PE

Patriot Exchange

Comprehensive Coverage,  Rated A- (Excellent)By: IMG,  UW: Sirius SpecialitySirius Specialty Insurance Corporation
AM Best Rating
A- (Excellent)
Administrator/Underwriter
IMG
Sirius Specialty Insurance Corporation
100%
In Network

After deductible, the plan pays 100% up to the policy maximum.

COVID-19 Included
extendable-cancelable
Extendable & Cancelable
urgent-care
Urgent Care
extendable-cancelable
Comprehensive Coverage Plan
Coverage from 5 days to 365 days
BUY
Patriot Exchange is a plan designed to meet the US visa requirement for a student studying abroad or a participant of a cultural exchange program including J1 and J2 visa holders . This plan has two options i.e. Standard and Basic.

Note: Patriot Exchange Plan is not available for the residents of Maryland (MD).
Please review Patriot Exchange Insurance Brochure brochure or Description of Coverage brochure (policy document) for complete and accurate coverage and exclusions.
Dr. / Physician Visit
Plan pays 100% up to the policy maximum.
Urgent Care
$50 copay for urgent care consultation
Prescription Drugs / Medicines
Plan pays 100% up to the policy maximum.
Lab & X-rays
Plan pays 100% up to the policy maximum.
Physical Therapy
Plan pays 100% up to the policy maximum.
Hospital Room
Plan pays 100% up to the use of Semi private room.
Hospital Intensive Care Unit
Plan pays 100% up to the policy maximum.
Drug/Alcohol Abuse
In-patient: Up to $10,000 max
Out-Patient: $50 maximum limit per day. $500 total limit
Ambulance Expenses
Plan pays 100% up to the policy maximum(For illness only hospitalization cases would be covered)
Emergency Room(ER)
Added $250 for illness that does not result in hospitalization
Acute, spontaneous and unexpected pain
Up to $350
Accidental emergency
Up to $500
Emergency Medical Evacuation / Repatriation
$50,000 Lifetime Maximum
Return of Remains
Up to $25,000
Emergency Reunion
Up to $15,000
Loss of checked Baggage
Covered under Optional Add-On plan
AD&D
Up to $25,000
Mental Illness
In-patient: Up to $10,000 max
Out-Patient: $50 maximum limit per day. $500 total limit
Pre-Existing Conditions
Covered after 12 months of continous coverage $500 per year; $50,000 lifetime maximum
Maternity
Not covered
General Physical full Checkup
Not covered
Terrorism Coverage
Not covered
24-Hrs Emergency Assistance
Yes. Contact number and details can be found on the ID card.

Plan Administrator Company

IMG

Carrier / Underwriter

Sirius Specialty Insurance Corporation

AM Best Rating

A- (Excellent)

Plan Type

Comprehensive Coverage Plan

Coverage in U.S.A.

Covered

Coverage outside U.S.A.

Covered

Co-Pay

$5 per visit for Student Health Center, $50 copay for urgent care consultations and $20 copay for walk in clinics

Co-Insurance

No Co-Insurance

Coverage Type

Per Illness or Injury

Deductible Type

$100 per Illness or Injury

Renewability

Extendable (Only if initially purchased for 1 month) with $5 fee each time you extend, up to a maximum period of 48 months.

Cancellation

Full refund available if cancelled before start date. Only Monthly refund available after start date if no claims have been made( $50 Cancellation Fee Applicable)

PPO Network

UnitedHealthcare Network

Coverage Length

Min 1 month to Max 48 months

Available Deductibles

$0, $100, $250, $500

Available Coverage

Ages 14 days - 64 years
Standard Short Term Plan: $50,000, $250,000, $500,000
Basic Short Term Plan: $10,000

Provider Directory

By Provider, 24 hours Worldwide, Phone Nos. : 866-281-1688

Plan Brochure

Patriot Exchange Insurance Brochure brochure

US States Restrictions

Not available for purchase in Maryland(MD) state.

Disclaimer

Plan features listed here are high level, provided for your convenience and information purpose only. Please review the Evidence of Coverage and Plan Contract (Policy) for a detailed description of Coverage Benefits, Limitations and Exclusions. Must read the Policy Brochure and Plan Details for complete and accurate details. Only the Terms and Conditions of Coverage Benefits listed in the policy are binding.