PATRIOT
Travel Series

Travel medical insurance for individuals,
families, and groups

WHY PATRIOT TRAVEL?
Traveling abroad is an exciting experience, but unpredictable
illnesses and accidents can happen. Most travelers assume they’realready covered by their standard medical plan—but that isn’t
always the case. While domestic plans provide sufficient coverage
at home, most are not designed to provide the coverage andassistance required for international travel.

outside of their home country. Ideal for international vacationers,
relatives visiting from overseas, and international businesstravelers, each plan is designed to protect you in the event of
an illness or injury when traveling abroad and provide medical
benefits in case of emergency.
Choose the Patriot Travel plan that meets your needs, and spend
more time enjoying your international experience—not worrying
about your medical coverage.

Each plan within the Patriot Travel Series provides various levels ofcoverage for individuals, families, and groups who need temporary
medical insurance while traveling for business or leisure anywhere
INSI D E THE U. S.

Patriot America

If you're visiting the United States, we offer three plans to meet your needs

Maximum Limits
Deductible

LITE

PLUS

PLATINUM

Up to $1 million

Up to $1 million

Up to $8 million$0 to $2,500$0 to $2,500$0 to $25,000

Extensions

Up to 24 continuous months

Up to 24 continuous months

Up to 36 continuous months

Coinsurance (In-Network)

100% up to the maximum limit

100% up to the maximum limit

100% up to the maximum limit

Coinsurance (Out-of-Network)

80% up to $5,000, then 100%80% up to $5,000, then 100%90% up to $5,000, then 100%

Optional add-on available

Optional add-on available

Acute Onset of Pre-Existing Conditions
Travel Intelligence
Telehealth
Evacuation PlusOUTSI D E THE U.S .

Patriot International

We also have plan options for those traveling outside the United States

LITE

PLATINUM

Up to $1 million

Up to $8 million

Deductible$0 to $2,500$0 to $25,000

Extensions

Up to 24 continuous months

Up to 36 continuous months

Coinsurance

100% up to the maximum limit

100% up to the maximum limit

Up to 2 weeks

Up to 2 weeks

Maximum Limits

Incidental Emergency in the U.S.
Acute Onset of Pre-Existing Conditions
Travel Intelligence
Telehealth

Optional add-on available

Evacuation Plus

2

All coverage and benefits in the plan 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 asummary of a selection of plan benefits offered only as an illustration and does not supersede in anyway the Certificate of Insurance and governing policy documents (together the “Insurance Contract”).
The Insurance Contract is the only source of the actual benefits provided.

The
Advantage

Our focus on Service, Strength, and Safety Solutions provides
you with the ultimate advantage: Global Peace of Mind.

S E R V I C E Help when and where you need it.

S T R E N G T H A market leader you can trust.

Nobody wants to experience an emergency while traveling the world,
but if you do, you’ll want a team you can trust to have your back.
IMG’s expert staff is here for you 24/7. We’re accustomed to working in
multiple time zones, languages, and currencies, so rest assured we havethe training to assist you—even in remote and hazardous locations.
Our international and U.S. provider networks include more than one
million physicians and facilities across the globe, giving you access toquality care while away from your primary care team. Our innovativetechnology allows you to manage your claims, your account, andsearch for providers through our online portal and mobile app aroundthe clock.

You can feel confident with IMG knowing our industry expertise has
led us to serve millions of customers worldwide since 1990. Owned
by SiriusPoint, a multi-billion-dollar insurance industry leader and rated“A-” by A.M. Best, an independent analyst of the insurance industry, IMG
has a strong financial backing and vision to become the preeminent
provider of travel and health safety solutions. With loyal customers
ranging from Fortune 500 companies, universities, to individuals andother insurance companies, our personalized offerings allow us tomeet the needs of nearly anyone traveling internationally.

S A F E T Y S O L U T I O N S Products and services designed with your safety in mind.
PHYSICAL HEALTH
You can’t plan when you get sick, and unfortunately, it
can happen anytime and anywhere. Medical bills canbe expensive, and IMG plans provide the cross-border
medical coverage you need for unexpected medical care.
FINANCIAL PROTECTION
Costs can add up while seeking medical treatment.
However, access to IMG’s physician and provider networks
and pharmacy discount programs can help you saveon out-of-pocket medical expenses and prescription
medications.

CRISIS SUPPORTNavigating an emergency in a foreign country is nevereasy. That’s why IMG offers a multilingual staff of nurses,
doctors, and case managers that provide 24/7 assistanceservices to facilitate a response to urgent and emergency
situations, such as evacuations.
PERSONAL PROPERTY
There are some belongings you know you can’t live
without. IMG has you covered and can reimburse costs
if your essential items like a phone, camera, luggage, or
important travel documents are lost, stolen, or damaged
during your travels abroad.

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PREMIUM BENEFITS
The following benefits vary by Patriot Travel Series plan level selected:
COVID-19 Coveragen

The COVID-19 pandemic has changed the way we think about
travel. With COVID-19 coverage, charges for treatment resulting
from COVID-19/SARS-CoV-2 are covered the same as any otherillness covered under the policy. This applies to all plans except
Patriot America Lite.
n

Acute Onset of Pre-Existing Conditions

PHYSICAL HEALTH

Should you experience a sudden and unexpected outbreak orrecurrence of a pre-existing condition, this coverage provides
necessary emergency care for any medical emergency that is life
threatening or requires immediate medical treatment. Coverage isavailable for travelers under age 70, and maximum limits vary byplan and age.
n

CRISIS SUPPORTn

TelehealthTravel Intelligence

With IMG Travel Intelligence, you can get location-specific alerts
across ten threat categories that span health, transportation,
security, and weather. Leverage location-specific travel intelligence,
like travel tips, tools, and key insights from local analysts through the
IMG mobile app.
n

Evacuation Plus

While all Patriot plans provide emergency medical evacuation
coverage for life-threatening injuries and illness, Evacuation Plus
provides coverage up to $25,000 for medical evacuations if you
experience a sudden, non-life-threatening medical condition that
requires hospitalization. IMG will arrange and cover ground andair transportation to the nearest hospital capable of providing
treatment.

Telehealth provides access to a national network of board-certified
doctors and pediatricians in the U.S. who are available 24 hours aday, seven days a week, 365 days a year to help diagnose, treat, andprescribe medication (when necessary and available) for many nonemergent medical issues via phone or online video consultations.
Telehealth does not replace existing primary care physician
relationships, but supplements them as a convenient, affordable
alternative for non-emergency medical care. Embedded in all Patriot
Platinum plans. Offered as an optional add-on on all other plans.

Designed for...

Vacations

Visitors

Business

PATRIOT T r a v e l S e r i e s

4All coverage and benefits in the plan 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 asummary of a selection of plan benefits offered only as an illustration and does not supersede in anyway the Certificate of Insurance and governing policy documents (together the “Insurance Contract”).
The Insurance Contract is the only source of the actual benefits provided.

SUMMARY OF BENEFITS
The following benefits and coverage levels are shared across all Patriot Travel Series products:

BenefitCoverageInpatient or Outpatient Services

Eligible Medical Expenses

Up to the maximum limit

Physician Visits / Services

Up to the maximum limit

Urgent Care Clinic$25 copay. Copay is not applicable when the $0 deductible is selected.
Not subject to deductible.

Walk-in Clinic$15 copay. Copay is not applicable when the $0 deductible is selected.
Not subject to deductible.

Hospital Emergency Room:
Inside the U.S.

Injury not subject to emergency room deductible. Illness: Subject to a $250
deductible for each emergency room visit for treatment that does not result in
direct inpatient hospital admission. Up to the maximum limit.

Hospital Emergency Room:
Outside the U.S.

Up to the maximum limit

PHYSICAL HEALTH

Hospitalization / Room & Board

Average semi-private room rate up to the maximum limit.
Includes nursing service.

Intensive Care

Up to the maximum limit

Bedside Visit
Hospitalized in an intensive care unit

$1,500 maximum limit.
Not subject to deductible.

Supplemental Accident$300 per covered accident

Outpatient Surgical / Hospital Facility

Up to the maximum limit

Laboratory

Up to the maximum limit

Radiology / X-ray

Up to the maximum limit

Chemotherapy / Radiation Therapy

Up to the maximum limit

Pre-Admission Testing

Up to the maximum limit

Surgery

Up to the maximum limit

Reconstructive Surgery
Surgery is incidental to and follows surgery that wascovered under the plan

Up to the maximum limit

Assistant Surgeon

20% of the primary surgeon’s eligible fee

All coverage and benefits in the plan 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 asummary of a selection of plan benefits offered only as an illustration and does not supersede in anyway the Certificate of Insurance and governing policy documents (together the “Insurance Contract”).
The Insurance Contract is the only source of the actual benefits provided.

5

SUMMARY OF BENEFITS
The following benefits and coverage levels are shared across all Patriot Travel Series products:

PHYSICAL HEALTH

BenefitCoverage
Anesthesia

Up to the maximum limit

Durable Medical Equipment

Up to the maximum limit

Chiropractic Care
Medical order or treatment plan required

Up to the maximum limit

Physical Therapy
Medical order or treatment plan required

Up to the maximum limit

Extended Care Facility
Upon direct transfer from an acute care facility

Up to the maximum limit

Home Nursing Care
Upon direct transfer from an acute care facility

Up to the maximum limit
Prescriptions

Prescription Drugs and Medications(Dispensing limit per prescription: 90 days)

Up to the maximum limit
Emergency Services

Remote Transportation

CRISIS SUPPORTEmergency Medical Evacuation

Up to $1,000,000 on Lite and Plus plans. Up to the maximum limit on
Platinum plans.

Emergency Local Ambulance
Injury or illness resulting in an inpatient
hospital admission

Up to the maximum limit. Subject to deductible and coinsurance.

Emergency Reunion
Must be approved in advance by the company$100,000 maximum limit. Not subject to deductible or coinsurance.

Interfacility Ambulance Transfer
Transfer from one licensed health care facility toanother licensed health care facility resulting in an
inpatient hospital admission

IMG pays 100%Natural Disaster Evacuation
Must be approved in advance by the company$25,000 maximum limit. Not subject to deductible or coinsurance.

Political Evacuation & Repatriation
Must be approved in advance by the company$100,000 maximum limit. Not subject to deductible or coinsurance.

Return of Minor Children
Must be approved in advance by the company$100,000 maximum limit. Not subject to deductible or coinsurance.

Return of Mortal Remains or Cremation/Burial
Must be approved in advance by the company

6$5,000 per period; $20,000 lifetime maximum

Up to the maximum limit for return of mortal remains or ashes to country ofresidence, or $5,000 maximum limit for cremation or local burial at the placeof death. Not subject to deductible.

All coverage and benefits in the plan 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 asummary of a selection of plan benefits offered only as an illustration and does not supersede in anyway the Certificate of Insurance and governing policy documents (together the “Insurance Contract”).
The Insurance Contract is the only source of the actual benefits provided.

SUMMARY OF BENEFITS
The following benefits and coverage levels are shared across all Patriot Travel Series products:

BenefitCoverage
Other Services

Accidental Death & Dismemberment (AD&D)
Death must occur within 90 days of the accident

FINANCIAL PROTECTION

Common Carrier Accidental Death
Identity Theft

Personal Liability
Secondary to any other insurance

PHYSICAL HEALTHCRISISSUPPORT$25,000 per insured child, $100,000 per insured adult, $250,000 maximum
limit per family. Not subject to deductible or coinsurance.
$500 maximum limit. Not subject to deductible or coinsurance.
$25,000 combined maximum limit. Injury to a third person: $100 per injury
deductible. Damage to a third person’s property: $100 per damage deductible.
No coverage for injury to a related third party
or damage to related third person’s property.

Pet Return
For a pet cat or dog traveling with the insured person$1,000 maximum limit. Not subject to deductible or coinsurance.

Small Pet Common Air Carrier
Accidental Death Benefit
For a pet cat or dog up to 30 pounds traveling with theinsured person$500 maximum limit. Not subject to deductible or coinsurance.

Return Travel$10,000 maximum limit. Not subject to deductible or coinsurance.

Dental Treatment

PERSONAL
PROPERTY$50,000 principal sum. Not subject to deductible.

Traumatic Dental Injury
Treatment at a hospital due to an accident

Emergency Eye Examination
Loss or damage to prescription corrective lenses
due to an accident$300 maximum limit due to dental accident or unexpected pain to soundnatural teeth. Subject to deductible and coinsurance.
Up to the maximum limit. Additional treatment for the same
injury rendered by a dental provider will be paid at 100%.
Subject to deductible and coinsurance.

$150 limit. $50 deductible per occurrence.
Subject to coinsurance.

Hospital Indemnity$250 per overnight inpatient confinement, maximum limit of 10 overnights.
Not subject to deductible or coinsurance.

Natural Disaster$250 per day and maximum limit of five days for accommodations.
Not subject to deductible or coinsurance.

Terrorism$50,000 maximum limit. Not subject to deductible or coinsurance.

Lost Luggage$50 per item, $500 maximum limit. Not subject to deductible or coinsurance.

All coverage and benefits in the plan 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 asummary of a selection of plan benefits offered only as an illustration and does not supersede in anyway the Certificate of Insurance and governing policy documents (together the “Insurance Contract”).
The Insurance Contract is the only source of the actual benefits provided.

7

INNOVATIVE TECHNOLOGY & MEMBER SERVICES
Self-Service Capabilities

U.S. Network Access

MyIMG provides service at your fingertips, giving you the informationand tools to manage your IMG plans anytime, anywhere, throughaward-winning, easy-to-use technology. You’ll have immediate accessvia our website and through IMG’s mobile app to plan documents,
claim management tools, Explanations of Benefits, and much more.

UnitedHealthcare provides travelers in the U.S. with direct access to oneof the largest networks of providers in the U.S. that includes:» Over 1.4M physicians» 6,797 hospitals» Over 45,000 clinics» 67,000 pharmacies» 1,800 convenience clinics

SM

Pharmacy Discount Savings
Universal Rx is a discount savings program that allows you to purchaseprescriptions from one of 35,000 participating pharmacies in the U.S. andreceive the lower of 1) Universal Rx contract price or 2) the pharmacy
regular retail price. This network offers a simplified claims process withminimal paperwork for the member if they visit an in-network provider.
This program is not insurance coverage; it is purely a discount program.

8International Provider AccessSM
Travelers outside of the U.S. can also enjoy access to quality healthcare
worldwide with our proprietary IPA network that includes:» Over 18,550 physicians and facilities» Direct billing arrangements that minimize time and upfront
expenseAll coverage and benefits in the plan 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 asummary of a selection of plan benefits offered only as an illustration and does not supersede in anyway the Certificate of Insurance and governing policy documents (together the “Insurance Contract”).
The Insurance Contract is the only source of the actual benefits provided.

EXPAND YOUR COVERAGE
It’s easy to customize your coverage to best meet your needs while away from home. When submitting your application,
simply add the riders you need to the plan you’ve selected.
Adventure Sports Rider

Lifetime Maximum
Age 0-49: $50,000
Age 50-59: $30,000
Age 60-64: $15,000nTelehealth Ridern

Mobile Device Protection Rider*

Cell phones are essential when traveling internationally to keep
you safe, connect with friends and family back home, and to
take photos of your travels. Device protection provides coveragefor repair or replacement of your cell phone if it is lost, stolen, or
accidentally damaged during your trip—so you can continue yourtrip uninterrupted and stay digitally connected wherever you are in
the world.
*Rider option is available on individual plans only.

Trip Cancellation, Interruption, & Travel Delay Rider**Should something unexpected happen before or during your trip,
this rider can protect you from financial losses with coverage fortrip cancellation and interruption, travel delay benefits, and more.
While all Patriot plans include benefits for return travel, the Trip
Cancellation, Interruption, & Travel Delay Rider provides coveragefor trip cancellation, travel delay, and trip interruption perils. If you
are prevented from taking your trip for a covered, unforeseen reason,
travel insurance can reimburse up to 100% of your prepaid, nonrefundable payments or deposits that would otherwise be forfeited.

If you’re a thrill-seeking traveler who enjoys life’s more adventurous
activities, you may want to consider adding supplemental coverage
to your plan. The Adventure Sports Rider provides coveragefor injuries sustained during certain extreme sports that would
otherwise be excluded from your insurance policy.

If you’d like the option of seeing a doctor virtually during your trip
in case of a non-emergency medical issue, consider adding theTelehealth rider. With Telehealth you have access to board-certified
doctors 24/7 without having to visit an office. Your provider canmeet with you over the phone or via a video consultation, and canhelp diagnose and treat non-emergency medical problems.

PERSONAL PROPERTYn**Rider option is available on individual plans for U.S. residents only.
FINANCIAL PROTECTIONPHYSICAL HEALTHnn Enhanced Accidental Death & Dismemberment Rider(AD&D)***
Accidents can happen—wouldn’t you rather be prepared, especiallywhen you’re away from home? The AD&D rider will pay you or yourbeneficiaries up to $400,000 if your death or dismemberment is the
direct result of an accident.
Note: Available to the primary insured only. Available with a minimumpurchase of three months of medical and AD&D rider coverage.
Premium is charged in whole-month increments.
***Rider option is available on individual plans only.

nChaperone/Faculty Leader Replacement Rider****If you are the designated chaperone/faculty leader and experiencean unexpected death of a relative, a medical emergency, or thedestruction of your residence that causes you to cancel or interrupt
travel, this rider covers reimbursement for a round trip economy
airline ticket up to $3,000 for a replacement chaperone/facultyleader.
****Rider option is available on group plans only

All coverage and benefits in the plan 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 asummary of a selection of plan benefits offered only as an illustration and does not supersede in anyway the Certificate of Insurance and governing policy documents (together the “Insurance Contract”).
The Insurance Contract is the only source of the actual benefits provided.

9

PATRIOT TRAVELMEDICAL INSURANCE®

HOW TO GET COVEREDHOW TO EXTEND YOUR COVERAGE

1

Step 1:
Contact your producer or apply online.

2

Step 2:Complete your online application: If applying as a family,
you may include yourself, your spouse, and dependents on
one application. Please complete a group application if you
have two or more primary insureds.

To meet the needs of our customers, Patriot Travel Series plans canbe purchased for up to a 12-month period. Lite and Plus plans can beextended up to 24 continuous months, and Platinum plans can beextended up to a maximum of 36 continuous months. To renew yourcoverage, please visit our website.

3

Step 3:
Receive a fulfillment kit that includes an identification card,declaration of insurance, and a Certificate of Insurance
outlining the details of the plan. Welcome to the IMG family!

IMPORTANT NOTICE REGARDING PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA): This insurance is not subject to and does not provide benefits required by PPACA. Since January 1, 2014, PPACA requires U.S. citizens, U.S.
nationals and certain U.S. residents to obtain PPACA-compliant insurance coverage unless they are exempt from PPACA. Penalties may be imposed on persons who are required to maintain PPACA-compliant coverage but do not do so. Eligibility topurchase, extend or renew this product, or its terms and conditions, may be modified or amended based upon changes to applicable law, including PPACA. Please note that it is an insured person’s sole and exclusive responsibility to determine theinsurance requirements applicable to them, and the Company and IMG shall have no liability whatsoever, including for any penalties a person may incur, for failure to obtain coverage required by any applicable law including, without limitation,
PPACA. For information on whether PPACA applies to you or whether you are eligible to purchase Patriot Travel Medical Insurance, please see IMG’s Frequently Asked Questions at www.imglobal.com/faq.

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U N D E R S T A N D I N G Y O U R N E E D S.
E X C E E D I N G Y O U R E X P E C T A T I O N S.

PATRIOT
Travel Series

Partner Contact Information
HIRANO - HOLCOMB INSURANCE AGENCY,
LLC
P.O. BOX 12580
MILL CREEK, WA 98082
Phone: 206-755-5585
Fax: 888-391-5155
masako@mhhinsurance.com
http://www.mhhinsurance.com

This invitation to inquire allows eligible applicants an opportunity to seek information about theinsurance 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.
Certain contracts do contain a pre-existing condition exclusion and do not cover losses or expenses
related to a pre-existing condition.

CM00502326A240326

This brochure contains many of the valuable trademarks, names, titles, logos, images, designs,
copyrights and other proprietary materials owned and registered and used by International Medical
Group, Inc. and its representatives throughout the world. © 2007-2024 International Medical Group,
Inc. All rights reserved.
The UnitedHealthcare name and logo are registered trademarks of UnitedHealth Group in the U.S.
and other jurisdictions.

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