PATRIOT
M u l t i - T r i p SM

Travel medical insurance for individuals, families andgroups of five or more taking multiple trips annually

WHY PATRIOT MULTI-TRIP?
Patriot Multi-Trip is designed for individuals, families, and groups of fiveor more who travel frequently outside of their country of residence
throughout the year. The annual plan — renewable up to a total of 36

months — is available for U.S. and non-U.S. residents who are under theage of 79. During the application process, you can choose a maximum
trip duration of 30, 60, or 90 days.

INSI D E THE U. S.

Patriot Multi-TripSM
A M E R I C A

Maximum Limits

Up to age 69: $1,000,000
Age 70-79: $50,000

Deductible$250

Extensions

Up to 36 continuous months

Coinsurance (In-Network)

100% up to the maximum limit

Coinsurance (Out-of-Network)

80% up to $1,000, then 100%

Sudden and Unexpected Recurrence of Pre-existing Conditions$5,000 maximum limit

OUTSI D E THE U.S .

Patriot Multi-TripSM

I N T E R N A T I O N A L

Maximum Limits
Deductible$250

Extensions

Up to 36 continuous months

Coinsurance100% up to the maximum limit

Sudden and Unexpected Recurrence of Pre-existing Conditions

2

Up to age 69: $1,000,000
Age 70-79: $50,000$5,000 maximum limit

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.

TheAdvantage

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 inmultiple 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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SUMMARY OF BENEFITS
The following benefits and coverage levels are shared across all Patriot Multi-Trip 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 copayment. Copayment is not applicable if the declaration
states a $0 deductible. Not subject to deductible

Walk-in Clinic$25 copayment. Copayment is not applicable if the declaration
states a $0 deductible. 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 hospitaladmission. Up to the maximum limit.

Hospital Emergency Room:
Outside the U.S.

Up to the maximum limit

PHYSICAL HEALTH

Hospitalization / Room & Board
Intensive Care
Bedside Visit
Hospitalized in an Intensive Care Unit

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

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 TherapyUp 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 was covered under the plan
Assistant Surgeon

4Average semi-private room rate up to the maximum limit,
includes Nursing services, miscellaneous and Ancillary services

Up to maximum limit

20% of the primary surgeon’s eligible fee

Anesthesia

Up to the maximum limit

Durable Medical Equipment

Up to the maximum limit

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 Multi-Trip products:

BenefitCoverage

PHYSICAL HEALTH

Inpatient or Outpatient ServicesChiropractic 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

Prescription Drugs and Medication
Prescription Drugs and Medication
Obtained through Retail Pharmacy, Inpatient and Outpatient
Surgery, Emergency Room and Outpatient Office Visits
Dispensing maximum for Retail Pharmacy: 90 days perprescription

Through age 69 Maximum Limit: $250,000 per period of insurance
Ages 70 to 79 Maximum Limit: Up to the period of coverage limit

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

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

Emergency Medical Evacuation
Must be approved in advance and coordinated by the company

Through age 65 maximum limit: Up to the period of coverage limit
Ages 66 to 79 maximum limit: $50,000
Not subject to deductible

CRISIS SUPPORTEmergency Reunion
Must be approved in advance by the companyInterfacility Ambulance Transfer
Transfer from one licensed health care facility to another licensed
health care facility resulting in an inpatient hospital admission$100,000 maximum limit. Not subject to deductible. 15 daymaximum.
Company pays 100%. Not subject to deductible.

Natural Disaster Evacuation
Must be approved in advance by the company$25,000 maximum limit .

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

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

Remote Transportation
Must be approved in advance by the company$20,000 maximum limit

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

Up to the maximum limit

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 Multi-Trip products:

BenefitCoverage
Other Services

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

PHYSICAL HEALTH

FINANCIAL PROTECTION

Identity TheftCRISISSUPPORT$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 perdamage 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 the insured
person$500 maximum limit. Not subject to deductible or coinsurance.

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

Dental Treatment$300 maximum limit due to dental accident or unexpected pain tosound natural teeth. Subject to deductible and coinsurance.

Emergency Eye Examination
Loss or damage to prescription corrective lenses
due to an accident

PERSONAL
PROPERTY$25,000 per insured child, $100,000 per insured adult, $250,000
maximum limit per family. Not subject to deductible or coinsurance.

Personal Liability
Secondary to any other insurance

Traumatic Dental Injury
Treatment at a hospital due to an accident

6$50,000 principal sum. Not subject to deductible.

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 maximum limit. $50 deductible per occurrence.

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 LuggageMaximum Limit per item $150, $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.

INNOVATIVE TECHNOLOGY & MEMBER SERVICES
Self-Service Capabilities

U.S. Network Access

MyIMGSM 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

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.

International 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

Adventure Sports Rider

PHYSICAL HEALTH

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.
Lifetime Maximum
Age 0-49: $50,000
Age 50-59: $30,000
Age 60-64: $15,000nEvacuation Plus Rider*

CRISIS SUPPORT

While Patriot Multi-Trip provides emergency medical evacuation
coverage for life-threatening injuries and illness, the Evacuation PlusRider 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 groundand air transportation to the nearest hospital capable of providing
treatment.

PHYSICAL HEALTHnPERSONAL PROPERTY

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.
nMobile 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 inthe world.
**Rider option is available on individual plans only.

nTelehealth Rider

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. .

Note: Must be purchased for a minimum of three months regardlessof the minimum number of days being traveled. Premium is charged inwhole-month increments.
*Rider option is available on individual 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 a summary of a selectionof 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 theactual benefits provided.

8PAT R I OT M U LT I - T R I P SMTRAVEL MEDICAL INSURANCEHOW TO GET COVEREDHOW TO RENEW YOUR COVERAGE

1

Step 1:
Contact your producer directly or to apply online.

2

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

The Patriot Multi-Trip individual and group plans may be renewed(unless there is a break in coverage) in increments of 12 months
up to a total of 36 continuous months. Any one period ofcoverage may not exceed 12 months. Please note: Renewal
premium rates may differ from initial rates.

3Step 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!

PROTECT YOUR INVESTMENT
IMG also offers trip cancellation plans to help protect your travel
investment. There are different plan options specifically designed
for your needs. For more information, please contact your trusted
insurance producer.

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 to purchase, extend or renew this product, or its terms and conditions, may be modified or amended based upon changes toapplicable law, including PPACA. Please note that it is an insured person’s sole and exclusive responsibility to determine the insurance requirements applicable to them, and the Company and IMG shall haveno 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 Multi-Trip 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.

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PATRIOT
M u l t i - T r i p SM

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.

CM0050A2336240329

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 MedicalGroup, Inc. and its representatives throughout the world. © 2007-2024 International Medical Group,Inc. All rights reserved.

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