保险条例保单原件.docx

1、保险条例保单原件保险条例保单原件GENERAL CONDITIONSEF ENGLISH FIRST TEACHERS(except Indonesia)_TRAVEL INSURANCE BASICPolicy no 903.300.WWSTRAVEL INSURANCE EXTENDEDPolicy no 903.302.WWS A INTRODUCTIONThis Travel Insurance is underwritten by ERIKA Insurance Company Limited (hereafter referred to as the Insurance Compa

2、ny). All EF English First teachers on duty abroad are automatically covered by the Basic Insurance in this policy. In addition, they are eligible to purchase the Extended Insurance coverage afforded by this policy. Accompanying Family Members are also eligible to purchase the Basic Insurance or the

3、Extended Insurance. The coverages available are reflected on the Policy Schedule page (page 4). All purchase of insurance must be done before the duty abroad begins by paying the applicable premium to EF English First.As a beneficiary of the coverage afforded by this policy, you are to act responsib

4、ly and take all reasonable measures to prevent a loss or to limit a loss already incurred. There are certain steps you must follow to be sure that you receive the full benefits available to you. These steps are explained in detail later in this policy. If you have any questions about coverage, you s

5、hould contact your EF English First representative or the Claims Agent. To file a claim, please call the Claims Agent at the number provided below.CLAIMS AGENTWorldwide Emergency Assistance and Claims HandlingERIKA AssistancePositionen 158SE-115 74 Stockholm, SwedenTel: (+46) 8-579 379 79 (24 hours)

6、Fax: (+46) 8-579 379 75E-mail: erikaassistans.nuPERIOD OF COVERAGECoverage provided by this insurance policy is from the first to the last day of the duty abroad period on behalf of EF English First. Coverage begins at 12:01 a.m. on the first day of the duty abroad period and terminates at 12:01 a.m

7、. on the day after the duty abroad period ends, when you leave the duty abroad, when you return to your city of residence, or when the duty abroad is interrupted, whichever date is earliest. If the return from the duty abroad period is delayed or cancelled for reasons covered by this insurance polic

8、y, coverage is extended until you return to your city of residence.POLICY SCHEDULES(Maximum Compensation - Amounts in USD)BASIC INSURANCEMedical & Accident Insurance A. Medical Expenses 500,000 ) B. Emergency Home Evacuation 50,000 ) A, B,C and D C. Family Member Reimbursement 10,000 ) combinedD. Ho

9、me Repatriation 10,000 ) maximum limit - local burial 10,000 ) of 500,000 E. Accidental Death 10,000 F. Accidental Disability 25,000 EXTENDED INSURANCEMedical & Accident Insurance A. Medical Expenses unlimited B. Emergency Home Evacuation unlimited C. Family Member Reimbursement unlimited D. Home Re

10、patriation unlimited - local burial 10,000 E. Accidental Death 10,000 F. Accidental Disability 25,000Baggage & Property Insurance G. Baggage and Property 3,300 - sublimit for defined valuable property (3,300) H. Cash 400 I. Valuable Documents 500 J. Baggage Delay 150 K. Personal Delay 900 - flight e

11、xtra cost 300 Liability & Legal Insurance N. Third Party Liability 700,000 O. Legal Expenses 11,000 DEDUCTIBLESMedical & Accident Insurance (Basic and Extended):USD 100 each condition.Baggage & Property Insurance (Extended only).USD 100 each event for Baggage and Property, Cash and Valuable Document

12、s.24 hour waiting period for Baggage Delay.8 hour waiting period for Personal Delay.Liability & Legal Insurance (Extended only):USD 100 for Third Party Liability.USD 100 for Legal Expenses.GENERAL INFORMATIONTERMS YOU SHOULD KNOWThe following definitions apply to the following words when used in thi

13、s policy:Accident bodily injury caused solely and directly by violent, unexpected, external, and/or visible means while you are covered by this insurance policy.Claim the process to follow when a loss that is covered by the insurance policy is incurred.Disability permanent loss or reduction of bodil

14、y function or permanent disfigurement as the result of an accident.Deductible the amount you pay before the Insurance Company begins to pay any benefits pursuant to this insurance policy. A deductible applies to each loss insurable by this policy. In most cases, there is no deductible. Refer to indi

15、vidual sections in this policy for the deductible that applies to each type of loss.Family Member a spouse, parent, child, sibling, legal guardian, or live-in companion.Illness sickness or disease that begins after you are insured by this insurance policy and which causes a loss insured by the insur

16、ance policy. The maximum period for which compensation is paid is the planned period of the duty abroad for EF English First.Inpatient health services when you are confined to a hospital. Admission Insured the teacher on duty abroad on behalf of EF English First, for whom the applicable premium has

17、been paid, or an accompanying Family Member, for whom the applicable premium has been paid.Loss any medical condition or incident that occurs for which you may make a claim for insurance benefits.Medical an acute medical condition caused by an accident Emergency or the sudden onset of a severe or su

18、spected severe illness. For example, conditions that require urgent care include: broken bones, sudden asthma attacks, convulsions, food or blood poisoning, loss of blood or suspected appendicitis. Examples of non-acute conditions include: colds, sore throats and the flu.Outpatient health services r

19、eceived when you are not confined to a hospital.Pre-existing any medical condition for which you have received Condition treatment or have been diagnosed, or which would have caused a prudent person to seek diagnosis or treatment prior to the effective date when this insurance coverage takes effect.

20、 You will not be covered for any expenses related to a pre-existing condition, insofar as they can be reasonably expected at the time when your insurance coverage becomes effective.Reasonable and the usual fees for services charged by professionals Customary charges in the geographical area in which

21、 they practise.Sound natural teeth healthy, natural teeth.You the person who has obtained this insurance and who is on duty abroad on behalf of EF English First, or an accompanying Family Member, who has obtained this insurance.WHAT TO DO IF A LOSS OCCURS / HOW TO FILE A CLAIMIf a loss occurs, you s

22、hould file a claim promptly and respond to all inquiries or instructions by the Insurance Company or Claims Agent. In addition:1. After a loss occurs, take the necessary steps to prevent or minimize a further loss;2. Document the loss by outlining the time, place and circumstances, the extent of the

23、 loss, the names and addresses of available witnesses. Provide this information promptly to the Claims Agent;3. For medical or accident loss, obtain medical care receipts and reports showing diagnosis, treatment periods, and other pertinent information about the illness or injury. You must also noti

24、fy the Claims Agent in the event of an accident, injury or illness as soon as possible, and no later than 30 days after your initial treatment;4. Complete a Claim Form in its entirety and attach all of the aforementioned documentation (including but not limited to bills, medical reports, death certi

25、ficate, police or insurance reports, receipts, etc.). Send the Claim Form to the Claims Agent as soon as possible after the accident;5. In order to be reimbursed for any expenses you incur, you must deliver a completed Claim Form to the Claims Agent together with all necessary documentation (includi

26、ng but not limited to a police report, a report from an airline, receipts, warranty documents, bills, medical bills, etc.). You must provide documentation to prove the extent of loss of or damage to the property insured and any other documents that the Insurance Company may require. In order to be e

27、ntitled to benefits, you must deliver a Claim Form to the Claims Agent as soon as possible, and latest within thirty days of the time of the loss. If you wait longer than thirty days, you will not be entitled to any benefits.The Insurance Company will not be liable under this policy in the event the

28、 insured or any person entitled to indemnity fails to comply with the requirements of items 1 through 5 or makes a false statement in the documents furnished to the Insurance Company or commits, or has another person or persons commit forgery or alteration of such documents.The Insurance Company wil

29、l review all available documentation when determining whether you are entitled to reimbursement.Payment will be made to you, or may be paid directly to the doctor in the case of a medical or accident claim. Payments will be made within a reasonable time after the Insurance Company has had the opport

30、unity to: review the injury, illness or accident; determine its cause; and evaluate the reasonableness, necessity and insurability of the medical bills and treatment.For further assistance or Claim Forms, contact the Claims Agent.IF YOU DO NOT AGREE WITH THE OUTCOME OFYOUR CLAIMIf you file a Claim a

31、nd do not agree with the outcome, you have six months from the date your Claim was paid or denied to notify the Claims Agent in writing that you want to contest the claim. If you do not so notify the Claims Agent within six months, the Insurance Company is under no obligation to review your Claim. S

32、end your Claims appeals to the Claims Agent at the address provided earlier in this policy (page 3).IF YOU RECEIVE PAYMENT FROM ANOTHER SOURCEIf you are entitled to reimbursement of your loss from another source - auto or household insurance, for example - you will not be eligible to receive additional benefits from the Insurance Company. If you have received payment from the Insurance Company and then receive payment from anot