Patriot Exchange Program^℠

Hello. Hola. Hallo. Hej. 您好.

You can greet someone in a foreign country in many ways. When you travel, stay safe and secure by saying hello to Patriot Exchange Program^SM, a one-of-a-kind international medical insurance plan that brings you Global Peace of Mind^® when you're traveling abroad.

Traveling abroad can be an exciting experience, especially when you're involved in an educational or cultural exchange program. But what would happen if you became ill or injured while away from home? Your experience can quickly turn frightening if you're not prepared for a medical emergency.

Whether your trip takes you abroad for a few weeks or an entire year, your cultural exchange experience should be an enjoyable one. You have enough to worry about when you're traveling. Don't let your medical coverage be an uncertainty. Patriot Exchange Program^SM provides you, your group, and your dependents traveling with you Coverage Without Boundaries^®. The plan offers a package of international benefits available 24-hours a day. Simply select the plan option that best fits your needs.

The Patriot Exchange Program is designed to meet the U.S. visa insurance requirements for individuals and groups of two or more students 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. Individuals and groups can select from different plan options - $50,000*, $100,000, $250,000, and $500,000 maximum limit per illness/ injury. This program also offers two different areas of coverage, and an optional add-on rider for high school sports, personal liability and legal assistance. In addition, groups may purchase annually-renewable long-term plans that have the flexibility to be tailored to meet specific needs of each program.

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

Our focus on Service, Strength, and Safety Solutions provides you with the ultimate advantage: Global Peace of Mind.

Service - Help when and where you need it.

Nobody wants to experience an emergency while traveling the world, but if you do, you’ll want a team you can trust to have your back. The expert staff is here for you 24/7. We’re accustomed to working in multiple time zones, languages, and currencies, so rest assured we have the training to assist you—even in remote and hazardous locations. Our international and U.S. provider networks include more than one million physicians and facilities across the globe, giving you access to quality care while away from your primary care team. Our innovative technology allows you to manage your claims, your account, and search for providers through our online portal and mobile app around the clock.

Strength - A market leader you can trust.

You can feel confident with the administrator knowing our industry expertise has led us to serve millions of customers worldwide since 1990. Owned by SiriusPoint, a multi-billion-dollar insurance industry leader and rated “A-” by A.M. Best, an independent analyst of the insurance industry, the administrator has a strong financial backing and vision to become the preeminent provider of travel and health safety solutions. With loyal customers ranging from Fortune 500 companies, universities, to individuals and other insurance companies, our personalized offerings allow us to meet the needs of nearly anyone traveling internationally.

Pursuing an education away from your home country is already stressful. We know your safety while studying abroad is important to you, so Patriot Exchange Program has solutions designed to protect you and give you Global Peace of Mind.

Physical Health

You can't plan when you get sick, and unforunately, it can happen anytime and anywhere. Medical bills can be expensive, and this plan provides the cross-border medical coverage you need for unexpected medical care and rountine visits.

Mental Wellness

Being away from your support system can be challenging. The administrator provides access to mental health services, like virtual counseling, to help with the transition as you adapt to cultural differences, adjust to a change in education, and navigate new relationships while you're away from loved ones.

Personal Property

There are some belongings you know you can't live without. The administrator has you covered and can reimburse costs if your mobile device is lost, stolen, or damaged during your travels abroad.

Crisis Support

Navigating an emergency in a foreign country is never easy. That's why the administrator offers a multilingual staff of nurses, doctors, and case managers provide 24/7 assistance services to facilitate a response to urgent and emergency situations, such as evacuations or search and rescue missions.

Financial Protection

Costs can add up while seeking medical treatment. However, access to the administrator's international physician and provider networks and pharmacy discount programs can help you save on out-of-pocket medical expenses and prescription medications.

Eligible Medical Expenses are limited to Usual, Reasonable, and Customary
Limits per Period of Coverage unless stated as Maximum Limit

Groups may also purchase a customizable long-term plan. Any coverages, benefits and premium rates offered are in U.S. Dollars. Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way the Certificate of Insurance and governing policy documents (together the "Insurance Contract"). The Insurance Contract is the only source of the actual benefits provided.

Pharmacy Discount Savings

Universal RX is a discount savings program that allows you to purchase prescriptions from one of over 35,000 participating pharmacies in the U.S. and receive the lower of 1) Universal Rx contract price or 2) the pharmacy regular retail price.

This program is not insurance coverage; it is purely a discount program.

Teleconsultation (For groups only)

Teleconsultation provides access to a national network of board-certified doctors and pediatricians in the U.S. who are available 24 hours a day, seven days a week, 365 days a year to help diagnose, treat and prescribe medication (when necessary and available) for many non-emergent medical issues via phone or online video consultations. Teleconsultation does not replace existing primary care physician relationships, but supplements them as a convenient, affordable alternative for non-emergency medical care. The use of Teleconsultation will be considered as treatment inside the U.S. - PPO Network.

Adventure Sports Rider (For Individuals and groups)

The Adventure Sports Rider is available on the Patriot Exchange Program for individuals and groups, and their dependents, up to the age of 65. Certain activities designated as adventure sports can be covered up to the maximums listed below. Certain activities are never covered, regardless of whether or not you purchase the Adventure Sports Rider. For a list of all the activities which can be considered to be adventure sports, please look at Adventure Sports Rider.

Chaperone / Faculty Leader Trip Interruption Rider (For groups only)

Groups may request the Chaperone/Faculty Leader Trip Interruption rider which offers up to $3,000 in benefits. In the event of the original chaperone/leader's hospitalization, a relative's unexpected death, or travel plans must be cancelled as a result of a break-in or destruction due to forces of nature at his/her residence, the subsequent chaperone/faculty leader can be reimbursed for the certain transportation costs to join the group.

Mobile Device Protection Rider (For Individuals only)

Cell phones are essential when travelling internationally to keep you safe, connect with friends and family back home, and to take photos of your travels. Device protection is for individuals and provides coverage for repair or replacement of your cell phone when it becomes lost, stolen, or accidentally damaged. With Mobile Device Protection, you can continue your travels and stay digitally connected wherever you are in the world.

Optional Add-on Rider (For Individuals and groups)

For policyholders looking for maximum protection we now offer our Add-on Rider, covering personal liability, lost personal property, legal assistance up to $500 per period of coverage, and limited High School and College sports, which is available with and without Collision Sports coverage.

*Benefits are subject to exclusions and limitations. This is only a summary and does not supersede in any way the Certificate of Insurance and governing policy documents (together the "Insurance Contract"). The Insurance Contract is the only source of the actual benefits provided.

Eligibility

To be eligible to apply to the Patriot Exchange Program plan, you must:

• Be a participant: a student, scholar, intern, teacher or trainee enrolled in an educational or cultural exchange program for the purposes of teaching, study, research or receiving on the job training for a temporary period of time
• Be the spouse of a participant or children of a participant and residing outside his/her primary country of residence for a temporary period of time. Primary applicant must hold a J, M, F, or A visa
• Be at least 31 days old but not yet 65 years old
• Be physically and legally residing in the destination country with the intent to reside there for at least 30 days on the effective date and at renewal

Enrollment Process

Before you begin your travel, simply apply online for the time period you, your group, and/or your dependents will be traveling.

Eligible individuals listed on the application and for whom premiums have been paid will be covered from the latest of the following dates:

1. The date the administrator approves your completed Application and receives the appropriate premium
2. The date you depart from your country of residence
3. The date requested on your application

Fulfillment Kits

We process applications in a quick, timely manner. Once processing is complete, they will email the fulfillment kit(s) to the email listed in the application. The fulfillment kit(s) will include an identification card(s), and the insurance certificate providing a complete description of the rights and benefits under the contract.

Conditions of Coverage

1) Coverage and benefits are subject to the deductible, limits, and coinsurance, and all terms of the certificate of insurance and master policy and all governing documents, as summarized in the certificate of insurance. 2) Coverage under a Patriot Exchange Program plan is secondary to any other coverage. 3) Coverage and benefits are for eligible medical expenses which are medically necessary and usual, reasonable and customary. 4) Charges must be administered or ordered by a licensed physician. 5) Charges must be incurred during the period of coverage.

Renewal of Coverage

Eligible insureds can request coverage under the plan be renewed a minimum of five (5) days, up to a maximum of 48 continuous months, as long as the premium is paid when due and the insured continues to meet the eligibility requirements of the plan.

Non-U.S. Citizens: As non-resident aliens, international students, scholars, and people involved in cultural exchange programs on F, J, M, or Q visas (and certain family members) are not subject to the individual mandate for their first five years in the U.S. All other J categories (teacher, trainee, work and travel, au pair, high school, etc.) are not subject to the individual mandate if in the U.S. for two of the past six years. Since international students are not subject to the mandate, they are not required to purchase a plan that meets ACA requirements and can purchase the Patriot Exchange Program.

U.S. Citizens: Under the ACA, all U.S. citizens, nationals, and resident aliens are required to purchase minimum essential coverage (ACA-compliant coverage), unless they are exempt. Exempt U.S. citizens include U.S. citizens who reside outside of the U.S. for 330 of any 365-day period, or have a tax home (main place of work or employment, or if you don’t have a main place of work or employment, your main residence) in a foreign country, and are a bona fide resident of a foreign country.

Please note that this insurance is not subject to, and does not provide benefits required by, ACA. Since January 1, 2014, ACA requires U.S. citizens, U.S. nationals and resident-aliens to obtain ACA compliant insurance coverage unless they are exempt from ACA (international students on F, J, M and Q visas (and certain family members of students) are not subject to the individual mandate for their first 5 years in the U.S. All other J categories - teacher, trainee, work and travel, au pair, high school, etc. - are not subject to the individual mandate for 2 years out of the past six). Penalties may be imposed on persons who are required to maintain ACA compliant coverage but do not do so. Eligibility to purchase or renew this product, or its terms and conditions, may be modified or amended based upon changes to applicable law, including ACA. Please note that it is solely your responsibility to determine if ACA is applicable to you and the Company and IMG shall have no liability whatsoever, including for any penalties that you may incur, for your failure to obtain required ACA compliant coverage. For information on whether ACA applies to you or whether you are eligible to purchase the Patriot Exchange Program, please contact us. The materials available on this website are for informational purposes only and not for the purpose of providing legal advice. You should contact your attorney to obtain advice with respect to any particular issue or problem. This brochure is intended to convey general information only and not to provide legal advice or opinions.

Precertification:

Certain treatment and supplies including hospital admission, inpatient or outpatient surgery, and other procedures as noted in the certificate wording must be precertified for medical necessity, which means the insured person or their attending physician must communicate with a representative at the number listed on the ID card prior to admission to a hospital before receiving certain treatments and supplies, or performance of a surgery. In case of an emergency admission, the precertification must be made within 48 hours of the admission, or as soon as reasonably possible. If a hospital admission or a surgery is not precertified, eligible claims and expenses will be reduced by 50 percent. It is important to note that precertification is only a determination of medical necessity, not an assurance of coverage, verification of benefits, or a guaranty of payment. All medical expenses eligible for reimbursement must be medically necessary and will be paid or reimbursed at usual, reasonable and customary rates. Please refer to the certificate wording for full details of the precertification requirements.

Note:You may begin the precertification process. You will be asked to provide the required information, which can then be submitted electronically. Once we have received all required information and medical records, our utilization management and review team will review the information provided and normally responds to the insured person or the provider within 2 business days. Please note that this online service will only initiate the process for treatment and supplies outlined in the contract, and it should not be used to request precertification for emergency admissions, procedures, or evacuations.

How to File a Claim

If a provider doesn’t submit a claim on your behalf, the fastest and most convenient way to submit a claim is through their online customer portal.

Claim forms can be accessed here and mailed to the address shown on the claim form. All contact numbers, claim forms and Certificate of Insurance are included in the fulfillment kit.

MyAccount

MyAccount provides service at your fingertips, giving you the information and tools to manage your plans anytime, anywhere, through easy-to-use technology. You’ll have immediate access to important resources online, including our service center team, plan document access, claim forms and much more.

U.S. Network Access

UnitedHealthcare provides travelers in the U.S. with direct access to one of the largest networks of providers in the U.S. that includes:

• Over 1.4M physicians
• 6,797 hospitals
• Over 45,000 clinics
• 67,000 pharmacies
• 1,800 convenience clinics

International Provider Access^SM

Travelers outside of the U.S. can also enjoy access to quality healthcare worldwide with our proprietary IPA network that includes:

• Over 45,000 physicians and facilities
• Direct billing arrangements that minimize time and upfront expense

Individual Monthly Rates

Individual Daily Rates

Group Monthly Rates

Group Daily Rates

New premium rates per insured person effective 10/30/2024 for eligible individuals whose applications are approved by the administrator. The administrator reserves the right to modify or replace these rates at any time.

FOR ADDITIONAL INFORMATION

Phone: (312) 927-8253
Website: palffy.brokersnexus.com

Version: CM0050A1973230118
1024