Designed for the international traveler: As you expect first-rate protection when you travel, the two Patriot Platinum plans offer a complete package of international benefits available 24 hours a day.
Patriot Platinum International provides coverage for U.S. citizens traveling abroad for a minimum of five days up to a maximum of three 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 three years.
Patriot Platinum America provides coverage for non-U.S. citizens traveling outside their home country for a minimum of five days up to a maximum of three 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 three years.
Most travelers assume they will be covered by their standard medical plan. The truth is, while traditional plans may offer adequate domestic coverage, they may not be designed for international travel. Without even realizing it, you may be putting your health - & that of your family - at risk.
What if you are injured or become ill during your trip? Could you get quality treatment at an unfamiliar hospital? How would you deal with the language and currency barriers? What if the treatment you need isn't available nearby? Who do you call? Imagine trying to call your insurance company at 3:00 a.m. from a foreign country during a medical emergency! Will they be there when you need them the most?
You have enough things to worry about when you're traveling. Don't let your medical coverage be one of them. International Medical Group (IMG) has developed three Patriot Platinum Medical Insurance plans to provide you and your family Coverage without Boundaries. Each plan offers a complete package of international benefits & 24 hour availability. Simply select the one that best fits your needs.
A Unique, Full-Service Approach:
At IMG, we know that the reasons to travel
abroad are many and varied - that's why our
services are designed to provide you with the
security you need no matter where you are.
Our goal is to make the medical process smooth and efficient. By
providing global products and services to vacationers, those
working or living abroad for short or extended periods, people
traveling frequently between countries, and those who maintain
multiple countries of residence, IMG is the single resource for all
your international travel needs.
How we service and support your needs is what sets us apart. Since
1990, we've served more than a million people around the globe -
always focused on the specific needs of each individual. We've set
the benchmark for industry service levels by integrating
independent credentialing services with in-house, fully owned and
operated service divisions. At IMG, we're with you, wherever you go
- bringing support for all your insurance needs around the globe -
providing you Global Peace of Mind®.
****CLICK HERE TO OBTAIN A PERSONALIZED QUOTE****
All the deductible and all the policy maximum plan options available.
Rates:
Patriot Platinum America The
following rates are on base of $250 deductible in all the policy maximum
options
Options:
Other lower and Higher deductible options
available as following to improve the deductible or reduced the
cost. please use this rate factors.
| Deductible |
Rate Factors |
Deductible |
Rate Factors |
| $0 |
1.25 |
$2,500 |
.70 |
| $100 |
1.10 |
$5,000 |
.60 |
| $250 |
1.00 |
$10,000 |
.55 |
| $500 |
.90 |
$25,000 |
.45 |
| $1,000 |
.80 |
|
|
| POLICY LIMIT |
Option 4
$1,000,000 |
Option 5
$5,000,000 |
Option 6
$8,000,000 |
| |
| AGE |
Monthly Rates |
| 18-29 |
$115.00 |
$134.00 |
$144.00 |
| 30-39 |
$151.00 |
$177.00 |
$188.00 |
| 40-49 |
$234.00 |
$274.00 |
$292.00 |
| 50-59 |
$347.00 |
$405.00 |
$434.00 |
| 60-64 |
$412.00 |
$481.00 |
$515.00 |
| 65-69 |
$433.00 |
$505.00 |
$540.00 |
| 70-79* |
$444.00 |
N/A |
N/A |
| 80+** |
$644.00 |
N/A |
N/A |
| DEP. CHILD |
$101.00 |
$117.00 |
$126.00 |
| CHILD ALONE |
$104.00 |
$122.00 |
$131.00 |
| |
| |
Daily Rates (Minimum length of coverage is 5 days) |
| 18-29 |
$3.85 |
$4.50 |
$4.80 |
| 30-39 |
$5.05 |
$5.90 |
$6.30 |
| 40-49 |
$7.80 |
$9.15 |
$9.75 |
| 50-59 |
$11.60 |
$13.50 |
$14.50 |
| 60-64 |
$13.75 |
$16.05 |
$17.20 |
| 65-69 |
$14.45 |
$16.85 |
$18.00 |
| 70-79* |
$14.80 |
N/A |
N/A |
| 80+** |
$21.50 |
N/A |
N/A |
| DEP. CHILD |
$3.40 |
$3.90 |
$4.20 |
| CHILD ALONE |
$3.50 |
$4.10 |
$4.40 |
* $100,000 Maximum
** $20,000 Maximum
Rates:
Patriot Platinum International The following rates are on base of $250 deductible in all the policy maximum options
Options:
Other lower and Higher deductible options
available as following to improve the deductible or reduced the
cost. please use this rate factors.
| POLICY LIMIT |
Option 1
$1,000,000
|
Option 2
$5,000,000
|
Option 3
$8,000,000
|
| |
| AGE |
Monthly Rates |
| 18-29 |
$80.00 |
$94.00 |
$100.00 |
| 30-39 |
$105.00 |
$123.00 |
$131.00 |
| 40-49 |
$135.00 |
$158.00 |
$169.00 |
| 50-59 |
$226.00 |
$264.00 |
$283.00 |
| 60-64 |
$298.00 |
$349.00 |
$373.00 |
| 65-69 |
$313.00 |
$366.00 |
$391.00 |
| 70-79* |
$321.00 |
N/A |
N/A |
| 80+** |
$465.00 |
N/A |
N/A |
| DEP. CHILD |
$72.00 |
$85.00 |
$90.00 |
| CHILD ALONE |
$77.00 |
$90.00 |
$96.00 |
| |
| |
Daily Rates
(Minimum length of coverage is 5 days) |
| 18-29 |
$2.70 |
$3.15 |
$3.35 |
| 30-39 |
$3.50 |
$4.10 |
$4.40 |
| 40-49 |
$4.50 |
$5.30 |
$5.65 |
| 50-59 |
$7.55 |
$8.80 |
$9.45 |
| 60-64 |
$9.95 |
$11.65 |
$12.45 |
| 65-69 |
$10.45 |
$12.20 |
$13.05 |
| 70-79* |
$10.70 |
N/A |
N/A |
| 80+** |
$15.50 |
N/A |
N/A |
| DEP. CHILD |
$2.40 |
$2.85 |
$3.00 |
| CHILD ALONE |
$2.60 |
$3.00 |
$3.20 |
* $100,000 Maximum
** $20,000 Maximum
Benefits:
| SCHEDULE OF BENEFITS (All amounts listed are in U.S. dollars) |
| MEDICAL BENEFITS |
Usual, reasonable and customary charges, subject to deductible and coinsurance |
| Hospital Room and Board |
Up to Policy Maximum |
|
| Intensive Care |
Up to Policy Maximum |
|
| Medical Expenses |
Up to Policy Maximum |
|
| Outpatient Medical Expenses |
Up to Policy Maximum |
|
| Local Ambulance |
Up to Policy Maximum |
|
| Emergency Room |
As described below |
|
| Emergency Room Accident |
Up to Policy Maximum |
|
Emergency Room Illness with
In-patient Admission |
Up to Policy Maximum |
|
Emergency Room Illness without
In-patient Admission |
Up to the Maximum Limit with
additional $250 deductible |
|
| Dental - Injury Due to Accident |
Up to the Maximum Limit |
|
| Hospital Daily Indemnity |
Up to $250 per night for a
maximum of 10 days |
|
| Supplemental Accident |
Up to $300 |
|
| Dental |
As described below |
Injury due to an accident: Each Patriot Platinum 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: Each plan will pay up to $250 for the necessary treatment of sudden, unexpected pain to sound natural teeth. |
| INTERNATIONAL EMERGENCY CARE (when coordinated through the Plan administrator) |
| Political Evacuation |
Up to $100,000 |
If the United States Department of State, Bureau of Consular Affairs, or similar government organization of the insured person's home country, orders the evacuation of all non-emergency government personnel from the host country, due to political unrest, that becomes effective on or after the insured person's date of arrival in the host country, the Company pays up to a $100,000 lifetime maximum for transportation to the nearest place of safety or for repatriation to the insured person's home country or country of res¬idence provided that:
- The insured person contacts the Company within 10 days of the United States Department of State, Bureau of Consular Affairs, or similar government organization of the insured person's home country, issuance of the evacuation order; and
- The evacuation order pertains to persons from the same home country as the insured person; and
- Political Evacuation and Repatriation is approved and coordinated by the Company; In no event will the Company pay for a political evacuation if there is a travel warning in effect on or within six (6) months prior to the insured person's date of arrival in the host country.
|
| Emergency Evacuation |
Up to Policy Maximum |
| The Patriot Platinum plans offer coverage for Emergency Medical Evacuation to the nearest qualified medical facility; expenses for reasonable transportation resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred, up to the Maximum Limit. |
| Emergency Reunion |
Up to $100,000 |
| Each Patriot Platinum plan also offers Emergency Reunion coverage, up to $100,000 for a maximum of 15 days, for the reasonable travel and lodging expenses of a relative or friend during an Emergency Medical Evacuation: either the cost of accompanying the insured during the evacuation or trav¬eling from the home country to be reunited with the insured |
Return of Mortal Remains or Cremation/
Burial |
Up to $100,000 |
| 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 $50,000; or up to $5,000 for the preparation, local burial or cremation of your mortal remains at the place of death. |
| Hospital Daily Indemnity |
| Each plan pays $250 directly to the insured person for each night of a required overnight stay in a hospital up to a maximum of 10 days. The hospital stay must be covered under this plan in order to receive this benefit. |
| Natural Disaster |
$250 per day for five days |
| This benefit is available in the event an insured person is required depart his/her destination due to an evacuation order issued prevailing authorities in connection with a Natural Disaster. Natural Disaster is defined as widespread disruption of human lives disasters such as flood, drought, tidal wave, fire, hurricane, earthquake, windstorm, or other storm, landslide, or other natural catastrophe event resulting in migration of the population for its safety. |
| Remote Transportation |
$5,000 per certificate period
$20,000 lifetime maximum |
in the event of a diagnosis of a critical medical condition which is not necessarily immediately life-threatening, but severe enough to result in death or a permanent disability if not treated right away, Remote Transportation will provide for eligible charges arising out of the transportation of an insured person to a qualified facility for further treatment (if the current facility is unable to provide such treatment).
To be eligible for the Transportation, Evacuation, Reunion and Return benefits, these must be recommended by the attending physician in critical medical situations, and approved in advance and coordinated by IMG. |
| Identity Theft Assistance |
Up to $500 |
| If an imposter obtains key personal information such as a Social Security or Driver's License number, or other method of identifying an insured person in order to impersonate or obtain credit, merchandise or services in the insured person's name, the Patriot Platinum plans will provide coverage for the reasonable, customary and necessary costs incurred by the insured for: re-filing a loan or other credit application that is rejected solely as a result of the stolen identity event; notarization of legal documents, long-distance telephone calls, and postage that has resulted solely as a result of reporting, amending and/or rectifying records as a result of the stolen identity event; up to three credit reports obtained within one year of the insured person's knowledge of the stolen identity event; and stop payment orders placed on missing or unauthorized checks as a result of the stolen identity event.
The identity theft event must occur during the Period of Coverage and must be reported within 6 months of the termination of coverage date. |
Lost / Theft
(luggage, valuables, personal papers) |
Up to $500 |
| This benefit will be paid in the event that damage to, loss of, or theft of your checked or stored baggage or personal items by a common carrier or while stored with your hotel and the replacement costs of travel documents. |
| Felonious Assault |
Up to $10,000 |
| If you are injured as a result of a Felonious Assault while traveling outside of your Home Country, each plan will pay $10,000. This benefit is in addition to any other benefit available under Patriot Platinum. |
|
| PLAN INFORMATION |
| Plan Maximum |
$1,000,000, $5,000,000, $8,000,000 |
|
| Deductible |
Your choice of $0, $100, $250, $500, $2,500, $5,000, $10,000 or $25,000 |
| On the Application Form, you will be asked to circle your choice of a deductible. Your premium rate is dependent on the deductible you choose. Please see the Application Form for more information. |
| Family Deductible |
Three times the individual deductible |
|
| Coinsurance |
As described below |
For treatment received outside the U.S. & Canada: 100%
For treatment received within the U.S. & Canada:
In the PPO Network: The plan pays 100% of eligible expenses up to the Policy Maximum
Outside the PPO Network: The plan pays 90% of eligible expenses up to $5,000, then 100% up to the Policy Maximum |
| Benefit Period |
12 months |
| If a covered injury or illness requires continuing treatment after the Period of Coverage expires, the twelve-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 twelve 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 twelve months of continuous coverage for the covered injury or illness. |
| Global Concierge & Assistance ServicesSM |
Access to a dedicated service team for assistance services |
| See brochure for more information |
| MyIMGSM |
24 hour secure access from anywhere in the world to manage your account at anytime |
|
| eDocAmericaSM |
Access to board-certified physicians, licensed psychologists and pharmacists to assist with any routine health related questions |
|
| World-class Medical Benefits |
Premium coverage available for in-patient and out-patient medical expenses |
|
| International Emergency Care |
A wide range of international emergency benefits available including emergency evacuation, emergency reunion, return of mortal remains, return of minor children and more |
|
| ADDITIONAL BENEFITS |
| Terrorism |
Up to Policy Maximum |
Each Patriot Platinum plan provides coverage for injuries and illness incurred as a result of an act of Terrorism, limited in amount and by circumstances. If an insured person is injured as a result of an act of Terrorism, and the insured person has no direct or indirect participation in the act, the plan will reimburse eligible medical claims up to the Policy maximum. However, claims incurred as a result of radiological, nuclear, chemical or biological weapons or events are not covered.
Terrorism is defined as the systematic or planned use of violence, fear, or threat of violence in order to intimidate a population or government, especially as a means of coercion or to obtain a granting orf any demand. However, this benefit does not cover an act of Terrorism in any country or location where the United States government has issued a travel advisory that has been in effect within the 6 months prior to the insured person's date of arrival.
This benefit also does not cover an act of Terrorism in the event that an advisory to leave a certain country or location is issued by the United States government after the insured person's arrival date, and the insured person unreasonably fails or refuses to depart the country or location. |
| Sports & Leisure Activities |
Up to Policy Maximum for basic sports |
Each Patriot Platinum 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. Some of these sports and activities include, but are not
limited to, motor cycle/motorscooter riding, scuba diving (to 10m),
snorkeling, wakeboarding, and water skiing. 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 unless the Adventure
Sports Rider is purchased: abseiling, BMX, bobsleigh, bungee jumping,
canyoning, caving, hang gliding, heli-skiing, high diving, horseback riding,
hot air ballooning, inline skating, jet skiing, jungle zip lining, kayaking,
mountain biking, paragliding, parascending, piloting a non-commercial
aircraft, rappelling, rock climbing or mountaineering (ropes and guides to
4500m from ground level), scuba diving (to 50m), skydiving, snow
boarding, snowmobiling, snow skiing, spelunking, surfing, trekking,
whitewater rafting (to Class V), and wildlife safaris. To be covered under
the Adventure Sports Rider, these adventure activities must be engaged in
solely for leisure, recreation, or entertainment purposes.
Injury sustained while participating in contact sports of any kind, racing
of any kind, BASE jumping, kiteboarding, mountaineering or climbing
or trekking above elevation 4500 meters above ground level or without
proper ropes or guides; luge, motocross, Moto-X, rodeo activity, ski
jumping, whitewater rafting exceeding Class V difficulty, scuba below
50 meters; and/or adventure sports not expressly covered hereunder
are excluded regardless of which plan or rider is selected. |
Adventure Sports Rider
(available to insured up to age 65)
|
|
|
Age
|
Lifetime Maximum
|
|
0 - 49
|
$50,000
|
|
50 - 59
|
$30,000
|
|
60 - 64
|
$15,000
|
|
| Hospital Daily Idemnity |
|
| Patriot Platinum will pay directly to the insured person $250 for each
night of a required overnight stay in a hospital up to a maximum of 10
days. However, the hospital stay must be covered under this plan in
order to receive this benefit.
|
Sudden and Unexpected Recurrence of a Pre-existing Condition
(for U.S. citizens only) |
|
| For those up to age 65 with a primary health plan, Patriot
Platinum International will pay the Usual, Reasonable and Customary
charges of a sudden and unexpected recurrence of a Pre-existing
Condition (defined on page 16) up to the plan maximum. For those without
a primary health plan, Patriot Platinum International will pay up to a $20,000
lifetime maximum. For those age 65 and older, with or without a primary
health plan, Patriot Platinum International will pay up to a $2,500 lifetime
maximum. The primary health plan must have existed prior to the effective
date and during coverage of the Patriot Platinum plan, and the Pre-existing
Condition must be covered under the primary health plan.
In addition, up to $25,000 will be paid for the eligible costs and
expenses of an Emergency Medical Evacuation arising or resulting from
a sudden and unexpected recurrence of a Pre-existing Condition.
|
Sudden and Unexpected Recurrence of a Pre-existing Condition
(for Non-U.S. citizens only) |
|
| For those under age 65, Patriot Platinum America
will pay up to a $20,000 lifetime maximum for eligible medical expenses
and up to a $20,000 lifetime maximum for emergency medical evacuation.
|
| Incidental Home Country Coverage |
Up to a cumulative two weeks |
| During the Period of Coverage an insured person may return to their home country for incidental visits up to a cumulative two weeks total, subject to: a. The insured person must have left their home country, b. The total Period of Coverage must be for a minimum of 30 days, and c. The return to the home country may not be taken to receive treatment for an illness or injury incurred while traveling. |
| End of Trip Home Country Coverage |
One month for every four months of travel coverage, up to a maximum of three months |
| For every four months of continuous coverage you purchase, you can purchase one additional month of home country coverage as an accommodation and supplemental travel benefit, up to a maximum of three months. To purchase this special home country extension coverage, please check the appropriate box on the Application Form, and calculate your premium to include the additional month(s). |
| Trip Interruption |
Up to $10,000 |
| If, during a covered trip, there is a death of an immediate family
member (spouse, child, parent or sibling), a break-in at the insured's
principle residence, or the substantial destruction of the insured's
principal residence due to a fire or natural disaster, each Patriot
Platinum plan will pay to return the insured to the area of principal
residence. The plan will pay 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.
|
| Common Carrier Accidental Death |
$100,000 per adult, $25,000 per child, maximum of $250,000 per family |
| If accidental death should occur while traveling on a commercial Common Carrier, $100,000 per adult and $25,000 per child will be paid to the designated beneficiary, to a maximum of $250,000 per family. |
| Accidental Death & Dismemberment |
$50,000 principle sum |
| Each Patriot Platinum plan includes $50,000 principal sum benefit for Accidental Death and Dismemberment occurring during the Period of coverage: Accidental Loss of life - principal sum; Accidental Loss of two Members - principal sum; Accidental Loss of one Member - 50% of principal sum. "Member" means hand, foot or eye. |
|
Riders:
| DESCRIPTION OF OPTIONAL RIDERS |
| ADVENTURE SPORTS RIDER: |
|
The Adventure Sports Rider is available on both Patriot Platinum
plans for those up to the age of 65. The following activities are covered
to the lifetime maximum amounts listed on page four: abseiling, BMX,
bobsleigh, bungee jumping, canyoning, caving, hang gliding, heliskiing,
high diving, horseback riding, hot air ballooning, inline skating,
jet skiing, jungle zip lining, kayaking, mountain biking, paragliding,
parascending, piloting a non-commercial aircraft, rappelling, rock
climbing or mountaineering (ropes and guides to 4500m from ground
level), scuba diving (to 50m), skydiving, snow boarding, snowmobiling,
snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class
V), and wildlife safaris. These adventure activities must be engaged in
solely for leisure, recreation, or entertainment purposes.
|
Adventure Sports Rider
(Age Lifetime Maximum)
|
|
|
Age
|
Lifetime Maximum
|
|
0 - 49
|
$50,000
|
|
50 - 59
|
$30,000
|
|
60 - 64
|
$15,000
|
|
| ENHANCED AD&D RIDER: |
|
This optional coverage is available for the primary insured person only.
This coverage is in addition to the Accidental Death and
Dismemberment already included in the Patriot Platinum plans. This
rider is available with a minimum purchase of three months of
medical and AD&D rider coverage.
|
| CITIZENSHIP RETURN RIDER: |
|
When purchased at the time of application, the Citizenship Return
Rider provides temporary medical coverage for non-U.S. citizens
returning to their country of citizenship. For U.S. citizens, the rider
provides up to 60 days of coverage for brief returns to the U.S.
provided you have a current health plan in force and have resided
outside the U.S. continuously for the past six months. Coverage for
sudden recurrence of pre-existing conditions is excluded if the rider is
selected. For premium information, please see the back of the
Application Form.
|
| PERSONAL LIABILITY RIDER: |
|
This optional coverage provides for the reimbursement of legal costs
associated with a personal liability event by a covered insured. This includes
legal costs incurred arising from the determination and/or settlement of
such legal liability associated with the injury of a third person or damage to
a third person's property during the period of coverage.
Personal Liability -
Injury to third party $2,000 limit after $100 deductible
|
| EVACUATION PLUS RIDER: |
|
This optional rider is available to insureds up to age 65 and provides
coverage for medical evacuations for medical conditions that are non
life-threatening and evacuations as a result of a natural disaster. This
rider must be purchased for a minimum of three months
regardless of the minimum number of days being traveled.
Up to age 65. Non Life threatening
Medical Evacuation -
Up to a maximum of $50,000;
Natural Disaster Evacuation - Up
to a maximum of $10,000
|
Exclusions:
Charges for the following services, treatments and/or conditions, among others, are
excluded from coverage under the Patriot Platinum plans.
- A Pre-existing Condition which is 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 dur¬ing the three years prior to the effective date of the insurance, including any subsequent, chronic or recurring complications or consequences related thereto or arising therefrom, whether or not previously manifested or known, diagnosed, treated, or disclosed.
- Treatment or surgeries which are elective, investigational, experimental or for research purposes.
- War, military action, terrorism, political insurrection, protest, or any act thereof. The Company
will not pay for a Political Evacuation if there is a travel advisory in effect on or within six (6) months
prior to the Insured Person's date of arrival in the Host Country.
- Immunizations and routine physical exams.
- Treatment of Temporomandibular Joint or dental treatment, except as expressly provided
for in the certificate of insurance.
- Venereal disease, AIDS virus, AIDS-related illness, ARC Syndrome, or AIDS, and 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.
- Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or
impotency, sterilization or reversal thereof, or abortion.
- Any illness or injury sustained while taking part in: Amateur Athletics, Professional Athletics, or other athletic activity that is sponsored or sanctioned by the National Collegiate Athletic Association (and/or any other collegiate sanctioning or governing body), or the International Olympic Committee. The following Adventure Sports are excluded unless the Adventure Sports Rider is purchased: abseiling, BMX, bobsled¬ding, bungee jumping, canyoning, caving, hang gliding, heli-skiing, high diving, hot air ballooning, inline skating (with proper use of helmet and pads), jet skiing, jungle zip lining, kayaking, mountain biking, parachuting, paragliding, parascending, piloting a non-commercial aircraft, rappelling, rock climbing or mountaineering (ropes and guides to 4500m from ground level), scuba diving (to 50m), skydiving, snowboard¬ing, snowmobiling, snow skiing, spelunking, surfing, trekking, whitewater rafting (to Class V), wildlife safaris, and windsurfing. All such activities must be carried out in strict accordance wit the rules, regulations and guidelines of the applicable Governing Body or Authority of each such activity.
Injury sustained while participating in contact sports of any kind, racing of any kind, any rodeo activity, BASE jumping, kiteboarding, mountaineering or climbing or trekking above elevation 4500 meters above ground level or without proper ropes or guides; luge, motocross, Moto-X, ski jumping, sub-aquatic activities below 50 meters, whitewater rafting exceeding Class V difficulty; and/or adventure sports activity not expressly covered hereunder are excluded regardless of which plan or rider is selected.
- Vision or ear tests and the provision of visual or hearing aids.
- Vocational, recreational, speech or music therapy.
- Treatment while confined primarily to receive custodial care, educational or rehabilitative
care, or nursing services.
- 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.
- Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
- 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.
- Willful self-inflicted injury or illness.
- Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.
- Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
- Treatment for mental and nervous disorders.
- Organ or tissue transplants or related services.
- Illness or injury where the trip to the host country is undertaken for treatment or advice for such
illness or injury, except as expressly provided for in the certificate of insurance.
- Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).
- Any infection of the urinary tract (or Illness arising there¬from), that occurs within ninety (90) days of the Effective Date of coverage and that requires Treatment of the Insured Person in a Hospital; provided that any such Illness will be deemed by the Company to be a Pre-existing Condition. See "Sudden and Unexpected Recurrence of a Pre-existing Condition," on brochure pdf page 11
IMPORTANT NOTICE REGARDING PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA): This insurance is not subject to, and does not provide benefits required by, PPACA. On January 1, 2014, PPACA will require U.S. citizens and certain U.S. residents to obtain PPACA compliant insurance coverage unless they are exempt from PPACA. Penalties may be imposed on U.S. citizens and U.S. residents who are required to maintain PPACA compliant coverage but do not do so. Please note that it is solely your responsibility to determine if PPACA is applicable to you.
Locating a Provider:
As a Platinum member, you may seek treatment with the hospital or
doctor of your choice. 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 health care
physicians 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 the U.S.,
IMG provides its online International Provider Access (IPA), a database
of over 17,000 providers.
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