BASIC PLAN INFORMATION & HIGHLIGHTS All coverages, benefits and premium amounts shown are in U.S. dollars
Plan Maximum	$10,000 per illness or injury with a Lifetime Maximum of $5,000,000.
Coinsurance	No Coinsurance
Deductible	$100 per Illness or Injury
Treatment Period	60 days per chronic illness
MyIMG SM	24 hour secure access from anywhere in the world to manage your account at anytime
International Emergency Care	A wide range of international emergency benefits available including emergency evacuation, emergency reunion, and return of mortal remains
Dependent Coverage	Coverage not only provided for dependents, but for faculty, scholars, students and exchange participants as well
Optional Add-on Plan	Additional coverage is available for high school sports, personal liability and legal assistance

SCHEDULE OF BENEFITS BASIC SHORT-TERM TRAVEL PLAN

MEDICAL BENEFITS *Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment.
Hospital Room and Board	Up to semi-private room rate
Hospital Intensive Care	URC*
Physical Therapy	URC* - 1 visit per day
Physician Visit	URC*
Student Health Center	$5 co-pay per visit
Prescription Drugs	Up to Policy Maximum
Eligible Medical Expenses	URC*
Emergency Room	URC*
Emergency Room Illness with In-patient Admission	URC*
Emergency Room Illness without In-patient Admission	Additional $250 deductible

INTERNATIONAL EMERGENCY CARE When coordinated through the Plan Administrator
Emergency Medical Evacuation	$25,000 Lifetime Maximum
Emergency Reunion	$5,000 Lifetime Maximum
Return of Mortal Remains	$7,500
Political Evacuation	Up to $10,000

ADDITIONAL BENEFITS
Accidental Death	$5,000
Dismemberment	$5,000 two limbs; $2,500 one limb
Terrorism Coverage	Up to $50,000 Lifetime Maximum
Sudden Recurrence of a Pre- existing Condition (U.S. citizens)
Medical	Up to $5,000 of eligible expenses
Emergency Medical Evacuation	Up to $25,000 of eligible costs and expenses
Pre-existing Conditions (For U.S. Citizens, this benefit will begin when the Sudden Recurrence benefit is exhaused.)	$500 per year; $50,000 lifetime maximum - after 12 months of continuous coverage
Incidental Home Country Coverage	Up to a cumulative two weeks

OPTIONAL ADD-ON PLAN
Baggage
Loss/theft of Baggage	$250
Loss/theft of Valuables	$250
Loss/theft of Personal Papers	$250
Legal Assistance
Binder Fee	$500 when served with summons
Personal Liability
Injury to third party	$2,000 limit after $100 deductible
Damage to third person property	$500 limit after $100 deductible. Secondary to any other insurance in force
Limited High School Sports Coverage	URC*

OPTIONAL RIDER
Applies to all individuals listed on the Application Form
Adventure Sports Rider (available to insured up to age 65 - apply 1.20 rate factor)	Age         Lifetime Maximum  0 - 49     $50,000 50 - 49     $30,000 60 - 64     $15,000

A long-term plan is also available. For more information, please contact your independent insurance agent or International Medical Group at 1-800-628-4664.

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

1. 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 during the three years prior to the effective date of the insurance, whether or not previously manifested or symptomatic, diagnosed, treated, or disclosed prior to the effective date, including any subsequent, chronic or recurring complications or consequences related thereto or arising therefrom.
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. 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.
4. Immunizations and routine physical exams.
5. Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.
6. 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.
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 under the certificate.
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. 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.
21. Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).
22. Charges for Treatment of a Chronic Illness incurred beyond sixty (60) days from the date of initial Treatment thereof.

This web page contains only a consolidated and summary description of all current Patriot Exchange Program 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.