Patriot Exchange Program

Medical insurance for students studying abroad or participants of cultural exchange programs

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Summary of Benefits

All amounts shown are in U.S. dollars.

Coverage Limit / Maximum Amount for Eligible Medical Expenses
 
Plan DetailsIn-NetworkOut-of-NetworkInternational
Maximum Limit$5,000,000$5,000,000$5,000,000
Deductible Options $0, $100, $250, or $500 per illness or injury available$0, $100, $250, or $500 per illness or injury available$0, $100, $250, or $500 per illness or injury available
Coinsurance for Eligible Medical Expenses
 
Plan DetailsIn-NetworkOut-of-NetworkInternational
Coinsurance
  • In addition to Deductible
Plan pays 90%
Insured pays 10%		Plan pays 80%
Insured pays 20%		Plan pays 100%
Insured pays 0%
Out of Pocket Maximum$1,000Up to the Maximum Limit$0
Precertification
 
Plan DetailsIn-NetworkOut-of-NetworkInternational
Interfacility Ambulance Transfer, Emergency Medical EvacuationNo coverage if Pre-certification requirements are not metNo coverage if Pre-certification requirements are not metNo coverage if Pre-certification requirements are not met
All other Treatments & supplies50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met
Pre-existing Conditions
 
Plan DetailsIn-NetworkOut-of-NetworkInternational
Pre-existing conditions
  • Charges resulting directly or indirectly from or relating to any Pre-existing Condition that existed within 36 months prior to the Effective Date are excluded until the Insured Person has maintained 12 months of continuous coverage under this insurance.
Period of Coverage Limit (after 12 months): $500 Maximum Limit: $1,500Period of Coverage Limit (after 12 months): $500 Maximum Limit: $1,500Period of Coverage Limit (after 12 months): $500 Maximum Limit: $1,500
Student Health Center
 
Plan DetailsIn-NetworkOut-of-NetworkInternational
Copayment per visit
  • Not subject to the per Illness or Injury Deductible
  • Copayment is not applicable if the Declaration states a $0 Deductible
$5$5$5
CoinsurancePlan pays 100%
Insured pays 0%		Plan pays 100%
Insured pays 0%		Plan pays 100%
Insured pays 0%
Inpatient/Outpatient Benefits
 
Plan DetailsIn-NetworkOut-of-NetworkInternational
Eligible Medical Expenses90%80%100%
Physician / Specialist Visit
  • Maximum Visits per day: 1
(unless visit is for a different medical/surgical specialty)		90%80%100%
Urgent Care
  • Not subject to Deductible
  • Copayment: $50
  • Copayment is not applicable if the Declaration states a $0 Deductible
90%80%100%
Walk-in Clinic
  • Not subject to Deductible
  • Copayment: $20
  • Copayment is not applicable if the Declaration states a $0 Deductible
90%80%100%
Hospital Emergency Room
  • Injury: Not subject to Emergency Room Deductible
  • Illness: Subject to a $500 Deductible for each Emergency Room visit for Treatment that does not result in a direct Hospital admission.
90%80%100%
Hospitalization / Room & Board
  • Average semi-private room rate
  • Includes nursing, miscellaneous and Ancillary Services
90%80%100%
Intensive Care90%80%100%
Bedside Visit
  • Not subject to Deductible
  • Maximum Limit: $1,500
  • Hospitalized in an Intensive Care Unit
  • Refer to the BEDSIDE VISIT provision for further details
90%80%100%
Outpatient Surgical / Hospital Facility90%80%100%
Laboratory90%80%100%
Radiology / X-ray90%80%100%
Pre-admission Testing90%80%100%
Surgery90%80%100%
Pre-admission Testing90%80%100%
Surgery90%80%100%
Reconstructive Surgery
  • Surgery is incidental to and follows Surgery that was covered under the plan
90%80%100%
Assistant Surgeon
  • 20% of the primary surgeon’s eligible fee
90%80%100%
Anesthesia90%80%100%
Durable Medical Equipment90%80%100%
Chiropractic Care
  • Medical order or Treatment plan required
90%80%100%
Physical Therapy
  • Maximum Visits per day: 1
  • Medical order or Treatment plan required
90%80%100%
Extended Care Facility
  • Upon direct transfer from an acute care Hospital
90%80%100%
Home Nursing Care
  • Provided by a Home Health Care Agency
  • Upon direct transfer from an acute care Hospital
90%80%100%
Prescription Drugs and Medication - The following Prescription Drugs and Medication Period of Coverage limit accumulates toward the Maximum Limit
 
Plan DetailsIn-NetworkOut-of-NetworkInternational
Prescription Drugs and Medication
  • Period of Coverage limit: $250,000 per person
  • Obtained through Retail Pharmacy, Inpatient and Outpatient Surgery, Emergency Room and Outpatient Office Visits
  • Dispensing maximum for Retail Pharmacy: 90 days per prescription
N/A90%100%
Mental or Nervous / Substance Abuse
 
Plan DetailsIn-NetworkOut-of-NetworkInternational
Inpatient Mental or Nervous / Substance Abuse
  • Maximum Limit: $10,000
  • Not covered if incurred at the Student Health Center
90%80%100%
Outpatient Mental or Nervous / Substance Abuse
  • Maximum Limit per day: $50
  • Maximum Limit: $500
  • Not covered if incurred at the Student Health Center
90%80%100%
Emergency Services
 
Plan DetailsIn-NetworkOut-of-NetworkInternational
Emergency Local Ambulance
  • Subject to Deductible
  • Injury
  • Illness resulting in a Hospitalization admission
100%100%100%
Emergency Medical Evacuation
  • Maximum Limit: $50,000
  • Must be approved in advance and coordinated by the Company
100%100%100%
Emergency Reunion
  • Maximum Limit: $15,000
  • Maximum Days: 15
  • Meal Maximum per day: $25
  • Reasonable and necessary travel costs and accommodations
  • Must be approved in advance by the Company
100%100%100%
Interfacility Ambulance Transfer
  • Up to the per Injury or Illness limit
  • Services rendered in the United States
  • Transfer must be a result of an Inpatient Hospital admission
100%100%N/A
Political Evacuation and Repatriation
  • Maximum Limit: $10,000
  • Must be approved in advance by the Company
100%100%100%
Repatriation for Medical Treatment
  • Maximum Benefit: $100,000
  • Approved in advance and coordinated by the Company
  • Refer to the REPATRIATION FOR MEDICAL TREATMENT provision for further details
100%100%100%
Return of Mortal Remains
  • Maximum Limit: $25,000
  • Local Burial / Cremation at place of death
  • Maximum Limit: $5,000
  • Return of Insured Person’s Mortal Remains to Country of Residence
  • Must be approved in advance by the Company
100%100%100%
Other Services
 
Plan DetailsIn-NetworkOut-of-NetworkInternational
Terrorism
  • Maximum Limit: $50,000
100%100%100%
Dental Treatment
  • Period of Coverage Limit: $350
  • (Treatment due to Unexpected pain to sound, natural teeth)
  • Period of Coverage Limit per Injury: $500
(Non-emergency Treatment at a Dental Provider due to an Accident) 		N/A90%100%
Traumatic Dental Injury
  • Subject to Deductible and Coinsurance
  • Up to the Maximum Limit
  • Treatment at a Hospital Facility due to an Accident
  • Additional Treatment for the same Injury rendered by a Dental Provider will be paid at 100%
90%80%100%
Accidental Death & Dismemberment
  • Principal Sum Maximum: $25,000
  • Death must occur within 90 days of the Accident
Accidental Death: 100% of Principal Sum
Accidental Dismemberment:
LossPercent of Principal Sum
Sight of 1 eye50%
1 hand or 1 foot50%
1 hand and loss of sight of 1 eye100%
1 foot and loss of sight of 1 eye100%
1 hand and 1 foot100%
Both hands or both feet100%
Sight of both eyes100%
Incidental Trip
  • Maximum days: 14
  • Country of Residence is outside the United States
  • Refer to the INCIDENTAL TRIP provision for further details
90%80%100%
Optional Add-On Rider
 
Plan DetailsIn-NetworkOut-of-NetworkInternational
Personal Liability
  • Injury to third party: $2,000 per period of coverage limit after $100 deductible
  • Damage to third party’s property: $500 per period of coverage limit after $100 deductible
100%100%100%
Lost Personal Property
  • $250 per period of cover age limit
100%100%100%
Limited High School and College Sports
  • Company pays 100% after deductible is met
100%100%100%
Legal Assistance$500 period of coverage limit $500 period of coverage limit $500 period of coverage limit

Adventure Sports Rider

The Adventure Sports Rider is available for those up to the age of 65. The following activities are covered to the lifetime maximum amounts listed below as long as they are engaged solely for leisure, recreation, or entertainment purposes: abseiling, BMX, bobsledding, bungee jumping, canyoning, caving, hot air ballooning, jungle zip lining, parachuting, paragliding, parascending, rappelling, skydiving; spelunking, whitewater kayaking, wildlife safaris, and windsurfing.

All such activities must be carried out in strict accordance with the rules, regulations, and guidelines of the applicable Governing Body or Authority of each such activity. Certain sports activities are never covered, regardless of whether or not you purchase the Adventure Sports Rider. A complete list of these sports activities can be found in the exclusions section of the Certificate of Insurance. Please note this is only a summary of Adventure Sports and exclusions. For additional information, please refer to the Certificate of Insurance.

Age Maximum Limit
Through age 49 $50,000
50-59 $30,000
60-64 $15,000

Chaperone/Faculty Leader Replacement Rider

(Groups only)

Groups may purchase the Chaperone/Faculty Leader Replacement Rider in the event that an insured person who is designated as a Chaperone/Faculty Leader by the sponsoring organization has an unexpected death of a relative, a medical emergency, or the substantial destruction of the principal residence in his/her home country, which causes the insured person to have to cancel or interrupt travel, this plan covers reimbursement up to $3,000 for the expense of a round trip economy airline ticket for a replacement Chaperone/Faculty Leader.

Disclaimer

This invitation to inquire allows eligible applicants an opportunity to inquire further about the insurance offered and is limited to a brief description of any loss for which benefits may be payable. Benefits are offered as described in the insurance contract. Benefits are subject to all deductibles, coinsurance, provisions, terms, conditions, limitations, and exclusions in the insurance contract. The contract does contain a pre-existing condition exclusion and does not cover losses or expenses related to a pre-existing condition.

Groups may also purchase a customizable long-term plan. Any coverages, benefits & premium rates offered are in U.S. Dollars.

 

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  • "Although one hopes never to use travel insurance, IMG was a godsend throughout our ordeal. We couldn’t have done it without your continued assistance."
    Joan D. United States
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  • "I took comfort in the fact
    that IMG had my back."

    Mark K. - United States

    While skiing in Chile, Mark, an IMG member, found himself on the brink of paralysis.