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Protection America - Visitors medical insurance for parents & relatives
5 days - 3 years

Introduction
Protection AmericaSM provides coverage for non-US citizens traveling outside their home country for a minimum of 5 days up to a maximum of 3 years. Protection America is renewable (without break in coverage) for 5 days up to 12 months per renewal for a total of up to 3 years. For each renewal of less than one month, you will be charged a fee of US$5 in addition to the premium costs. An insured person must only satisfy one deductible and coinsurance within each yearly coverage period. If you or other family members applying for coverage are age 65 or older, please see the Eligibility section below for additional information.

Rates
 
POLICY LIMIT $50,000 $100,000 $500,000 $1,000,000
 
AGE Monthly Rates
18-29 $50.00 $58.00 $74.00 $85.00
30-39 $64.00 $76.00 $96.00 $109.00
40-49 $96.00 $108.00 $143.00 $159.00
50-59 $135.00 $165.00 $199.00 $229.00
60-64 $159.00 $197.00 $235.00 $280.00
65-69 $185.00 $235.00 $260.00 $305.00
70-79 $249.00 N/A N/A N/A
80+* $432.00 N/A N/A N/A
DEP. CHILD $29.00 $33.00 $41.00 $45.00
CHILD ALONE $45.00 $53.00 $67.00 $75.00
 
AGE Daily Rates (Minimum length of coverage is 5 days)
18-29 $1.70 $1.95 $2.50 $2.85
30-39 $2.15 $2.55 $3.20 $3.65
40-49 $3.20 $3.60 $4.80 $5.30
50-59 $4.50 $5.50 $6.65 $7.65
60-64 $5.30 $6.60 $7.85 $9.35
65-69 $6.15 $7.85 $8.70 $10.20
70-79 $8.30 N/A N/A N/A
80+* $14.40 N/A N/A N/A
DEP. CHILD $1.00 $1.10 $1.40 $1.50
CHILD ALONE $1.50 $1.80 $2.25 $2.50

* US$15,000 Maximum

All premium rates are in US dollars and are effective through 10/31/2008. Rates include 2.5% surplus lines tax where applicable. A dependent child is your child shown on the Application Form over 14 days and under 18 years of age, traveling with you, and for whom premium has been paid.

Premiums shown above are for $250 annual deductible. If you would like to choose different deductible, the following deductible factors apply.
Deductible
Factor
$0
+25%
$100
+10%
$500
-10%
$1000
-20%
$2500
-30%

The uncertainties of travel
As an international traveler, you know that traveling abroad can be an exciting experience. But you also know that the unexpected could happen. What would happen if you or one of your family members became ill or injured while away from home?

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 - and that of your family - at risk.

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 two Passport Protection PlusSM plans to provide you and your family Coverage Without Boundaries®. Each plan offers a complete package of international benefits and 24 hour availability. Simply select the one that best fits your needs.

In addition to providing a wide range of benefits, these plans also offer you flexibility. Your travel schedule can change unexpectedly and you need coverage that can adapt to those changes. With Passport Protection Plus, you have the option of extending or cancelling your coverage as necessary. You can renew your coverage for as little as five days or as long as 12 months. You can also cancel your coverage as outlined in the plan.

The experienced plan administrator
Since 1990, International Medical Group has provided a unique, full-service approach to insurance coverage. Dedicated exclusively to the international insurance market, IMG provides coverage services to individuals and families in more than 150 countries.

Medical treatment while traveling is often an unfortunate fact of life. IMG's goal is to make the medical process a smooth and efficient one. IMG’s multilingual claims administrators, on-site medical staff and customer service professionals work together to ensure that your medical needs are met. IMG processes as many as 100,000 claims each year from countries throughout the world, and can confidently handle virtually any language or currency.

To give you true Global Peace of Mind®, IMG representatives are available 24 hours a day, seven days a week, 365 days a year for medical emergencies, evacuations and precertification. IMG's customer service is routinely rated among the highest in the industry. You can rest assured that IMG will be there for you, whether it be for routine treatment or during a medical emergency.

IMG gives you worldwide coverage experience, impeccable service and international expertise. Don’t leave your medical care to chance. Let IMG reduce the uncertainties of international travel for you and your family.


SCHEDULE OF BENEFITS
 
MEDICAL BENEFITS Usual, reasonable and customary charges, subject to deductible and coinsurance
Hospital Room and Board Up to Policy Maximum for average semi-private room rate
 
Intensive Care Up to Policy Maximum
 
Medical Expenses Up to Policy Maximum
 
Outpatient Medical Up to Policy Maximum
 
Local Ambulance Up 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: Each 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 US$100 for the necessary treatment of sudden, unexpected pain to sound natural teeth.
 
INTERNATIONAL EMERGENCY CARE
Emergency Evacuation Up to Policy Maximum when coordinated through the Plan Administrator
Each plan includes coverage for Emergency Medical Evacuations to the nearest qualified medical facility; expenses for reasonable travel and accommodations resulting from the evacuation; and the cost of returning to either the home country or the country where the evacuation occurred, up to the policy limit.
Emergency Reunion Up to US$15,000 when coordinated through the Plan Administrator
Each 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: either the cost of accompanying the insured during the evacuation or traveling from the home country to be reunited with the insured.
Return of Mortal Remains Up 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 home country will be covered up to a maximum of US$25,000.
Returning Minor Children Up 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 plans will pay 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).
 
PLAN INFORMATION
Deductible Your choice of US$0, $100, $250, $500, $1,000 or $2,500
On the Application Form, you will be asked your choice of a deductible. Your premium rate is dependent on the deductible you choose. Please see the Application Form for more information.
Coinsurance As described below
For treatment received outside the U.S. & Canada: No coinsurance

If elected and proper premium paid for buy-up option: The plan pays 90% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum.

For treatment received within the U.S. & Canada: The plan pays 80% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum

For treatment received within the US from a provider outside the PPO network: The plan pays 70% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum; please see below for more information on the Preferred Provider Organization Network
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.
 
SPECIAL COVERAGES
Home Country Coverage As described below
Incidental Home Country Coverage - 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 - For every 5 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 two 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 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, each 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.
Lost Luggage Up to US$50 per item of personal property; maximum of US$250 per Period of Coverage
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.
 
Sports & Activities Coverage Up to Policy Maximum for basic sports Coverage as described below
Each 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. 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, snowboarding, snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, windsurfing and whitewater rafting.

Optional Leisure or Extreme Sports Riders: Please see below for more information.
 
Accidental Death & Dismemberment US$25,000 principal sum
Each 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 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.
 
Terrorism Coverage Up to US$50,000 lifetime maximum

Each 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.

 
Identity Theft Assistance Up to US$500 per Period of Coverage

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 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.


OPTIONAL RIDERS
Leisure Sports Rider
The Leisure Sports Rider is available and adds coverage for jet skiing, scuba diving, snow skiing, snowboarding, snowmobiling, snorkeling, surfing, wakeboarding, water skiing and windsurfing. For premium information, please see the back of the Application Form.

Extreme Sports Rider
The Extreme Sports Rider is available and adds up to 12 months of coverage for those under the age of 49. This rider provides up to US$50,000 lifetime maximum for the following activities: abseiling, BMX, bungee jumping, canyoning, caving, flying (private plane), hang gliding, heli-skiing, high diving, hot air ballooning, kayaking, inline skating, mountain biking, mountaineering (ropes and guides to 4500m from ground level), paragliding, parascending, rappelling, rock climbing (ropes and guides to 4500m from ground level)), skydiving, spelunking, whitewater rafting (to Class V). These extreme activities must be engaged in solely for leisure, recreation, or entertainment purposes.

Monthly Rates
Available in monthly increments up to a maximum of 12 months
U.S. Citizen
Non-U.S. Citizen
US$30
US$45

Patriot T.R.I.P. LiteSM
Trip cancellation coverage is also available for your trip. With this plan, the loss of pre-paid, non-refundable, and unused payments may be recovered when a trip is cancelled due to: illness, injury or death to you, a family member or travel companion; bankruptcy or financial default; a terrorist incident; jury duty; home made uninhabitable by fire, wind, storm, flood, or vandalism; quarantine; auto accident on way to airport; job termination; cancelled leave for active duty military, police or fire fighters. The benefits are outlined below and premium information can be found on the back of the Application Form.

Benefits
Maximum benefit per insured person
Trip cancellation
Trip cost up to US$20,000
Travel delay
Up to US$500
Baggage delay
Up to US$100

Protection Return Rider
The Protection Return Rider is only available to non-U.S. citizens who have purchased Protection America. When purchased at the time of application, Protection Return provides temporary medical coverage for non-U.S. citizens returning to their home country. The insured person must be outside his/her home country at time of application. For premium information, please see the back of the Application Form.

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 Protection plans. Coverage must be purchased for a minimum of three months.

Monthly Rates - coverage must be purchased for a minimum of three months
Up to US$100,000 additional coverage
US$8
Up to US$200,000 additional coverage
US$16
Up to US$300,000 additional coverage
US$24
Up to US$400,000 additional coverage
US$32

Universal RX Pharmacy Discount Savings Plan*
This is a value added program available to certificate holders of the Passport Protection PlusSM plans. It is accepted at over 35,000 chain pharmacies in the U.S and is made available and administered by Universal Rx. Once activated with Universal Rx, the card allows members to purchase prescriptions at the lowest available cost.

* This plan does not guarantee that the prescribed medication is covered under the benefit plan, claims must be submitted to IMG for claim determination

More details

QUALITY GUARANTEE
Your satisfaction is very important to the plan underwriter, and to IMG as the plan administrator. If, for any reason, you are not pleased with this product, you may submit a written request for cancellation and refund of your premium. In order to be considered for a full refund, your request for cancellation must be received by IMG prior to your effective date. If you do not have any claims filed with IMG, you may cancel your plan after your effective date, however, the following conditions will apply: 1) you will be required to pay a US$25 cancellation fee and 2) only full month premiums will be considered for refunds (e.g., if you choose to cancel your coverage two months and two weeks prior to the date your coverage ends, IMG will only consider the two full months for a refund). If you have filed claims, your premium is non-refundable.

LOCATING A PROVIDER
With Passport Protection Plus, you may seek treatment with the hospital or doctor of your choice. When seeking treatment in the U.S, you may reduce your out-of-pocket costs by using the independent Preferred Provider Organization (PPO), a separately organized network of approximately 500,000 physicians and 4,700 privately owned and operated hospitals contracted by IMG (all PPO providers are contracted separately through First Health Group Corp.). If you choose to use a provider outside of this network, the plan pays 70% of eligible expenses up to US$5,000, then 100% up to the Policy Maximum.

IMG also provides an on-line International Provider Access database that can be used to locate health care providers outside the U.S. as needed. (Note: Use of this service is subject to the terms and conditions specified on-line. These terms must be agreed to prior to using the service.)

EXCLUSIONS
Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under these plans.
  1. Pre-existing Conditions. 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.
  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, wake boarding, 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).
This brochure contains only a consolidated and summary description of all current Passport Protection Plus 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. IMG reserves the right to issue the most current Policy 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 Policy Wordings are available upon request.


CLAIMS PROCEDURE
PRECERTIFICATION
Each proposed hospital admission, inpatient or outpatient surgery, and other procedures as noted in the Certificate Wording must be Precertified for medical necessity, which means the insured person or their attending physician must call the number listed on the IMG Identification Card prior to admittance to a hospital or performance of a surgery. In case of an Emergency Admission, the Precertification call must be made within 48 hours of the admission, or as soon as reasonably possible. If a hospital admission or a surgery is not Precertified, eligible claims and expenses will be reduced by 50%. Precertification is not an assurance of coverage, a verification of benefits, or a guarantee of payment. All medical expenses must meet usual, reasonable, customary, and eligible payment guidelines. Please refer to the Certificate Wording for full details of the Precertification requirements.

For precertification, emergency evacuation, and return of mortal remains, please call: IMG in the U.S.: 1-800-628-4664 (toll free) or 1-317-655-4500. Call IMG outside the U.S.: 001-317-655-4500 (collect if necessary). This information will also be provided on your ID card.

Note: An insured person may begin the precertification process at IMG's website. Simply click the "Current Clients" title, then click the "Initiate Precertification" option. You will be asked to provide the required information, which can then be submitted electronically to IMG. The Medical Department at IMG will notify you upon receipt of the email, and once IMG has received the request, their utilization management and review team will review the information provided and respond to the insured person or the provider within 2 business days. Please note that this online service will only initiate the precertification process, and it should not be used to precertify emergency admissions, procedures, or evacuations.

CLAIM PAYMENT
All benefits payable under these plans are subject to the provisions described in this brochure and as contained in the Policy Wording and certificate of coverage. To make claim processing efficient, claims may be paid in two ways. Please mail completed claim forms to International Medical Group, P.O. Box 88500, Indianapolis, IN 46208-0500 USA. All IMG contact numbers, claim forms and Certificate Wordings will be included in the fulfillment kit. IMG may also be contacted by fax: 317-655-4505

CONDITIONS OF COVERAGE
  1. Coverage and benefits are subject to the deductible and coinsurance, and all terms of the certificate of coverage and Master Policy.
  2. Coverage under these plans is secondary to any other coverage.
  3. Coverage and benefits are for medically necessary, usual, reasonable and customary charges only.
  4. Charges must be administered or ordered by a physician.
  5. Charges must be incurred during the Period of Coverage or the Benefit Period.
  6. Claims must be presented to IMG for payment within the Period of Coverage, Benefit Period or during the three months immediately following the Period of Coverage.

EMERGENCY MEDICAL EVACUATION, EMERGENCY REUNION AND REPATRIATION COVERAGE
  1. All Conditions and Exclusions apply to these coverages.
  2. All Emergency Medical Evacuation, Emergency Reunion, and Return of Mortal Remains expenses, including all costs arising from trips outside the country where the incident which gave rise to the claim occurred, must be approved and coordinated in advance by IMG to be eligible for coverage.

ENROLLMENT PROCESS & APPLICATION FORM

You should read the following important information prior to completing the Application Form.

HOW TO ENROLL
You may either apply online for Instant Quotes & Purchase or make Paper Application

If you are applying online, no papers are required to be mailed or faxed. If you are making paper application, you can either fax the credit card applications to (972) 767-4470 or mail all applications to

BuyAmericanInsurance.com
3105 Broken Bow Way,
Suite 100
Plano, TX 75093 USA

You can apply over the phone as well by calling toll-free 1-866-INSU-BUY.

You, your spouse and unmarried dependent children (over 14 days and under 18 years of age) listed on the Application Form and for whom premiums have been paid will be covered from the latest of the following dates:
  1. the date IMG receives your completed Application Form and the appropriate premium (for non-U.S. citizens, the date following such receipt);
  2. the date you depart from your home country; or
  3. the date requested on your Application Form.
Passport Protection Plus coverage ends on the earliest of the following dates:
  1. The end of the period for which premium has been paid;
  2. the date requested on your Application Form; or
  3. the date you return to your home country (however, see Home Country Coverage for incidental coverage).

ENROLLMENT PROCESSING & FULFILLMENT KITS
IMG normally processes Application Forms within 24 hours of receipt. Once processing is complete, IMG will mail a fulfillment kit to the mailing address listed on the Application Form. The fulfillment kit will include an IMG Identification Card, IMG contact numbers, Claim Forms and an insurance certificate containing a complete outline of the Policy Wording. Please note: If you require express mail delivery, there is an additional charge listed on the Application Form.

ELIGIBILITY REQUIREMENTS
The following conditions apply to all persons applying for and/or enrolling in Passport Protection Plus.

EXTENSION OF COVERAGE
The Protection America and Protection International plans must be purchased for a minimum initial period of 5 days, and is renewable (without break in coverage) for 5 days up to 12 months per renewal for a total of up to 3 years. For each renewal of less than one month, you will be charged a fee of US$5 in addition to the premium costs. An insured person must only satisfy one deductible and coinsurance within each yearly coverage period.

ONLINE FULFILLMENT KIT
You may choose to download your fulfillment kit from the IMG website rather than having it mailed to you. To do this, you must check the appropriate box listed in Section 2 of the Application Form. We must have your correct email address to complete this process. Once IMG has received and processed your Application Form, you will receive an email from IMG that contains all of the hyperlinks to obtain the fulfillment information through the Internet.

INTERNATIONAL PROVIDER ACCESS
IMG provides an on-line International Provider Access database that can be used to locate health care providers outside the U.S. as needed. (Note: Use of this service is subject to the terms and conditions specified on-line. These terms must be agreed to prior to using the service.)

IMG IS YOUR CLEAR CHOICE FOR TRAVEL MEDICAL INSURANCE

EASY ACCESS
EMERGENCY ASSISTANCE
CLAIMS SERVICES

PLAN ADMINISTRATOR AND UNDERWRITER
Plan Administrator:
As the Plan Administrator for Passport Protection PlusSM, IMG acts as the authorized agent for and on behalf of Sirius International.

International Medical Group® (IMG®), Inc. is located at
2960 North Meridian Street,
Indianapolis, IN 46208 USA

Plan Underwriter:

These Passport Protection Plus plans are surplus lines products underwritten by Sirius International Insurance Corporation (publ), rated A (excellent) by A.M. Best and A- by Standard & Poor’s (at the time of printing). Sirius International is a White Mountains Re company.

IMG, International Medical Group, the IMG block design logo, imglobal, Passport Protection Plus, Protection International, Protection America, Patriot Travel Medical Insurance, Patriot Group Travel Medical Insurance, Patriot Executive, Patriot Executive Group, Patriot Extreme, Global Medical Insurance, GEO Group, Patriot T.R.I.P., Coverage Without Boundaries, and Global Peace of Mind are the trademarks, service marks and/or registered marks of International Medical Group, Inc.

Sirius, Sirius International, and the Sirius design logo are the trademarks, service marks and/or registered marks of Sirius International Insurance Corporation (publ).