIONS
IMG will not pay for any Illness, Injury or loss caused by or as a result of:
1. A Pre-Existing Condition, except as waived by Us under the terms of the Policy.
2. War or any act of war (whether declared or undeclared), civil disturbance, riot or insurrection.
3. Serving in one of the armed forces of any country or international authority.
4. Operating, learning to operate, piloting or riding in or on any aircraft or flying device, other than riding as a passenger in a licensed commercial aircraft.
5. Suicide or attempted suicide, while sane; intentionally self-inflicted Injury or Illness.
6. Being under the influence of any intoxicant, drug or narcotic unless prescribed by a Physician.
7. Training, practicing or participating in any motor sport or motor racing.
8. Parachuting, hang gliding, parasailing, hot air ballooning, scuba diving below 135 feet or any type of scuba diving without the proper diving training and certification from a professional organization, rock or mountain climbing, or hunting.
9. Pregnancy or childbirth when You are expected to give birth within two months from the date of a Covered Trip or an elective abortion.
10. Traveling against the advice of a Physician, traveling while on a waiting list for inpatient Hospital or clinic treatment, or traveling for the purpose of obtaining medical treatment abroad.
11. Taking part in any scheduled athletic event or competition.
12. Any emotional, psychological, mental or nervous disorder.
13. Any potentially fatal condition which was diagnosed before the date Your coverage became effective, or any condition for which You are traveling to seek treatment.
14. Dental treatment due to normal wear and tear or the normal maintenance of dental health.

T.R.I.P. LITE PRE-EXISTING CONDITIONS
The Pre-Existing Condition exclusion is waived if coverage is purchased within 14 days after the date your initial payment for the covered trip was paid to the travel supplier. Insureds also must be medically able to travel on the date coverage is purchased.

If the Pre-Existing Condition exclusion is not waived, your pre-existing condition might still be covered if the answer to all of the following questions is “no.” 1. Were you treated for a new illness in the last 60 days? 2. Has your condition worsened or required medical attention in the past 60 days? 3. Have you received any new medications in the past 60 days or have any of your current dosages been changed?

This is a summary of the principal provisions of the master policy offered through NSBTHA for its members. It is not considered to be a contract of insurance. Coverage may vary by state and may not be available in all states. For more information regarding the exclusions and all other terms and conditions of Patriot T.R.I.P. Lite, please see the certificate wording for your state which is available upon request.

This brochure is not intended to be an offer to sell Patriot T.R.I.P. Lite or a solicitation by iTravelInsured in any jurisdiction where such action would be unlawful or in which iTravelInsured is not qualified to do so.

Insurance products are underwritten and offered where available by Delos Insurance Company, New York, NY 10036.

PLAN ADMINISTRATOR AND UNDERWRITER
Plan Administrator:
As the Plan Administrator for Patriot GoTravelSM, IMG acts as the authorized agent for and on behalf of Sirius International.

International Medical Group®, Inc.
P.O. Box 88509
Indianapolis, IN 46208-0809, USA

Plan Underwriter:

These Patriot GoTravel plans are surplus lines products underwritten by Sirius International Insurance Corporation (publ), rated A (excellent) by A.M. Best and A- by Standard & Poor’s (at the time of printing). Sirius International is a White Mountains Re company.

IMG, International Medical Group, the IMG block design logo, imglobal, Patriot GoTravel, Patriot GoTravel International, Patriot GoTravel America, Coverage Without Boundaries, and Global Peace of Mind are the trademarks, service marks and/or registered marks of International Medical Group, Inc.

Sirius, Sirius International, and the Sirius design logo are the trademarks, service marks and/or registered marks of Sirius International Insurance Corporation (publ).