PE

Patriot Exchange

Comprehensive Coverage,  Rated A- (Excellent)By: IMG,  UW: Sirius Int.Sirius International
AM Best Rating
A- (Excellent)
Administrator/Underwriter
IMG
Sirius International
100%
In Network

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

extendable-cancelable
Extendable & Cancelable
comprehensive
Comprehensive Coverage Plan
coverage-days
Coverage from 5 days to 365 days
urgent-care
Urgent Care
COVID-19 Excluded
  • Not available for Citizens of: Botswana, Gambia, Ghana, Niger, Nigeria & Sierra Leone.
    Not available if Home Country is: Botswana, Gambia, Ghana, Niger, Nigeria, Cuba, Iran, North Korea, Syria, Sierra Leone, United States, and Venezuela.
    Not available for purchasing addresses in: Maryland or New York
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.

Out-Patient

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.

In-Patient

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

Emergency Services

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

Dental

Acute, spontaneous and unexpected pain

Up to $350

Accidental emergency

Up to $500

Travel

Emergency Medical Evacuation / Repatriation

$50,000 Lifetime Maximum

Return of Remains

Up to $25,000

Emergency Reunion

Up to $15,000

Return of minor Child(ren)

Not Covered

Loss of checked Baggage

Covered under Optional Add-On plan

Life

AD&D

Up to $25,000

Other

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

Brochure

Support

24-Hrs Emergency Assistance

Yes. Contact number and details can be found on the ID card.

Plan Administrator Company

IMG

Carrier / Underwriter

Sirius International

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.