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Global Medical Insurance^SM application

Patriot Executive Travel Medical Insurance^SM brochure and application

Patriot Travel Medical Insurance^SM brochure and application

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GLOBAL MEDICAL INSURANCE^SM

To see a pdf version of the complete Global Medical Insurance brochure, click on the brochure.

Global Medical Insurance^SM is a long-term, annually renewable, US- style major medical insurance plan designed to provide worldwide coverage to US expatriates and non-US citizens.

US citizens must leave the US on their effective date and plan to reside abroad for at least six months. Non-US citizens may reside anywhere including their home country, although certain eligibility requirements may apply to non-US citizens permanently residing in the US.

You also have the option of adding Global Term Life Insurance^SM and Global Daily Indemnity^SM to your Global Medical Insurance coverage.

Global Term Life Insurance

• Global Term Life Insurance provides protection for your family at the time of a traumatic loss and is available with no additional underwriting. This coverage is available for a standard annual premium of $240 and includes an Accidental Death and Dismemberment benefit.

Global Daily Indemnity

• Global Daily Indemnity pays you US$100 for each covered overnight hospital stay other than those related to pregnancy.

Lifetime Eligibility

Individuals covered by the Global Medical Insurance plan by their 65th birthday who maintain continuous coverage to age 75 are eligible for IMG's Global Senior Plan^SM.

For more information on this coverage, go to the Global Medical Insurance^SM brochure.

Global Medical Insurance^sm (GMI) covers the Usual, Reasonable and Customary (URC) charges for eligible expenses in the area where you receive treatment. Each person will only need to satisfy their deductible once per policy period (12 months) with a maximum of three deductibles per family per calendar year.  For eligible expenses incurred in the U.S. and Canada: once the deductible is met, GMI pays 80% of the next US$5000 in eligible expenses then 100% of eligible expenses up to the policy maximum. For eligible expenses incurred outside the U.S. and Canada:once the deductible is met, GMI will pay100% up to the policy maximum.

MEDICAL INSURANCE	BENEFIT              Subject to deductible and coinsurance
Coverage Area	Worldwide
Policy Maximum Per Individual Hospitalization Semi-private room and board l Nursing services l Prescription medication l Physician charges l Diagnostic and laboratory testing l X-rays l Chemotherapy and radiation l Durable medical equipment l Treatment, services and supplies routinely provided	US$5,000,000 lifetime
Intensive Care Unit	URC
Surgery Surgical care l Second surgical opinion l Anesthetics l Physician charges for surgery l Treatment, services and supplies routinely provided	URC
Transplants Covered only within IMG's PPO Transplant Facilities	US$500,000 lifetime
Outpatient Emergency treatment of illness or injury l Surgery l Rehabilitative treatment l Treatment, services or supplies routinely provided l Prescription medication	URC
Emergency Surgery or dental treatment following an accident l Emergency room following an accident	URC
Emergency Transportation by Ground Ambulance	URC
Emergency Medical Evacuation Included with Emergency Medical Evacuation is an Emergency Reunion benefit of US$10,000 lifetime	US$50,000 lifetime
Repatriation	US$25,000
Supplemental Accident The first $300 will be covered for each accidental injury	US$300 per occurrence (not subject to the deductible or coinsurance)
Maternity After 12 months of continuous coveragel Pre and Post-natal carel Normal delivery or  C-sectionl Well baby care and treatment of newborn coverage) for first 31 days	US$25,000 lifetime maximum of US$5,000 for normal delivery for each pregnancy lmaximum of US$7,500 for C-Section delivery for each pregnancy
Newborns Eligible newborn children may be added without evidence of insurability.  An application must be submitted within 31 days of child's birth	URC
Child Wellness Available for eligible children from 14 days to 18 years of age after 12 months of continuous coverage	US$50 maximum per visit; US$150 per policy period (not subject to deductible or coinsurance)
Pre-existing Conditions After 24 months of continuous coverage	US$50,000 lifetime (maximum of US$5,000 per policy period)
Mental/Nervous Care After 12 months of continuous coverage l Inpatient and outpatient care by a  licensed psychiatrist	US$10,000 per period, US$25,000 lifetime
Wellness Females and Males age 35 and over after 24 months on the plan. Routine physicals l Mammogram, ob/gyn visit, etc. (exams must be separtated by 12 months)	US$250 per period (not subject to deductible or coinsurance)
Complimentary Medicine
Acupuncture	US$150
Aroma Therapy	US$50
Herbal Therapy	US$50
Magnetic Therapy	US$75
Massage Therapy	US$150
Vitamin therapy	US$100
Other Chiropractor when referred by a physician l Radiation treatment l Home nursing care l Hospice care l Physical therapy (maximum US$50 per visit) l Prosthetic devices	URC
Other Chiropractor when referred by a physician Radiation treatment Home nursing care l Hospice care Physical therapy (maximum US$50 per visit) Prosthetic devices	100%

This is a summary of benefits. Please refer to the policy wording for a complete description.