Patriot Exchange Insurance Eligibility
Renewal/Extension
| Benefits | Coverage |
| Hospital room and board | Average semi-private room rate, including nursing services |
| Intensive care | 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 co-pay 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 | Injury due to covered accident - $500 maximum Sudden & unexpected pain to natural teeth - $350 maximum |
| 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 |
| Emergency medical evacuation | $50,000 lifetime maximum |
| Emergency reunion | $15,000 lifetime maximum |
| Return of mortal remains or cremation/burial | $25,000 maximum for return of mortal remains or $5,000 for cremation/burial |
| Accidental death & dismemberment | $25,000 principal sum, Not subject to deductible |
| Terrorism | $50,000 maximum limit, Not subject to deductible |
| Incidental trip coverage | Up to a cumulative 14 days |
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