Patriot America

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Patriot America provides coverage for non-U.S. citizens traveling outside their home country for a minimum of five 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.

If you or other family members applying for coverage are age 65 or older, please see the Eligibility section in the brochure for additional information.

	PATRIOT AMERICA POLICY PREMIUMS
	50,000 MAX	100,000 MAX	500,000 MAX	1,000,000 MAX
	option 1	option 2	option 3	option 4
AGE	One Month	One Month	One Month	One Month
18-29	$39.00	$46.00	$59.00	$71.00
30-39	$52.00	$62.00	$78.00	$91.00
40-49	$78.00	$90.00	$119.00	$133.00
50-59	$113.00	$138.00	$169.00	$194.00
60-64	$142.00	$174.00	$207.00	$248.00
65-69	$162.00	$208.00	$226.00	$270.00
70-79	$219.00	N/A	N/A	N/A
80 PLUS*	$381.00	N/A	N/A	N/A
DEP CHILD	$35.00	$41.00	$53.00	$59.00
CHILD ALONE	$39.00	$46.00	$59.00	$66.00
*US$10,000 limit

All premium rates are in U.S. dollars and are effective through 31-Dec-2009. 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.

*See specific policy for age limit.

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 effective date, 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 $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 non-refundable.

Precertification, Emergency Evacuation and Return of Mortal Remains

For precertification, emergency evacuation and return of mortal remains, please call: IMG in the US: 1-800-628-4664 (toll free) or 1-317-655-4500. Call IMG outside the US: 001-317-655-4500 (collect if necessary). This information will also be provided on your ID card.

IMG must be notified prior to treatment or within 48 hours of an emergency.

To Report Claims

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 or e-mail: insurance@imglobal.com.

This web page contains only a consolidated and summary description of all current Patriot Travel Medical Insurance 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.

Underwritten by: Sirius International Insurance Corporation


	We accept faxed applications if payment is made by credit card. To download a complete brochure and application. Click here. For an Instant Quote/Apply online! Click Here.

We accept faxed applications if payment is made by credit card. To download a application. Click here.

Download the complete brochure. Click here.

For an Instant Quote! Click Here. Choose 12 months or longer on our policy picker

Need Help? call India Travel Insurance . com at: 1-574-287-9643