保险条例保单原件.docx
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保险条例保单原件
保险条例保单原件
GENERALCONDITIONS
EFENGLISHFIRSTTEACHERS
(exceptIndonesia)
______________
TRAVELINSURANCEBASIC
Policyno903.300.WWS
TRAVELINSURANCEEXTENDED
Policyno903.302.WWS
A.INTRODUCTION
ThisTravelInsuranceisunderwrittenbyERIKAInsuranceCompanyLimited(hereafterreferredtoasthe"InsuranceCompany").AllEFEnglishFirstteachersondutyabroadareautomaticallycoveredbytheBasicInsuranceinthispolicy.Inaddition,theyareeligibletopurchasetheExtendedInsurancecoverageaffordedbythispolicy.AccompanyingFamilyMembersarealsoeligibletopurchasetheBasicInsuranceortheExtendedInsurance.ThecoveragesavailablearereflectedonthePolicySchedulepage(page4).AllpurchaseofinsurancemustbedonebeforethedutyabroadbeginsbypayingtheapplicablepremiumtoEFEnglishFirst.
Asabeneficiaryofthecoverageaffordedbythispolicy,youaretoactresponsiblyandtakeallreasonablemeasurestopreventalossortolimitalossalreadyincurred.Therearecertainstepsyoumustfollowtobesurethatyoureceivethefullbenefitsavailabletoyou.Thesestepsareexplainedindetaillaterinthispolicy.Ifyouhaveanyquestionsaboutcoverage,youshouldcontactyourEFEnglishFirstrepresentativeortheClaimsAgent.Tofileaclaim,pleasecalltheClaimsAgentatthenumberprovidedbelow.
CLAIMSAGENT
WorldwideEmergencyAssistanceandClaimsHandling
ERIKAAssistance
Positionen158
SE-11574Stockholm,Sweden
Tel:
(+46)8-57937979(24hours)
Fax:
(+46)8-57937975
E-mail:
erika@assistans.nu
PERIODOFCOVERAGE
CoverageprovidedbythisinsurancepolicyisfromthefirsttothelastdayofthedutyabroadperiodonbehalfofEFEnglishFirst.Coveragebeginsat12:
01a.m.onthefirstdayofthedutyabroadperiodandterminatesat12:
01a.m.onthedayafterthedutyabroadperiodends,whenyouleavethedutyabroad,whenyoureturntoyourcityofresidence,orwhenthedutyabroadisinterrupted,whicheverdateisearliest.Ifthereturnfromthedutyabroadperiodisdelayedorcancelledforreasonscoveredbythisinsurancepolicy,coverageisextendeduntilyoureturntoyourcityofresidence.
POLICYSCHEDULES
(MaximumCompensation-AmountsinUSD)
BASICINSURANCE
Medical&AccidentInsurance
A.MedicalExpenses500,000)
B.EmergencyHomeEvacuation50,000)A,B,CandD
C.FamilyMemberReimbursement10,000)combined
D.HomeRepatriation10,000)maximumlimit
-localburial10,000)of500,000
E.AccidentalDeath10,000
F.AccidentalDisability25,000
EXTENDEDINSURANCE
Medical&AccidentInsurance
A.MedicalExpensesunlimited
B.EmergencyHomeEvacuationunlimited
C.FamilyMemberReimbursementunlimited
D.HomeRepatriationunlimited
-localburial10,000
E.AccidentalDeath10,000
F.AccidentalDisability25,000
Baggage&PropertyInsurance
G.BaggageandProperty3,300
-sublimitfordefinedvaluableproperty(3,300)
H.Cash400
I.ValuableDocuments500
J.BaggageDelay150
K.PersonalDelay900
-flightextracost300
Liability&LegalInsurance
N.ThirdPartyLiability700,000
O.LegalExpenses11,000
DEDUCTIBLES
Medical&AccidentInsurance(BasicandExtended):
USD100eachcondition.
Baggage&PropertyInsurance(Extendedonly).
USD100eacheventforBaggageandProperty,CashandValuableDocuments.
24hourwaitingperiodforBaggageDelay.
8hourwaitingperiodforPersonalDelay.
Liability&LegalInsurance(Extendedonly):
USD100forThirdPartyLiability.
USD100forLegalExpenses.
GENERALINFORMATION
TERMSYOUSHOULDKNOW
Thefollowingdefinitionsapplytothefollowingwordswhenusedinthispolicy:
Accidentbodilyinjurycausedsolelyanddirectlybyviolent,unexpected,external,and/orvisiblemeanswhileyouarecoveredbythisinsurancepolicy.
Claimtheprocesstofollowwhenalossthatiscoveredbytheinsurancepolicyisincurred.
Disabilitypermanentlossorreductionofbodilyfunctionorpermanentdisfigurementastheresultofanaccident.
DeductibletheamountyoupaybeforetheInsuranceCompanybeginstopayanybenefitspursuanttothisinsurancepolicy.Adeductibleappliestoeachlossinsurablebythispolicy.Inmostcases,thereisnodeductible.Refertoindividualsectionsinthispolicyforthedeductiblethatappliestoeachtypeofloss.
FamilyMemberaspouse,parent,child,sibling,legalguardian,orlive-incompanion.
Illnesssicknessordiseasethatbeginsafteryouareinsuredbythisinsurancepolicyandwhichcausesalossinsuredbytheinsurancepolicy.ThemaximumperiodforwhichcompensationispaidistheplannedperiodofthedutyabroadforEFEnglishFirst.
Inpatienthealthserviceswhenyouareconfinedtoahospital.
Admission
InsuredtheteacherondutyabroadonbehalfofEFEnglishFirst,forwhomtheapplicablepremiumhasbeenpaid,oranaccompanyingFamilyMember,forwhomtheapplicablepremiumhasbeenpaid.
Lossanymedicalconditionorincidentthatoccursforwhichyoumaymakeaclaimforinsurancebenefits.
Medicalanacutemedicalconditioncausedbyanaccident
Emergencyorthesuddenonsetofasevereorsuspectedsevereillness.Forexample,conditionsthatrequireurgentcareinclude:
brokenbones,suddenasthmaattacks,convulsions,foodorbloodpoisoning,lossofbloodorsuspectedappendicitis.Examplesofnon-acuteconditionsinclude:
colds,sorethroatsandtheflu.
Outpatienthealthservicesreceivedwhenyouarenotconfinedtoahospital.
Pre-existinganymedicalconditionforwhichyouhavereceived
Conditiontreatmentorhavebeendiagnosed,orwhichwouldhavecausedaprudentpersontoseekdiagnosisortreatmentpriortotheeffectivedatewhenthisinsurancecoveragetakeseffect.Youwillnotbecoveredforanyexpensesrelatedtoapre-existingcondition,insofarastheycanbereasonablyexpectedatthetimewhenyourinsurancecoveragebecomeseffective.
Reasonableandtheusualfeesforserviceschargedbyprofessionals
Customarychargesinthegeographicalareainwhichtheypractise.
Soundnaturalteethhealthy,naturalteeth.
YouthepersonwhohasobtainedthisinsuranceandwhoisondutyabroadonbehalfofEFEnglishFirst,oranaccompanyingFamilyMember,whohasobtainedthisinsurance.
WHATTODOIFALOSSOCCURS/HOWTOFILEACLAIM
Ifalossoccurs,youshouldfileaclaimpromptlyandrespondtoallinquiriesorinstructionsbytheInsuranceCompanyorClaimsAgent.Inaddition:
1.Afteralossoccurs,takethenecessarystepstopreventorminimizeafurtherloss;
2.Documentthelossbyoutliningthetime,placeandcircumstances,theextentoftheloss,thenamesandaddressesofavailablewitnesses.ProvidethisinformationpromptlytotheClaimsAgent;
3.Formedicaloraccidentloss,obtainmedicalcarereceiptsandreportsshowingdiagnosis,treatmentperiods,andotherpertinentinformationabouttheillnessorinjury.YoumustalsonotifytheClaimsAgentintheeventofanaccident,injuryorillnessassoonaspossible,andnolaterthan30daysafteryourinitialtreatment;
4.CompleteaClaimForminitsentiretyandattachalloftheaforementioneddocumentation(includingbutnotlimitedtobills,medicalreports,deathcertificate,policeorinsurancereports,receipts,etc.).SendtheClaimFormtotheClaimsAgentassoonaspossibleaftertheaccident;
5.Inordertobereimbursedforanyexpensesyouincur,youmustdeliveracompletedClaimFormtotheClaimsAgenttogetherwithallnecessarydocumentation(includingbutnotlimitedtoapolicereport,areportfromanairline,receipts,warrantydocuments,bills,medicalbills,etc.).YoumustprovidedocumentationtoprovetheextentoflossofordamagetothepropertyinsuredandanyotherdocumentsthattheInsuranceCompanymayrequire.
Inordertobeentitledtobenefits,youmustdeliveraClaimFormtotheClaimsAgentassoonaspossible,andlatestwithinthirtydaysofthetimeoftheloss.Ifyouwaitlongerthanthirtydays,youwillnotbeentitledtoanybenefits.
TheInsuranceCompanywillnotbeliableunderthispolicyintheeventtheinsuredoranypersonentitledtoindemnityfailstocomplywiththerequirementsofitems1through5ormakesafalsestatementinthedocumentsfurnishedtotheInsuranceCompanyorcommits,orhasanotherpersonorpersonscommitforgeryoralterationofsuchdocuments.
TheInsuranceCompanywillreviewallavailabledocumentationwhendeterminingwhetheryouareentitledtoreimbursement.
Paymentwillbemadetoyou,ormaybepaiddirectlytothedoctorinthecaseofamedicaloraccidentclaim.PaymentswillbemadewithinareasonabletimeaftertheInsuranceCompanyhashadtheopportunityto:
reviewtheinjury,illnessoraccident;determineitscause;andevaluatethereasonableness,necessityandinsurabilityofthemedicalbillsandtreatment.
ForfurtherassistanceorClaimForms,contacttheClaimsAgent.
IFYOUDONOTAGREEWITHTHEOUTCOMEOF
YOURCLAIM
IfyoufileaClaimanddonotagreewiththeoutcome,youhavesixmonthsfromthedateyourClaimwaspaidordeniedtonotifytheClaimsAgentinwritingthatyouwanttocontesttheclaim.IfyoudonotsonotifytheClaimsAgentwithinsixmonths,theInsuranceCompanyisundernoobligationtoreviewyourClaim.SendyourClaimsappealstotheClaimsAgentattheaddressprovidedearlierinthispolicy(page3).
IFYOURECEIVEPAYMENTFROMANOTHERSOURCE
Ifyouareentitledtoreimbursementofyourlossfromanothersource-autoorhouseholdinsurance,forexample-youwillnotbeeligibletoreceiveadditionalbenefitsfromtheInsuranceCompany.IfyouhavereceivedpaymentfromtheInsuranceCompanyandthenreceivepaymentfromanot