terryd1@erols.com
www.duckworthins.com
Global Medical Insurance®
Global Medical Insurance®

The following is a summary schedule of benefits for eligible medical expenses. Benefits are subject to maximums, deductible and coinsurance unless otherwise noted. NA (Not Applicable).

Summary of Benefits Subject to deductible and coinsurance unless otherwise noted
Lifetime Maximum Limit
Deductible (Per Period of Coverage)
Deductible Carry Forward
Treatment Outside the U.S.
Treatment inside the U.S. using Medical Concierge
Treatment inside the U.S. - PPO Network
Treatment inside the U.S. - Non-PPO Network
Hospitalization / Room & Board
Intensive Care Unit
Surgery
Assistant Surgeon
Outpatient 1) Office visits 2) Diagnostic/X-Ray
Chemotherapy or Radiation Therapy
Transplants
Emergency Room Illness (Additional $250 deductible if not admitted as an in patient)
Emergency Room Accident
Supplemental Accident
Local Ambulance due to Injury or Illness resulting in Hospitalization
Mental/Nervous
Emergency Evacuation
Emergency Reunion
Return of Mortal Remains
Remote Transportation
Political Evacuation and Repatriation
Child Wellness (Through age 18)
Adult Wellness (Age 19 or older)
Rx Coverage
Physical Therapy
Complementary Medicine
Recreational Scuba
Non-emergency Dental
Emergency Dental due to Accident
Emergency Dental due to Sudden Unexpected Pain
Vision
Maternity
Delivery, wellness, new born care & congenital disorders, Family Matters Maternity Program (available after 10 months of coverage)
Hospital Indemnity (Outside the U.S. only)
Pre-Existing Conditions Limitation

* This Web page contains only a consolidated and summary description of all current benefits, conditions, limitations and exclusions. A certificate containing the complete Certificate Wording with all terms, conditions and exclusions will be included in the fulfillment kit. IMG reserves the right to issue the most current Certificate Wording for this insurance plan in the event this Web page, application, and/or brochure has expired, is modified, or is replaced with a newer version. Current Certificate Wordings are available upon request.