Individual Executive Insurance | Print |

Benefits

SCHEDULE OF BENEFITS
INTERNATIONAL EMERGENCY CARE
Emergency Evacuation Up to US$25,000 for pre-existing conditions; up to policy maximum for covered incidents for insured persons under age 66; up to US$50,000 for covered incidents for insured persons from ages 66 to 75
Patriot Executive® plan includes coverage for emergency medical evacuation to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred up to the policy limit. The plan pays up to US$25,000 for evacuations resulting from a pre-existing condition; up to the policy maximum for covered incidents for insured persons under age 66; and up to US$50,000 for covered incidents for insured persons from ages 66 to 75.
Emergency Reunion To US$15,000 when coordinated through the Plan Administrator
The Patriot Executive® plan also provides emergency reunion coverage, up to US$15,000 for a maximum of 15 days, for the reasonable travel and lodging expenses of a relative or friend during an emergency medical evacuation of the insured person: either the cost of accompanying the insured during the evacuation or traveling from the home country to be reunited with the insured.
Return of Mortal Remains To US$25,000 when coordinated through the Plan Administrator
If a covered illness/injury results in death, expenses for repatriation of bodily remains or ashes to the home country will be covered up to a maximum of US$25,000.
Returning Minor Children To US$5,000 when coordinated through the Plan Administrator
If an insured person is hospitalized due to a covered illness/injury and is traveling alone with child(ren) 19 or under that otherwise would be left unattended, the Patriot Executive plan will reimburse up to US$5,000 for one way economy fare to their home country, including a chaperone, if necessary, for the safety of the child(ren).
 
SPECIAL COVERAGES
Trip Interruption To US$5,000
If, during a covered trip, there is a death of an immediate family member (spouse, child, parent or sibling) or the substantial destruction of the insured’s principal residence, the Patriot Executive plan will reimburse the insured up to US$5,000 for the cost of returning the insured to the area of principal residence. The plan will cover reimbursement for a one way air or ground transportation ticket of the same class as the unused travel ticket, less the value of the unused return ticket.
Lost Luggage To US$50 per item of luggage; maximum of US$250
This benefit will be paid in the event that the Common Carrier permanently loses an insured person’s checked luggage. This coverage is secondary to any other available coverage, including the Carrier’s.
Common Carrier Accidental Death US$50,000 to Beneficiary; maximum of US$250,000 per family
If accidental death should occur while traveling on a commercial Common Carrier, US$50,000 will be paid to the designated beneficiary, to a maximum of US$250,000 per family.*
 
MEDICAL BENEFITS usual, reasonable and customary charges, subject to deductible
Hospital Room and Board To Policy Maximum for average semi-private room rate
 
Intensive Care To Policy Maximum
 
Medical Expenses To Policy Maximum
 
Outpatient Medical To Policy Maximum
 
Local Ambulance To Policy Maximum
 
Emergency Room As described below
Charges incurred for the use of the Emergency Room due to an accident are covered up to the Policy Maximum.

Charges incurred for the use of the Emergency Room for treatment of an illness are subject to an additional (extra) US$250 deductible if treatment does not require admittance to the hospital.
Dental As described below
Injury due to an accident: The plan covers the cost of emergency dental treatment and dental procedures necessary to restore sound natural teeth lost or damaged in an accident up to the Policy Maximum.

Sudden dental pain: The plan will pay up to US$100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.
Pre-existing Conditions To US$5,000 per period of coverage
The plan will cover up to US$5,000 maximum, per insured person, per period of coverage (not per trip), for the sudden and unexpected recurrence of a pre-existing condition, as defined in the certificate wording.
Sports & Activities Coverage To Policy Maximum for basic sports as described below
The Patriot Executive plan covers injuries incurred during amateur athletic activities which are non-contact and engaged in by the insured person solely for leisure, recreation, entertainment or fitness purposes. However, activities not covered include amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition. The following hazardous activities are excluded: racing of any kind, aviation (except when traveling as a passenger in a commercial aircraft), BMX, BASE jumping, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, luge, motocross (moto-x), mountain biking, mountaineering, parachuting, rappelling, rock climbing, rodeo, scuba diving, ski jumping, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, windsurfing and whitewater rafting.
Accidental Death & Dismemberment US$25,000 principal sum
The Patriot Executive plan includes US$25,000 principal sum benefit for Accidental Death and Dismemberment occurring during the period of coverage: • Accidental Loss of life - principal sum* • Accidental Loss of life which occurred during a hijacking, kidnapping or attempted kidnapping - two times the principal sum* • Accidental Loss of two Members - principal sum • Accidental Loss of one Member - 50% of principal sum.
“Member” means hand, foot or eye. For more information see the Conditions of Coverage section on panel 9 of the Patriot Executive brochure.*
 
BASIC PLAN INFORMATION
Deductible US$250 per each covered Illness; deductible waived for claims incurred as a result of a covered accident
 
Coinsurance None
 
Policy Maximum US$1,000,000; US$50,000 for travelers who are 70-75 years old
 
Benefit Period Six Months
If a covered injury or illness requires continuing treatment after the period of coverage expires, the six-month Benefit Period may provide continued coverage. When the certificate expires, the Company will review the date of initial treatment for the covered injury or illness. If treatment began less than six months before the period of coverage expired, benefits for the covered injury or illness will continue subject to the Policy Limits and the other terms of the plan until there have been six months of continuous coverage for the covered injury or illness.
 
* Notwithstanding separate benefits, limits and sublimits for Common Carrier Accidental Death benefit and Accidental Death & Dismemberment benefits (above), no more than US$50,000 dollars per individual will be paid to a beneficiary in the event of any death that occurs while covered by the Patriot Executive plan.
 
This web page contains only a consolidated and summary description of all current Patriot Executive benefits, conditions, limitations and exclusions, and is subject to all of the terms and conditions of the full Policy Wording. A certificate containing the complete Policy Wording with all terms, conditions and exclusions will be included with the fulfillment kit. The Company reserves the right to issue the most current Policy 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 Policy Wordings are available upon request.

Exclusions

Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under the Patriot Executive plan.

  1. Treatment for pre-existing conditions in excess of US$5000, per Insured Person, per Period of Coverage (not per trip). A pre-existing condition is defined as any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that, with reasonable medical certainty, existed at the time of application or at any time prior thereto, including any subsequent, chronic or recurring complications or consequences relating thereto or arising therefrom, whether or not previously manifested or known, diagnosed, treated, or disclosed.
  2. Treatment or surgeries which are elective, investigational, experimental or for research purposes.
  3. War, military action, terrorism, political insurrection, protest, or any act thereof.
  4. Immunizations and routine physical exams.
  5. Treatment of Temporomandibular Joint or dental treatment, except as provided for in the Certificate of Coverage.
  6. Venereal disease, AIDS virus, AIDS related illness, ARC Syndrome, or AIDS, the cost of testing for these conditions, and charges for treatment or surgeries which are incurred by any Insured who was HIV+ at time of enrollment into this insurance.
  7. Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
  8. Injury sustained while participating in amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition. The following hazardous activities are excluded: racing of any kind, aviation (except when traveling as a passenger in a commercial aircraft), BMX, BASE jumping, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, luge, motocross (moto-x), mountain biking, mountaineering, parachuting, rappelling, rock climbing, rodeo, scuba diving, ski jumping, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, wind-surfing and whitewater rafting.
  9. Vision or ear tests and the provision of visual or hearing aids.
  10. Vocational, recreational, speech or music therapy.
  11. Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
  12. Charges, injuries and/or illnesses resulting or arising from or occurring during the commission or continuing perpetration of a violation of law by the insured, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
  13. Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
  14. Injury and/or illness resulting or arising from being under the influence of alcohol or drugs; and injury or illness resulting from operating any type of vehicle after consuming any alcohol or drugs.
  15. Willful self-inflicted injury or illness.
  16. Treatment required as a result of or arising from complications from a treatment or condition not covered hereunder.
  17. Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
  18. Treatment for mental and nervous disorders.
  19. Organ or tissue transplants or related services.
  20. Treatment for Illness or Injury where the trip is undertaken for the purpose of obtaining such treatment or advice for a pre-existing condition.
  21. Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).
This web page contains only a consolidated and summary description of all current Patriot Executive benefits, conditions, limitations and exclusions, and is subject to all of the terms and conditions of the full Policy Wording. A certificate containing the complete Policy Wording with all terms, conditions and exclusions will be included with the fulfillment kit. The Company reserves the right to issue the most current Policy 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 Policy Wordings are available upon request.

Premiums

Through age 75*
 
Maximum Trip Duration** 30 Days
U.S. CITIZENS
Annual Premium US$200
Spouse & 2 children US$100
Each additional child US$40
NON-U.S. CITIZENS
Annual Premium US$236
Spouse & 2 children US$118
Each additional child US$47
 
Rates include 2.5% surplus lines tax where applicable. Rates are effective through 31-Oct-2008.
 
* The plan pays a policy maximum of US$50,000 for travelers who are 70-75 years old. Otherwise, the policy maximum is US$1,000,000.
** The maximum duration of any one trip is 30 days