Medical Coverage

• All eligible inpatient and outpatient medical expenses — physician visits, hospital room and board (average semi-private room rate, including nursing and ancillary services), intensive care, surgery, and anesthesia
• Outpatient surgical facility, laboratory, radiology, and X-ray
• Chemotherapy and radiation therapy
• Pre-admission testing
• Reconstructive surgery (incidental to and following a covered surgery)
• Assistant surgeon (20% of primary surgeon's eligible fee)
• Durable medical equipment
• Chiropractic care (medical order or treatment plan required)
• Physical therapy (medical order or treatment plan required)
• Extended care facility and home nursing care (upon direct transfer from an acute care facility)
• Prescription drugs and medications — 90-day dispensing maximum per retail pharmacy prescription; covered out-of-network at 80% and internationally at 100%; not covered at in-network U.S. pharmacies
• Urgent Care Clinic — $25 copay; not subject to deductible (copay waived with $0 deductible)
• Walk-in Clinic — $15 copay; not subject to deductible (copay waived with $0 deductible)
• Hospital Emergency Room (U.S.) — injury not subject to ER deductible; illness subject to a $250 deductible per visit not resulting in direct inpatient admission; in-network: 100%, out-of-network: 80%
• Hospital Emergency Room (International) — 100%, no ER deductible
• Supplemental Accident Benefit — $300 per covered accident; not subject to deductible

Emergency Services

All emergency services are not subject to deductible or coinsurance unless otherwise noted, and are paid at 100% regardless of network or location.

• Emergency Medical Evacuation — up to $1,000,000; must be approved in advance and coordinated by IMG
• Interfacility Ambulance Transfer — 100%; pre-certification required; no coverage if pre-certification requirements are not met
• Emergency Local Ambulance — subject to deductible and coinsurance; covered for injury or illness resulting in inpatient admission
• Remote Transportation — up to $20,000 lifetime / $5,000 per period; must be approved in advance
• Emergency Reunion — up to $100,000 for reasonable travel costs and accommodations for one person to join you when hospitalized; up to 15 days; $25/day meal maximum; must be approved by IMG
• Return of Minor Children — up to $100,000 to return unattended minor children to their home country; must be approved by IMG
• Return of Mortal Remains — up to the policy maximum to return remains to your country of residence; local burial or cremation up to $5,000; must be approved by IMG
• Political Evacuation & Repatriation — up to $100,000; must be approved in advance by IMG
• Natural Disaster Evacuation — up to $25,000; must be approved in advance by IMG
• Natural Disaster Lodging — $250/day for up to 5 days for accommodations during a covered natural disaster
• Bedside Visit — up to $1,500 for a visitor's reasonable expenses when you are hospitalized in the ICU; not subject to deductible
• Return Travel — up to $10,000 to return home following a covered emergency

Accidental Death & Dismemberment

• AD&D — $50,000 Principal Sum; death must occur within 90 days of the accident; covers loss of sight of one eye or one hand/foot (50%), and various combinations at 100%
• Common Carrier Accidental Death — $100,000 per adult / $25,000 per child / $250,000 per family maximum; not subject to deductible or coinsurance

Additional Benefits

• Incidental Trip — up to 14 days of coverage during a brief return to your country of residence (available only when your country of residence is not the United States)
• Hospital Indemnity — $250 per overnight inpatient confinement; up to 10 nights; applies outside the insured's country of residence and the United States only; not subject to deductible
• Terrorism — up to $50,000; not subject to deductible
• Identity Theft — up to $500; not subject to deductible
• Personal Liability — up to $25,000 combined; $100 per-injury and per-damage deductible; secondary to other insurance; no coverage for related-party injury or property damage
• Dental Treatment — up to $300 for unexpected pain or accident to sound natural teeth; subject to deductible and coinsurance; not covered in-network in the U.S.
• Traumatic Dental Injury — up to the policy maximum for hospital treatment due to accident; additional dental provider treatment for the same injury also paid at 100%; subject to deductible and coinsurance
• Emergency Eye Examination — up to $150 for loss or damage to prescription corrective lenses due to an accident; $50 per-occurrence deductible; not covered in-network in the U.S.
• Lost Luggage — up to $500 ($50 per item); not subject to deductible
• Pet Return — up to $1,000 for a traveling cat or dog; not subject to deductible
• Small Pet Common Air Carrier Accidental Death — up to $500 for a cat or dog under 30 pounds; not subject to deductible

What's Not Included on the Lite Plan

Compared to the Patriot America Plus and Platinum plans, the Lite plan does not include:

• Acute Onset of Pre-Existing Conditions coverage
• Telehealth (not available as an add-on either)
• COVID-19 coverage — specifically excluded on Patriot America Lite

These benefits are available on the Patriot America Plus and Patriot America Platinum plans.

U.S. PPO Network Access

When receiving treatment inside the United States, insured persons have access to the UnitedHealthcare PPO network with direct billing arrangements. In-network care is covered at 100% after the deductible. Out-of-network care inside the U.S. is covered at 80% with a $1,000 out-of-pocket maximum.

The Patriot America Lite plan is the most affordable entry point in the Patriot America series — ideal for budget-conscious travelers who still need solid emergency medical protection, evacuation coverage, and access to the U.S. PPO network.

This plan is an excellent fit for:

• Non-U.S. citizens visiting the United States on a budget
• Parents, relatives, and friends making shorter visits to family in the U.S.
• International students who need basic compliant coverage for a U.S. study term
• Employees of foreign companies making brief work trips to the United States
• Travelers who primarily plan to use in-network U.S. providers (where full 100% coverage applies)
• Groups needing affordable baseline coverage for volunteers or short-term workers

How it compares to Patriot America Plus:

The Lite plan offers the same emergency services, evacuation benefits, and in-network medical coverage as the Plus plan. The key trade-offs are a higher out-of-network coinsurance rate (80% vs. 90%), a higher out-of-pocket maximum for out-of-network care ($1,000 vs. $500), and the absence of the Acute Onset of Pre-Existing Conditions benefit and COVID-19 coverage. If those protections are important, consider the Patriot America Plus or Platinum.

Eligibility notes:

• Available to non-U.S. residents only — must reside outside the United States
• Area of coverage: worldwide excluding your country of residence
• Coverage is available for 5 days up to 12 months; extendable up to 24 continuous months
• Pre-existing conditions are excluded (no Acute Onset exception on this plan)
• Pre-certification required for certain services; failure to pre-certify results in a 50% reduction of eligible expenses
• Underwritten by SiriusPoint Specialty Insurance Corporation

Expand your Patriot America Lite coverage with add-on riders available at the time of application.

Adventure Sports Rider

Provides coverage for injuries sustained during certain extreme sports and adventure activities that would otherwise be excluded from the base plan.

Lifetime maximum by age:

• Ages 0–49: $50,000
• Ages 50–59: $30,000
• Ages 60–64: $15,000
• Not available for ages 65+

Covered activities include (but are not limited to) high-risk adventure sports such as extreme skiing, mountaineering, rock climbing, skydiving, BASE jumping, bungee jumping, and similar activities. Refer to the Certificate of Insurance for the complete list of covered and excluded activities.

Enhanced AD&D Rider

Increases your Accidental Death & Dismemberment benefit beyond the base $50,000 Principal Sum, up to $400,000, if death or dismemberment is the direct result of an accident. Available to the primary insured only; requires a minimum of 3 months of medical coverage purchased alongside the rider. Premium charged in whole-month increments.

Trip Cancellation, Interruption & Travel Delay Rider

(Available to U.S. residents on individual plans only)

Adds trip cancellation, trip interruption, and travel delay protection to your plan. If you are prevented from taking your trip for a covered, unforeseen reason, this rider can reimburse up to 100% of prepaid, non-refundable trip costs. Covers travel delay expenses and additional transportation costs to rejoin or return from your trip.

Note: All Patriot America Lite plans include a Return Travel benefit up to $10,000. This rider adds the pre-departure trip cancellation layer.

Mobile Device Protection Rider

(Available on individual plans only)

Covers repair or replacement of your cell phone if lost, stolen, or accidentally damaged during your trip.

Provided by International Medical Group (IMG) — 24/7 Global Assistance Services

Every Patriot America Lite plan includes access to IMG's expert global assistance team, available around the clock in multiple time zones, languages, and currencies.

To reach IMG Assistance:

• Phone: +1 (317) 655-4500
• Online: www.imglobal.com
• MyIMG Member Portal & Mobile App — manage your plan, submit and track claims, view Explanations of Benefits, and search for providers 24/7

What assistance services include:

• Coordination and pre-authorization of Emergency Medical Evacuation and Repatriation
• Arrangement of Political and Natural Disaster Evacuations
• Emergency Reunion, Return of Minor Children, and Return of Mortal Remains coordination
• Location of physicians and facilities through IMG's global networks:
  • U.S. Network (UnitedHealthcare PPO): 1.4M+ physicians, 6,797+ hospitals, 45,000+ clinics, 67,000 pharmacies
  • International Provider Access (IPA): 18,550+ physicians and facilities worldwide with direct billing
• Multilingual staff including nurses, doctors, and case managers
• Travel Intelligence — location-specific health, security, transportation, and weather alerts via the IMG mobile app
• Universal Rx Pharmacy Discount Program — savings at 35,000+ participating U.S. pharmacies

Important: Emergency Medical Evacuation requires advance approval and coordination by IMG. Interfacility Ambulance Transfers require pre-certification — no coverage is provided if pre-certification requirements are not met. Failure to obtain pre-certification for other required services results in a 50% reduction of eligible expenses.

• • • Patriot America Lite Certificate of Insurance (Sample Contract) — full benefit schedule, provisions, exclusions, and definitions
    • Patriot Travel Series Brochure — overview and benefit comparison across Lite, Plus, and Platinum levels
    • Find a Doctor — search IMG's U.S. and international provider networks
    • Get a Quote / Apply Online

    The Certificate of Insurance and governing policy documents are the only source of actual benefits provided. This page is a summary for illustration purposes only. Benefits are subject to exclusions, limitations, and Usual, Reasonable, and Customary charge requirements. Underwritten by SiriusPoint Specialty Insurance Corporation.

IMG requires claims to be submitted within 180 days of the date a claim is incurred. Claims can be filed online through the MyIMG member portal or by mail.

Step-by-step claims process:

1. Pre-certify when required — certain services require pre-certification before treatment. Contact IMG's assistance line before scheduled inpatient admissions, surgeries, or other listed services. Failure to pre-certify results in a 50% reduction of eligible expenses; interfacility ambulance transfers receive no coverage without pre-certification.
2. Log in to MyIMG at www.imglobal.com/member to complete and submit an IMG Claim Form online. One claim form is required per new illness, diagnosis, or injury.
3. Gather required documentation:
   • Completed IMG Claim Form
   • Universal Billing Forms, Superbills, and itemized statements from all treating providers
   • Original receipts for all costs, medications, and expenses paid out-of-pocket (including provider name, address, phone, date of service, procedure codes, and diagnosis codes)
   • If IMG is secondary payer: copy of the primary insurer's Explanation of Benefits (EOB)
4. Submit within 180 days of the date of service. If additional information is requested by IMG, respond within 60 days to avoid denial.

Claims mailing address:

International Medical Group Attn: Claims Department PO Box 240429 Apple Valley, MN 55124 USA

Appeals: If a claim is denied, you have 90 days from the date of the denial notice to submit a written appeal with supporting documentation to:

International Medical Group Attn: Benefit Review PO Box 240429 Apple Valley, MN 55124 USA

General contact:

Phone: +1 (317) 655-4500 Email: Insurance@imglobal.com Secure messages: www.imglobal.com/secure-message-center Online portal: www.imglobal.com/member

The Patriot America Lite plan includes a free look period — if you are not completely satisfied with your coverage, you may request cancellation and a full refund of premium provided no claims have been filed.

Free Look / Cancellation: The insured person may request cancellation of the Certificate and a refund of premium if not completely satisfied, provided the request is made before any claims have been submitted. Contact IMG directly to initiate a cancellation request.

In plain terms:

• You may cancel for a full refund before any claims are filed, provided you act promptly after receiving your policy documents
• Once a claim has been submitted, the premium is considered earned for the coverage period
• For extensions or renewals: a new deductible and pre-existing condition exclusion apply to each successive period of coverage

To request a cancellation or refund, contact IMG:

International Medical Group, Inc. 9200 Keystone Crossing, Suite 800 Indianapolis, IN 46240 USA Phone: +1 (317) 655-4500 Email: Insurance@imglobal.com Online: www.imglobal.com/contact

This page is a general summary only and does not supersede the Certificate of Insurance or governing policy documents, which are the only source of actual benefits. Benefits are subject to exclusions, limitations, and Usual, Reasonable, and Customary charge requirements. Underwritten by SiriusPoint Specialty Insurance Corporation. Administered by International Medical Group, Inc. (IMG), 9200 Keystone Crossing, Suite 800, Indianapolis, IN 46240. This insurance is not subject to and does not provide benefits required by PPACA. This insurance is issued pursuant to applicable surplus lines law.