International Health Insurance for Travelers

Patriot International provides coverage for US citizens traveling abroad for a minimum of 10 days up to a maximum of one year. Although the Patriot International Plan is not renewable, it can be rewritten for succeeding or subsequent coverage periods. New Deductible, Coinsurance, Eligibility, Conditions of Coverage and Pre-Existing Condition Exclusions apply to any succeeding or subsequent Period of Coverage. A new application also must be completed.

If you are traveling for six (6) months or more, please review the ExPatriot Plus® plan, which offers a 10% discount on rates and is renewable.

	PATRIOT INTERNATIONAL POLICY PREMIUMS
	$50,000 MAX	$100,000 MAX	$500,000 MAX	$1,000,000 MAX	$2,000,000 MAX
	option 5	option 6	option7	option 8	option 9
AGE	One Month	One Month	One Month	One Month	One Month
18-29	$36.00	$42.00	$48.00	$54.00	$60.00
30-39	$42.00	$48.00	$64.00	$70.00	$80.00
40-49	$66.00	$74.00	$82.00	$90.00	$110.00
50-59	$106.00	$122.00	$136.00	$152.00	$170.00
60-64	$122.00	$144.00	$170.00	$200.00	$224.00
65-69	$144.00	$154.00	$176.00	$210.00	$270.00
70-79	$210.00	N/A	N/A	N/A	N/A
80 PLUS*	$420.00	N/A	N/A	N/A	N/A
DEP CHILD	$20.00	$26.00	$30.00	$32.00	$38.00
CHILD ALONE	$36.00	$40.00	$46.00	$50.00	$58.00
*US$10,000 limit

Patriot America provides coverage for non-US citizens traveling outside their country of citizenship for a minimum of 10 days up to a maximum of one year. Although the Patriot America plan is not renewable, it can be rewritten for succeeding or subsequent coverage periods. New Deductible, Coinsurance, Eligibility, Conditions of Coverage and Pre-Existing Condition Exclusions apply to any succeeding or subsequent Period of Coverage. A new application also must be completed. If you or other family members applying for coverage are age 65 or older, please see the Eligibility section of the Patriot brochure for additional information.

	PATRIOT AMERICA POLICY PREMIUMS
	$50,000 MAX	$100,000 MAX	$500,000 MAX	$1,000,000 MAX
	option 1	option 2	option 3	option 4
AGE	One Month	One Month	One Month	One Month
18-29	$48.00	$56.00	$72.00	$84.00
30-39	$62.00	$74.00	$94.00	$108.00
40-49	$94.00	$106.00	$140.00	$158.00
50-59	$134.00	$164.00	$198.00	$228.00
60-64	$158.00	$194.00	$230.00	$276.00
65-69	$180.00	$232.00	$252.00	$300.00
70-79	$244.00	N/A	N/A	N/A
80 PLUS*	$424.00	N/A	N/A	N/A
DEP CHILD	$28.00	$32.00	$40.00	$44.00
CHILD ALONE	$44.00	$52.00	$66.00	$74.00
*US$10,000 limit

ExPatriot Plus® provides coverage for US citizens AND non-US citizens traveling outside their country of citizenship for a minimum of three months up to a maximum of two years. ExPatriot Plus must be purchased for a minimum initial period of three months, and is renewable for a total of two years. For Expatriot Plus®, an insured must satisfy only one deductible and coinsurance limit within any 12 month period.

ExPatriot Plus® Monthly Premiums for Citizens traveling outside their country of citizenship.

	EXPATRIOT PLUS® POLICY PREMIUMS
	$500,000 MAX	$1,000,000 MAX	$2,000,000 MAX	$500,000 MAX	$1,000,000 MAX
	US CITIZEN	US CITIZEN	US CITIZEN	NON-US CITIZEN	NON-US CITIZEN
	option 10	option 11	option 12	option 13	option 14
AGE	One Month	One Month	One Month	One Month	One Month
18-29	$43.00	$48.00	$54.00	$64.00	$75.00
30-39	$57.00	$63.00	$72.00	$84.00	$97.00
40-49	$73.00	$81.00	$99.00	$126.00	$142.00
50-59	$122.00	$136.00	$153.00	$178.00	$205.00
60-64	$153.00	$180.00	$201.00	$207.00	$248.00
65-69	$158.00	$189.00	$243.00	$226.00	$270.00
DEP CHILD	$27.00	$28.00	$34.00	$28.00	$39.00
CHILD ALONE	$41.00	$45.00	$52.00	$49.00	$66.00

Fifteen (15) day premium is 50% of the monthly rate.

All premium rates are in US dollars and are effective through 12/31/2003. Rates include 2.5% surplus lines tax. A dependent child is your child shown on the Enrollment Form over 14 days and under 18 years of age, traveling with you, and for whom premium has been paid.

*See specific policy for age limit.

Benefit Period

The Benefit Period is the period of time specified in the Policy Limits. It begins once an eligible incident occurs to the insured. While coverage is in effect under this policy, the Benefit Period does not apply. When coverage under this policy terminates, as defined, Patriot Travel Medical Insurance^SM will pay eligible expenses for covered Injuries or Illnesses which commenced during the period of coverage for up to, but not exceeding the Benefit Period, subject to the Policy Limits.