Patriot Executive® Travel Medical Insurance for Business People Purchase Patriot Executive® Insurance easily online! Not sure which option is right for you? SelectaPlansm can help! Patriot Executive®, a complete assistance package of international benefits and 24 hour availability, is for executives traveling outside their home country throughout the year. It is ideal for executives who are employed by a multi-national company, are covered by an individual or group medical plan while in their home country, and are frequent travelers outside their home country. Patriot Executive for Business Travelers Coverage Benefits Download the Brochure[PDF - 352k] With Patriot Executive, you purchase coverage for a period of one year and select a maximum trip duration of 30 days on your enrollment form. You are then covered during that year, up to US$1,000,000 in medical coverage for you and your family in accordance with the terms of the plan, for the selected trip duration of each trip you take outside the country of your citizenship beginning on the date of departure for each trip. Patriot Executive Insurance is designed for: US citizens who: are under the age of 76, are covered by an individual or group medical plan, and travel outside of the United States frequently throughout the year. Non-US citizens who: are under the age of 76, are covered by an individual or group medical plan, and travel outside your country of citizenship frequently throughout the year. Although the Patriot Executive plan is not renewable, it can be rewritten for succeeding or subsequent coverage periods. New Deductible, 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. Premiums Through age 75*         Maximum Trip Duration**  30 Days  45 Days  U.S. CITIZENS      Annual Premium  $200  $245  Spouse and two children  $100  $122  Each additional child  $40  $49  NON-U.S. CITIZENS      Annual Premium  $236  $289  Spouse and two children  $118  $145  Each additional child  $47  $58        Rates include 2.5% surplus lines tax.  Rates are effective through 12/31/07.            *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 on the Patriot Executive.     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 The 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 country of residence 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 and up to US$50,000 for evacuations resulting from other covered incidents. 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 country of residence 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 country of citizenship 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). Political Evacuation To US$10,000 when coordinated through the Plan Administrator If the United States Department of State, Bureau of Consular Affairs issues a travel advisory that becomes effective on or after the Insured Person’s date of arrival in the Host Country, the Company will pay up to US$10,000 for transportation to the nearest place of safety or for repatriation to the Insured Person’s home country or country of residence provided that: The Insured Person contacts the Company within 10 days of the United States Department of State, Bureau of Consular affairs issues the travel advisory;  Political Evacuation and Repatriation is approved and coordinated by the Company.   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 certain amateur athletic activities which are non-contact and engaged in by an 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, snow boarding, snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, wind-surfing and white water rafting. Terrorism Coverage Up to US$50,000 lifetime maximum Each Patriot 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 subject to a US$50,000 lifetime 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 of 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. 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. Universal RX Pharmacy Discount Savings   This is a discount savings program available for every certificate holder of the Patriot travel plans. This program allows card members to purchase prescriptions at one of over 35,000 participating pharmacies in the U.S. and receive the lower of 1) Universal Rx contract price or 2) the pharmacy regular retail price. This discount program is not insurance coverage. It is purely a discount program to purchasers of the Patriot travel plans. Use of the discount card does not guarantee that prescribed medication is covered under the insurance benefit plan.  Exclusions Charges for the following services, treatments and/or conditions among others are excluded from coverage under the Patriot Executive plan. Treatment for pre-existing conditions in excess of US $5,000, 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 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. Immunizations and routine physical exams. Treatment of Temporomandibular Joint or dental treatment, except as provided for in the certificate of coverage. 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. Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion. 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: Scuba diving, mountain climbing (up to 4500 meters or where ropes or guides are normally used), jet, snow and water skiing and snowboarding, skydiving, amateur racing, piloting an aircraft, bungee jumping and spelunking.  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, moutaineering, parachuting, rappelling, rock climbing, rodeo, scuba diving, ski jumping, sky diving, snow skiing, snow boarding, snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, wind-surfing and white water rafting. 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 or sustained while under the influence of or disablement of drugs or alcohol; 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 hereunder. 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. Treatment for Illness or Injury where the trip is undertaken for the purpose of obtaining such treatment or advice for a pre-existing condition. Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s)