TRAVEL MEDICAL INSURANCE FOR NON‑U.S. CITIZENS
TRAVELING TO THE USA

www.americapatriotinsurance.com

WORLDWIDE COVERAGE. WORLD‑CLASS SERVICES.

International Medical Group® (IMG®), an award‑winning provider of global insurance benefits and assistance services for more than 25 years, enables its members to worry less and experience more by delivering the protection they need, backed by the support they deserve. IMG offers a full line of international medical insurance products, as well as trip cancellation programs, stop loss insurance, medical management services, and 24/7 emergency medical and travel assistance — all designed to provide members Global Peace of Mind® while they’re away from home.

Global Support. With offices and partners across the globe, IMG provides the support you need when you need it. In fact, it’s our corporate mission to be there to protect and enhance your health and well‑being.

Financial Stability. Our globally recognized underwriters, A‑rated Sirius International Insurance Corporation (publ) and
certain underwriters at Lloyd’s, offer the financial security and reputation demanded by international consumers.

Service Without Obstacles. IMG’s team of international, multilingual specialists is accustomed to working in multiple time zones, languages, and currencies. Our global reach means We can work without barriers.

International Emergency Care. When you’re away from home, and a medical emergency occurs, you may not be able to wait for regular business hours. With our on‑site medical staff, you have 24‑hour access to highly qualified coordinators of emergency medical services and international treatment. 

International Provider AccessSM (IPA). In addition to ourAn 
expansive PPO network available for treatment received within the U.S., our proprietary IPA network of more than 17,000 accomplished physicians and facilities allows you to access quality care worldwide. Our direct billing arrangements can also ease the time and upfront expense at select providers. 

Accessible Technology. Log on to the secure, 24‑hour online portal, MyIMGSM, to submit and view your claims, manage your account, search for providers, Live Chat with representatives, and more.

WHY YOU NEED 
TRAVEL MEDICAL INSURANCE

Accidents and emergencies happen — and when they do, you wouldn’t want to be hundreds or thousands of miles away from home without the proper coverage.

Most people assume they will be covered by their standard health insurance when they travel internationally, but that isn’t always the case. 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 at risk.

Don’t let your medical coverage be an uncertainty. Travel with IMG’s Patriot America® Plus so you can spend more time enjoying your international experience and less time worrying about your medical coverage. 

WHY CHOOSE IMG’S 
PATRIOT AMERICA PLUS

Patriot America Plus provides coverage for non‑U.S. citizens traveling to the United States. The plan offers a complete package of international benefits available 24 hours a day to individuals, families, and groups of five or more travelers. The plan provides a wide range of plan maximum limits and deductible options, and is available for trips of five days up to two years.

PLAN INFORMATION & HIGHLIGHTS

Maximum Limit Per Period of Coverage Options

$50,000, $100,000, $500,000

Individual Deductible Options

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

Coinsurance ‑ Treatment Received Outside of the U.S. 

No coinsurance

Coinsurance ‑ Treatment Received Within the U.S. 

In the PPO Network  
The plan pays 90% of eligible medical expenses up to $5,000, then 100%
Out of the PPO Network
The plan pays 80% of eligible medical expenses up to $5,000, then 100%

Continuation of Treatment Period

Earlier of 6 months per injury or illness OR upon return to home country

MyIMG SM

24‑hour secure access from anywhere in the world 
to manage your account

World‑Class Medical Benefits

Coverage available for eligible inpatient and outpatient medical expenses

International Emergency Care

A wide range of international emergency benefits available, including
emergency medical evacuation, emergency reunion, return of mortal
remains, return of minor children and more

PATRIOT AMERICA PLUS ‑ SUMMARY OF BENEFITS

INPATIENT/OUTPATIENT BENEFITS

Subject to the coinsurance and deductible when applicable, and Usual, Reasonable, and Customary (URC) charges.

Hospital Room and Board

Average semi‑private room rate up to the maximum limit

Intensive Care Unit

Up to the maximum limit

Eligible Medical Expenses

Up to the maximum limit

Acute Onset of Pre‑Existing Condition 
Prior to Age 70 ‑ Medical Expenses

Up to the maximum limit

Local Ambulance

Up to the maximum limit

Prescription Medication

Up to the maximum limit

Emergency Room Accident

Up to the maximum limit

Emergency Room Illness with 
Inpatient Admission

Up to the maximum limit

Emergency Room Illness without 
Inpatient Admission

Up to the maximum limit 
Additional $250 deductible

Dental ‑ Treatment Related to an Accident

Up to the maximum limit

Dental ‑ Emergency

$100 maximum

Hospital Daily Indemnity

$100 per overnight 
Up to a maximum limit of 10 overnights

Terrorism

$50,000 lifetime maximum

Recreational Sports & Activities

Up to the maximum limit for non‑organized, non‑contact and non‑col
lision activities

PATRIOT AMERICA PLUS ‑ SUMMARY OF BENEFITS (CONTINUED)

EVACUATION BENEFITS

Not subject to a deductible or coinsurance.

Emergency Medical Evacuation

$500,000 lifetime maximum 
(independent of the maximum limit)

Acute Onset of Pre‑Existing Condition Prior to Age 
70 ‑ Emergency Medical Evacuation

$25,000 lifetime maximum

Emergency Reunion

$50,000 lifetime maximum

Return of Mortal Remains or Cremation/Burial

$50,000 for return of mortal remains or 
$5,000 for cremation/burial

Return of Minor Children

$50,000 lifetime maximum

Political Evacuation

$10,000 lifetime maximum

ADDITIONAL BENEFITS

Not subject to a deductible or coinsurance.

Incidental Trips

Up to a cumulative two weeks

End‑of‑Trip Home Country Coverage

One month for every six months of continuous 
coverage; up to two months

Trip Interruption

$5,000 maximum

Common Carrier Accidental Death

$50,000 to beneficiary; maximum of $250,000 per family

Accidental Death & Dismemberment

$25,000 principal sum

Lost Luggage

$50 per item; maximum of $250

Natural Disaster

$100 per day; up to five days

Identity Theft

$500 maximum

OPTIONAL RIDERS

Other than the enhanced AD&D rider, optional riders apply to all eligible individuals listed on the application.

Adventure Sports Rider
(available to insureds up to age 65)

Age

0 - 49

50 - 59

60 - 64

Age

$50,000

$30,000

$15,000

Enhanced AD&D Rider
available to the primary insured only)

Up to an additional $400,000

Citizenship Return Rider

Up to the maximum limit

Evacuation Plus Rider
(available to insureds up to age 65)

Non-life-threatening medical evacuation: Up to a maximum of
$25,000. Natural disaster evacuation: Up to a maximum of $5,000.

All coverage and benefits in this Policy are in United States (U.S.) dollars. Benefits are subject to the exclusions and limitations and are payable only at Usual, Reasonable and Customary charges. This is a summary and does not supersede in any way the Certificate of Insurance and governing policy documents (together the “Insurance Contract”). The Insurance Contract is the only source of the actual benefits provided. *Must be approved in advance and coordinated by the Company.

PATRIOT AMERICA PLUS - INDIVIDUAL PREMIUM RATES

MONTHLY RATES

Maximum Limit Options

Age

$50,000

$100,000

$500,000

18-29

$42

$52

$66

30-39

$55

$70

$88

40-49

$82

$101

$135

50-59

$120

$155

$190

60-64

$152

$196

$233

65-69

$173

$234

$254

70-79

$235

N/A

N/A

80+*

$407*

N/A

N/A

Dependent Child

$38

$46

$60

Individual Child

$42

$52

$66

*Individuals age 80+ are limited to a $10,000 maximum limit

DAILY RATES

Maximum Limit Options

Age

$50,000

$100,000

$500,000

18-29

$1.35

$1.70

$2.15

30-39

$1.80

$2.25

$2.85

40-49

$2.65

$3.25

$4.35

50-59

$3.90

$5.00

$6.15

60-64

$4.90

$6.30

$7.50

65-69

$5.60

$7.55

$8.20

70-79

$7.60

N/A

N/A

80+*

$13.15

N/A

N/A

Dependent Child

$1.25

$1.50

$1.95

Individual Child

$1.35

$1.70

$2.15

*Individuals age 80+ are limited to a $10,000 maximum limit

OPTIONAL RIDERS

Other than the enhanced AD&D rider, optional riders apply to all eligible individuals listed on the application.

Additional AD&D Coverage

Monthly Rate

$100,000

$8

$200,000

$16

$300,000

$24

$400,000

$32

**Available to the primary insured only. Available to insureds who are applying for three months of Patriot America Plus coverage.
Premium is charged in whole-month increments.

IMG reserves the right to assess the most current rates at the time of the effective date in the event these rates expire, are modified or are replaced. Rates include premium tax where applicable.

PATRIOT AMERICA PLUS - GROUP PREMIUM RATES

MONTHLY RATES

Maximum Limit Options

Age

$50,000

$100,000

$500,000

18-29

$38

$47

$59

30-39

$50

$63

$79

40-49

$74

$91

$122

50-59

$108

$140

$171

60-64

$137

$176

$210

65-69

$156

$211

$229

70-79

$212

N/A

N/A

80+*

$366

N/A

N/A

Dependent Child

$34

$41

$54

Individual Child

$38

$47

$59

*Individuals age 80+ are limited to a $10,000 maximum limit

DAILY RATES

Maximum Limit Options

Age

$50,000

$100,000

$500,000

18-29

$1.20

$1.50

$1.90

30-39

$1.60

$2.05

$2.55

40-49

$2.40

$2.95

$3.90

50-59

$3.50

$4.50

$5.50

60-64

$4.40

$5.70

$6.75

65-69

$5.00

$6.80

$7.40

70-79

$6.80

N/A

N/A

80+*

$11.80

N/A

N/A

Dependent Child

$1.10

$1.35

$1.75

Individual Child

$1.20

$1.50

$1.90

*Individuals age 80+ are limited to a $10,000 maximum limit

OPTIONAL RIDERS

Other than the enhanced AD&D rider, optional riders apply to all eligible individuals listed on the application.

Additional AD&D Coverage

Monthly Rate

$100,000

$8

$200,000

$16

$300,000

$24

$400,000

$32

**Available to the primary insured only. Available to insureds who are applying for three months of Patriot America Plus coverage.
Premium is charged in whole-month increments.

IMG reserves the right to assess the most current rates at the time of the effective date in the event these rates expire, are modified or are replaced. Rates include premium tax where applicable.

PATRIOT AMERICA PLUS - SERVICES

MyIMGSM

Service at your fingertips anytime, anywhere — that's what MyIMG provides. MyIMG is our online member portal located at www.imglobal.com/member that allows you to easily access and manage your insurance information. Our service centers in the U.S. and Europe are always available to handle medical emergencies, but through MyIMG, you have immediate access to a wealth of information about your account and plan, and can manage routine areas to help you save time when you may need it most. Key features include:

  • Manage your claims
  • Initiate precertification
  • Locate a provider
  • Obtain plan documents
  • Request ID cards
  • Recommend a provider/facility

Extensive Provider Networks

When seeking treatment in the U.S., you can reduce your out-of-pocket costs by using the independent Preferred Provider Organization (PPO), a separately organized network of hundreds of thousands of established, highly qualified medical practitioners and many well-recognized hospitals in the U.S. contracted by IMG. You can quickly search the network through MyIMG. Additionally, to help you locate health care providers outside of the U.S., IMG provides its online International Provider AccessSM (IPA), a database of more than 17,000 physicians and facilities.

Medical Management Services

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 AkesoCareSM, a URAC-accredited, on-site division devoted entirely to medical management.

From routine medical care and check-ups to complex case management and emergency medical evacuations, AkesoCare 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.

Universal Rx Pharmacy Discount Savings

This is a discount savings program available to every insured of the Patriot America Plus plan. This program allows cardholders to purchase prescriptions at one of more than 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. It is purely a discount program available to insureds of the Patriot America Plus plan. Use of the discount card does not guarantee that medication is covered or will be reimbursed under the insurance plan.

P.O. Box 88509
2960 North Meridian Street
Indianapolis, IN 46208-0509 USA
For sales questions, please call +1.866.368.3724
For all other inquiries, please call +1.800.628.4664 or +1.317.655.4500 Fax: +1.317.655.4505
Email: insurance@imglobal.com
www.imglobal.com

Coverage is underwritten and issued by Sirius International
Insurance Corporation, rated A (excellent) by A.M. Best and A- by
Standard & Poor’s (at the time of printing).

This invitation to inquire allows eligible applicants an opportunity to seek information 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.

This brochure contains many of the valuable trademarks, names, titles, logos, images, designs, copyrights and other proprietary materials owned, registered and used by International Medical Group and its representatives throughout the world. ©2007-2017

www.imglobal.com | +1.800.628.4664

IMG Producer Use Only

305 WASHINGTON STREET
P.O. BOX 1569
COLUMBUS, IN 47201
Phone: 812-372-7829
Fax: 812-348-7657
joliver@jwinsurance.com http://http://jwinsurance.com

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