PATRIOT AMERICA TRAVEL MEDICAL INSURANCE

Patriot America

Patriot America provides coverage for non-US citizens traveling outside their country of citizenship for a minimum of 15 days up to a maximum of one year. Although the Patriot America plan is not renewable, it can be rewritten for succeeding or subsequent coverage periods. New Deductible, Coinsurance, Eligibility, Conditions of Coverage and Pre-Existing Condition Exclusions apply to any succeeding or subsequent Period of Coverage. A new application also must be completed. If you or other family members applying for coverage are age 65 or older, please see the Eligibility section of the Patriot brochure for additional information.

If you are traveling for six (6) months or more, please review the ExPatriot Plus® plan, which offers a 10% discount on rates and is renewable.

	PATRIOT AMERICA POLICY PREMIUMS
	50,000 MAX	100,000 MAX	500,000 MAX	1,000,000 MAX
	option 1	option 2	option 3	option 4
AGE	One Month	One Month	One Month	One Month
18-29	$48.00	$56.00	$72.00	$84.00
30-39	$62.00	$74.00	$94.00	$108.00
40-49	$94.00	$106.00	$140.00	$158.00
50-59	$134.00	$164.00	$198.00	$228.00
60-64	$158.00	$194.00	$230.00	$276.00
65-69	$180.00	$232.00	$252.00	$300.00
70-79	$244.00	N/A	N/A	N/A
80 PLUS*	$424.00	N/A	N/A	N/A
DEP CHILD	$28.00	$32.00	$40.00	$44.00
CHILD ALONE	$44.00	$52.00	$66.00	$74.00
*US$10,000 limit

Fifteen (15) day premium is 50% of the monthly rate.

All premium rates are in US dollars and are effective through 6/30/2002. Rates include 2.5% surplus lines tax. A dependent child is your child shown on the Enrollment Form over 14 days and under 18 years of age, traveling with you, and for whom premium has been paid.

*See specific policy for age limit.

Benefit Period. If a covered injury or illness requires continuing treatment after the policy expires, the Benefit Period may provide continued coverage. When the policy expires, IMG will review the date of the initial treatment for the covered injury or illness. If treatment began less than six months before the policy expired, benefits for the covered injury or illness will continue subject to the Policy Limits until there has been six months of coverage. The Benefit Period serves as an extension of benefits and does not limit the treatment time during the Policy Period.

Refund of Premium............................

IMG will refund premium only if a written request is received prior to the policy's effective date. The premium is non-refundable after that date.

For Precertification, Emergency Evacuation and Repatriation..............

Please call IMG
in the U.S. 1.800.628.4664
Outside the U.S. 01.317.655.4500
(collect if necessary).
IMG must be notified prior to treatment or within 48 hours of an emergency.

To Report Claims...............................
Please mail to IMG
International Medical Group, Inc.
407 Fulton Street
Indianapolis, IN 46202 U.S.A.
Please include Identification Number in all correspondence.

This is only a consolidated and summary description of all current Patriot Travel Medical Insurance benefits, conditions, limitations and exclusions. A certificate containing the complete Policy Wording with all terms, conditions and exclusions will be included with the fulfillment kit. In support of Patriot Travel Medical Insurance^SM, IMG has established the Global Medical Services Group Insurance Trust in Indiana. The trust owns a master group international travelers insurance policy. Individual certificates of insurance are issued from the master policy.

Underwritten by: Sirius International Insurance Corporation