Patriot Exchange Program SM
Short-term accident and sickness coverage available from one month up to four years for educational and cultural exchange programs, including J1 scholars and exchange program participants, as well as J2 dependents of J1 visa holders.
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.
Please note the rates displayed below reflect a $100 deductible per occurrence. Enrollees can choose from deductible options of $0, $100, $250, or $500 after clicking Enroll Now and proceeding to obtain a quote.
Rates (per month) --$100,000 Benefit Maximum
Rates (per month)-- $250,000 Benefit Maximum
Rates (per month)-- $500,000 Benefit Maximum
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 |
Urgent Care |
$50 copay. Not subject to deductible. |
Walk-in Clinic |
$20 copay. Not subject to 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 |
Company pays 100%. Transfer must be a result of an inpatient hospital admission |
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 |
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 |
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 |
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 |
$2,000 per period of coverage limit after $100 deductible |