保险条例保单原件.docx

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