Patriot Exchange ProgramSM 
Short-term coverage available from one month up to four years for educational and cultural exchange programs.

Patriot Exchange Program is designed to meet the U.S. visa travel insurance requirements for individuals studying abroad or participating in a cultural exchange program, including J1 and J2 visa holders. Coverage may be purchased for spouses and unmarried dependent children traveling with the student/participant on individual coverage. Individuals and groups have the option to select from different plan options - $50,000, $100,000, $250,000, and $500,000 maximum per illness/Injury.

The $50,000 maximum per Illness/Injury option does not comply with J1 and J2 visa requirements.

 

Rates (per month) --$50,000 of Coverage w/o Add On

$51

Rates (per month) --$100,000 of Coverage w/o Add On

$59

Rates (per month)-- $250,000 of Coverage w/o Add On

$63

Rates (per month)-- $500,000 of Coverage w/o Add On

$67

DETAILED BROCHURE

Patriot Exchange ProgramSM 

SUMMARY OF BENEFITS - ELIGIBLE MEDICAL EXPENSES ARE LIMITED TO USUAL, REASONABLE AND CUSTOMARY LIMITS PER PERIOD OF COVERAGE UNLESS STATED AS MAXIMUM LIMIT

Maximum Limit

$5,000,000

Deductible Options

$0, $100, $250 or $500 per illness or injury available

Maximum Limit Per Illness or Injury

Choice of $50,000, $100,000, $250,000 or $500,000

Coinsurance

Company pays 100%

 

INPATIENT/OUTPATIENT BENEFITS

 

Hospital Room and Board

Up to average semi-private room rate

Intensive Care Unit

Company pays 100% after deductible is met

Physical Therapy

Company pays 100% after deductible is met; one visit per day (Medical order or treatment plan required)

Bedside Visit

$1,500 maximum limit. Must be hospitalized in an intensive care unit. Not subject to deductible

Physician Visit

Company pays 100% after deductible is met; one visit per day

Student Health Center

$5 copay per visit. Not subject to deductible

Prescription Drugs

Company pays 100% after deductible is met
90 day dispensing maximum

Urgent Care

$50 copay. Not subject to deductible.
Copay is not applicable if you choose a $0 Deductible

Walk-in Clinic

$20 copay. Not subject to deductible.
Copay is not applicable if you choose a $0 Deductible

Eligible Medical Expenses

Company pays 100% after deductible is met

Emergency Room visit with In-patient Admission

Company pays 100% after deductible is met

Emergency Room visit without In-patient Admission

Additional $250 deductible

Interfacility Ambulance Transfer
(For Services Rendered in the U.S. )

Company pays 100%. Transfer must be a result of an inpatient hospital admission
Not subject to deductible

Dental

Non-emergency treatment at a dental provider due to an accident: $500 period of coverage limit per injury; Treatment due to unexpected pain to sound, natural teeth: $350 period of coverage limit

Mental or Nervous / Substance Abuse

Not covered if incurred in student health center
Inpatient: $10,000 maximum limit
Outpatient: $50 maximum limit per day. $500 maximum limit

 

EVACUATION BENEFITS (NOT SUBJECT TO DEDUCTIBLE)

 

Emergency Medical Evacuation

$50,000 maximum limit

Emergency Reunion

$15,000 maximum limit

Return of Mortal Remains or Cremation/Burial

$25,000 maximum limit for return of mortal remains or $5,000 maximum limit for cremation/burial

Political Evacuation

$10,000 maximum limit

 

ADDITIONAL BENEFITS

Accidental Death & Dismemberment

$25,000 principal sum; Not subject to deductible

Terrorism

$50,000 maximum limit; Not subject to deductible

Sudden & Unexpected Recurrence of a Pre-existing Condition

Eligible medical expenses: $5,000 maximum limit
Emergency medical evacuation: $25,000 maximum limit

Pre-Existing Conditions

For conditions existing within 36 months before effective date, charges excluded until after 12 months of coverage and then $500 per period of coverage and $1,500 maximum limit

Incidental Trip Coverage
(Available for non-U.S. residents only)

Up to a cumulative 14 days

  

OPTIONAL ADD-ON RIDERS

Lost Personal Property

$250 per period of coverage limit

Legal Assistance

$500 per period of coverage limit

Personal Liability - Injury to third party
Personal Liability - Damage to third party’s property

$2,000 per period of coverage limit after $100 deductible
$500 per period of coverage limit after $100 deductible