|
Protection International - International Travel Insurance
US citizens. 5 days-3 years.
|
|
Protection InternationalSM provides coverage for US citizens traveling outside the U.S. for a minimum of 5 days up to a maximum of 3 years. Protection International is renewable (without break in coverage) for 5 days up to 12 months per renewal for a total of up to 3 years. For each renewal of less than one month, you will be charged a fee of US$5 in addition to the premium costs. An insured person must only satisfy one deductible and coinsurance within each yearly coverage period. If you or other family members applying for coverage are age 65 or older, please see the Eligibility section for additional information.
In addition to the benefits listed below, Protection International for US citizens also provides the two benefits outlined below, subject to all Conditions of Coverage.
Sudden Recurrence of a Pre-existing Condition - Up to US$15,000 will be paid for the eligible expenses of a sudden and unexpected recurrence of a Pre-existing Condition while traveling outside of the US. In addition, up to US$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. For the definition of a Pre-existing Condition, please see Exclusion number 1 in the Exclusions section.
Indemnity - Under the Protection International plan, US$100 will be paid directly to the insured person for each night of a required and covered overnight stay in a hospital.
| |
| POLICY LIMIT |
Option 1
$50,000
|
Option 2
$100,000
|
Option 3
$500,000
|
Option 4
$1,000,000
|
Option 5
$2,000,000
|
| |
|
AGE
|
Monthly Rate |
|
18-29
|
$37.00
|
$43.00
|
$49.00
|
$55.00
|
$61.00
|
|
30-39
|
$43.00
|
$49.00
|
$65.00
|
$71.00
|
$81.00
|
|
40-49
|
$67.00
|
$75.00
|
$83.00
|
$91.00
|
$111.00
|
|
50-59
|
$107.00
|
$123.00
|
$137.00
|
$153.00
|
$171.00
|
|
60-64
|
$123.00
|
$145.00
|
$171.00
|
$201.00
|
$225.00
|
|
65-69
|
$145.00
|
$155.00
|
$177.00
|
$211.00
|
$271.00
|
|
70-79
|
$211.00
|
N/A
|
N/A
|
N/A
|
N/A
|
|
80+*
|
$428.00
|
N/A
|
N/A
|
N/A
|
N/A
|
|
DEP. CHILD
|
$21.00
|
$27.00
|
$31.00
|
$33.00
|
$39.00
|
|
CHILD ALONE
|
$37.00
|
$41.00
|
$47.00
|
$51.00
|
$59.00
|
| |
|
AGE
|
Daily Rates (Minimum length of coverage is 5 days) |
|
18-29
|
$1.25
|
$1.45
|
$1.65
|
$1.85
|
$2.05
|
|
30-39
|
$1.45
|
$1.65
|
$2.15
|
$2.40
|
$2.70
|
|
40-49
|
$2.25
|
$2.50
|
$2.75
|
$3.00
|
$3.70
|
|
50-59
|
$3.60
|
$4.10
|
$4.55
|
$5.15
|
$5.70
|
|
60-64
|
$4.10
|
$4.85
|
$5.70
|
$6.70
|
$7.50
|
|
65-69
|
$4.85
|
$5.15
|
$5.90
|
$7.05
|
$9.05
|
|
70-79
|
$7.05
|
N/A
|
N/A
|
N/A
|
N/A
|
|
80+*
|
$14.25
|
N/A
|
N/A
|
N/A
|
N/A
|
|
DEP. CHILD
|
$0.70
|
$0.90
|
$1.00
|
$1.10
|
$1.30
|
|
CHILD ALONE
|
$1.25
|
$1.35
|
$1.55
|
$1.70
|
$2.00
|
* US$15,000 Maximum
All premium rates are in US dollars and are effective through 12/31/08. Rates include 2.5% 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.
Premiums shown above are for $250 annual deductible.
If you would like to choose different deductible, the following deductible factors apply.
|
|
|
|
$0
|
+25%
|
|
$100
|
+10%
|
|
$500
|
-10%
|
|
$1000
|
-20%
|
|
$2500
|
-30%
|
|
As an international traveler, you know that traveling abroad can be an exciting experience. But you also know that the unexpected could happen. What would happen if you or one of your family members became ill or injured while away from home?
Most travelers assume they will be covered by their standard medical plan. The truth is, while traditional plans may offer adequate domestic coverage, they may not be designed for international travel. Without even realizing it, you may be putting your health - and that of your family - at risk.
You have enough things to worry about when you’re traveling. Don’t let your medical coverage be one of them. International Medical Group® (IMG®) has developed two Passport Protection PlusSM plans to provide you and your family Coverage Without Boundaries®. Each plan offers a complete package of international benefits and 24 hour availability. Simply select the one that best fits your needs.
In addition to providing a wide range of benefits, these plans also offer you flexibility. Your travel schedule can change unexpectedly and you need coverage that can adapt to those changes. With Passport Protection Plus, you have the option of extending or cancelling your coverage as necessary. You can renew your coverage for as little as five days or as long as 12 months. You can also cancel your coverage as outlined in the plan.
Since 1990, International Medical Group has provided a unique, full-service approach to insurance coverage. Dedicated exclusively to the international insurance market, IMG provides coverage services to individuals and families in more than 150 countries.
Medical treatment while traveling is often an unfortunate fact of life. IMG's goal is to make the medical process a smooth and efficient one. IMG’s multilingual claims administrators, on-site medical staff and customer service professionals work together to ensure that your medical needs are met. IMG processes as many as 100,000 claims each year from countries throughout the world, and can confidently handle virtually any language or currency.
To give you true Global Peace of Mind ®, IMG representatives are available 24 hours a day, seven days a week, 365 days a year for medical emergencies, evacuations and precertification. IMG's customer service is routinely rated among the highest in the industry. You can rest assured that IMG will be there for you, whether it be for routine treatment or during a medical emergency.
IMG gives you worldwide coverage experience, impeccable service and international expertise. Don’t leave your medical care to chance. Let IMG reduce the uncertainties of international travel for you and your family.
|
|
| |
| 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 |
| |
| 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 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.
|
| |
|
INTERNATIONAL EMERGENCY CARE
|
|
Emergency Evacuation
|
Up to Policy Maximum when coordinated through the Plan Administrator
|
|
Each plan includes coverage for Emergency Medical Evacuations to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred, up to the policy limit.
|
|
Emergency Reunion
|
Up to US$15,000 when coordinated through the Plan Administrator
|
|
Each plan also provides emergency reunion coverage, up to US$15,000 for a maximum of 15 days, for the reasonable travel and lodging expenses of a relative or friend during an Emergency Medical Evacuation: either the cost of accompanying the insured during the evacuation or traveling from the home country to be reunited with the insured.
|
|
Return of Mortal Remains
|
Up to US$25,000 when coordinated through the Plan Administrator
|
|
If a covered illness/injury results in death, expenses for Repatriation of bodily remains or ashes to the home country will be covered up to a maximum of US$25,000.
|
|
Returning Minor Children
|
Up to US$5,000 when coordinated through the Plan Administrator
|
|
If an insured person is hospitalized due to a covered illness/injury and is traveling alone with child(ren) 19 or under that otherwise would be left unattended, the plans will pay up to US$5,000 for one way economy fare to their home country, including a chaperone, if necessary, for the safety of the child(ren).
|
| |
|
PLAN INFORMATION
|
|
Deductible
|
Your choice of US$0, $100, $250, $500, $1,000 or $2,500
|
|
On the Application Form, you will be asked your choice of a deductible. Your premium rate is dependent on the deductible you choose. Please see the Application Form for more information.
|
|
Coinsurance
|
As described below
|
|
For treatment received outside the U.S. & Canada: No coinsurance
If elected and proper premium paid for buy-up option: The plan pays 90% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum.
For treatment received within the U.S. & Canada: The plan pays 80% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum
For treatment received within the US from a provider outside the PPO network: The plan pays 70% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum; please see below for more information on the Preferred Provider Organization Network
|
|
Benefit Period
|
Six months
|
|
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.
|
| |
|
SPECIAL COVERAGES
|
|
Home Country Coverage
|
As described below
|
|
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: a. The insured person must have left their home country, b. The total Period of Coverage must be for a minimum of 30 days, and c. 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 5 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).
|
| Trip Interruption |
Up 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, each 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 |
Up to US$50 per item of personal property; maximum of US$250 per Period of Coverage |
|
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 designated beneficiary, to a maximum of US$250,000 per family.
|
| |
| Sports & Activities Coverage |
Up to Policy Maximum for basic sports Coverage as described below
|
|
Each 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: 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, windsurfing and whitewater rafting.
Optional Leisure or Extreme Sports Riders: Please see below for more information.
|
| |
| Accidental Death & Dismemberment |
US$25,000 principal sum |
|
Each plan includes US$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. For more information, see the Conditions of Coverage section.
|
| |
| Terrorism Coverage |
Up to US$50,000 lifetime maximum |
Each 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 US$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 |
Up to US$500 per Period of Coverage |
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 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.
|
The Leisure Sports Rider is available and adds coverage for jet skiing, scuba diving, snow skiing, snowboarding, snowmobiling, snorkeling, surfing, wakeboarding, water skiing and windsurfing. For premium information, please see the back of the Application Form.
The Extreme Sports Rider is available and adds up to 12 months of coverage for those under the age of 49. This rider provides up to US$50,000 lifetime maximum for the following activities: abseiling, BMX, bungee jumping, canyoning, caving, flying (private plane), hang gliding, heli-skiing, high diving, hot air ballooning, kayaking, inline skating, mountain biking, mountaineering (ropes and guides to 4500m from
ground level), paragliding, parascending, rappelling, rock climbing (ropes and guides to 4500m from ground level)), skydiving, spelunking, whitewater rafting (to Class V). These extreme activities must be engaged in solely for leisure, recreation, or entertainment purposes.
|
Monthly Rates
Available in monthly increments up to a maximum of 12 months
|
|
U.S. Citizen
|
Non-U.S. Citizen
|
|
US$30
|
US$45
|
Trip cancellation coverage is also available for your trip. With this plan, the loss of pre-paid, non-refundable, and unused payments may be recovered when a trip is cancelled due to: illness, injury or death to you, a family member or travel companion; bankruptcy or 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. The benefits are outlined below and premium information can be found on the back of the Application Form.
|
Benefits
|
Maximum benefit per insured person
|
|
Trip cancellation
|
Trip cost up to US$20,000
|
|
Travel delay
|
Up to US$500
|
|
Baggage delay
|
Up to US$100
|
The Protection Return Rider is only available to non-U.S. citizens who have purchased Protection America. When purchased at the time of application, Protection Return provides temporary medical coverage for non-U.S. citizens returning to their home country. The insured person must be outside his/her home country at time of application. For premium information, please see the back of the Application Form.
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 Protection plans. Coverage must be purchased for a minimum of three months.
|
Monthly Rates - coverage must be purchased for a minimum of three months
|
|
Up to US$100,000 additional coverage
|
US$8
|
|
Up to US$200,000 additional coverage
|
US$16
|
|
Up to US$300,000 additional coverage
|
US$24
|
|
Up to US$400,000 additional coverage
|
US$32
|
This is a value added program available to certificate holders of the Passport Protection Plus SM
plans. It is accepted at over 35,000 chain pharmacies in the U.S and is made available and administered by Universal Rx. Once activated with Universal Rx, the card allows members to purchase prescriptions at the lowest available cost.
* This plan does not guarantee that the prescribed medication is covered under the benefit plan, claims must be submitted to IMG for claim determination
More details
Your satisfaction is very important to the plan underwriter, and to IMG as the plan administrator. If, for any reason, you are not pleased with this product, you may submit a written request for cancellation and refund of your premium. In order to be considered for a full refund, your request for cancellation must be received by IMG prior to your effective date. 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 US$25 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 non-refundable.
With Passport Protection Plus, you may seek treatment with the hospital or doctor of your choice. When seeking treatment in the U.S, you may reduce your out-of-pocket costs by using the independent
Preferred Provider Organization (PPO), a separately organized network of approximately 500,000 physicians and 4,700 privately owned and operated hospitals contracted by IMG (all PPO providers are contracted separately through First Health Group Corp.). If you choose to use a provider outside of this network, the plan pays
70% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum.
IMG also provides an on-line International Provider Access database 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 on-line. These terms must be agreed to prior to using the service.)
Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under these plans.
- 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.
- 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, wake
boarding, 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).
This brochure contains only a consolidated and summary description of all current Passport Protection Plus 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. IMG reserves the right to issue the most current Policy 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 Policy Wordings are available upon request.
CLAIMS PROCEDURE
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%. Precertification is not an assurance of coverage, a 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 website. 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, their 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.
All benefits payable under these plans are subject to the provisions described in this brochure and as contained in the Policy Wording and certificate of coverage. To make claim processing efficient, claims may be paid in two ways.
- Eligible claims that have been paid by or on behalf of the Insured Person will be reimbursed directly to the Insured Person. Payment will be sent by check.
- Eligible claims that have not yet been paid by the Insured Person will, at the option of IMG, be made 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
- Coverage and benefits are subject to the deductible and coinsurance, and all terms of the certificate of coverage and Master Policy.
- Coverage under these plans is secondary to any other
coverage.
- Coverage and benefits are for medically necessary, usual,
reasonable and customary charges only.
- Charges must be administered or ordered by a physician.
- Charges must be incurred during the Period of Coverage or the
Benefit Period.
- 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.
- All Conditions and Exclusions apply to these coverages.
- All Emergency Medical Evacuation, Emergency Reunion, and Return of Mortal Remains expenses, including all costs arising from trips outside the country where the incident which gave rise to the claim occurred, must be approved and coordinated in advance by IMG to be eligible for coverage.
You should read the following important information prior to completing the Application Form.
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:
- the date IMG receives your completed Application Form and the appropriate premium (for non-U.S. citizens, the date following such receipt);
- the date you depart from your home country; or
- the date requested on your Application Form.
Passport Protection Plus coverage ends on the earliest of the following dates:
- The end of the period for which premium has been paid;
- the date requested on your Application Form; or
- the date you return to your home country (however, see Home Country Coverage for incidental coverage).
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 an insurance certificate containing a complete outline of the Policy Wording. Please note: If you require express mail delivery, there is an additional charge listed on the Application Form.
The following conditions apply to all persons applying for and/or
enrolling in Passport Protection Plus.
- Passport Protection Plus is travel insurance for U.S. citizens traveling outside the United States and for non-U.S. citizens traveling outside their home country.
- For those over age 65 and visiting the U.S., your initial Period of Coverage must begin within 30 days of arrival in the U.S. This requirement will be waived with proof of previous valid insurance. Please provide the name of your insurance carrier on the Application Form. If you are not in the U.S. at the time of application, please indicate your expected date of arrival on your Application Form.
The Protection America and Protection International plans must be purchased for a minimum initial period of 5 days, and is renewable (without break in coverage) for 5 days up to 12 months per renewal for a total of up to 3 years. For each renewal of less than one month, you will be charged a fee of US$5 in addition to the premium costs. An insured person must only satisfy one deductible and coinsurance within each yearly coverage period.
You may choose to download your fulfillment kit from the IMG 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 obtain the fulfillment information through the Internet.
IMG provides an on-line
International Provider Access
database 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 on-line. These terms must be agreed to prior to using the service.)
- IMG may be reached via phone, fax, email or Live Help
- Free calls to IMG from anywhere in the world
- Internet services - insured members can search for a health care
services provider; print plan descriptions; and initiate precertification
- International emergency assistance, including medical evacuation
- 24-hour availability for emergency services, medical evacuation and precertification
- On-site, executive medical director/physician and registered nurses
- Multilingual claim adjudication and customer service
- Claim inquiries, status of claim information and reimbursement options available
by phone, fax and email
- Experienced international currency conversion
- Claim reimbursement directly to provider or insured via check, direct deposit to
U.S. bank account, or electronic transfer to international account
Plan Administrator:
As the Plan Administrator for Passport Protection Plus SM, IMG acts as the authorized agent for and on behalf of Sirius International.
International Medical Group ® (IMG ®), Inc. is located at
2960 North Meridian Street,
Indianapolis, IN 46208 USA
Plan Underwriter:
These Passport Protection Plus 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, Passport Protection Plus, Protection International, Protection America, Patriot Travel Medical Insurance, Patriot Group Travel Medical Insurance, Patriot Executive, Patriot Executive Group, Patriot Extreme, Global Medical Insurance, GEO Group, Patriot T.R.I.P., 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).
|
Printer Friendly
