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.WWSA INTRODUCTIONThis Travel Insurance is underwritten by ERIKA Insurance Company Limited (hereafter referred to as the Insurance Company). 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 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 responsibly 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 should 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)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. 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 policy, coverage is extended until you return to your city of residence.POLICY SCHEDULES(Maximum Compensation - Amounts in USD)BASIC INSURANCEMedical & Accident InsuranceA.Medical Expenses 500,000)B.Emergency Home Evacuation50,000)A, B,C and D C.Family Member Reimbursement10,000)combinedD.Home Repatriation10,000)maximum limit- local burial10,000)of 500,000 E.Accidental Death10,000F.Accidental Disability25,000EXTENDED INSURANCEMedical & Accident InsuranceA.Medical Expenses unlimitedB.Emergency Home Evacuationunlimited C.Family Member ReimbursementunlimitedD.Home Repatriationunlimited- local burial10,000E.Accidental Death10,000F.Accidental Disability25,000Baggage & Property InsuranceG.Baggage and Property3,300- sublimit for defined valuable property(3,300) H.Cash400I.Valuable Documents500J.Baggage Delay150K.Personal Delay900- flight extra cost300Liability & Legal InsuranceN.Third Party Liability700,000 O.Legal Expenses11,000DEDUCTIBLESMedical & 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 Documents.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 this policy:Accidentbodily injury caused solely and directly by violent, unexpected, external, and/or visible means while you are covered by this insurance policy.Claimthe process to follow when a loss that is covered by the insurance policy is incurred.Disabilitypermanent loss or reduction of bodily function or permanent disfigurement as the result of an accident.Deductiblethe 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 individual sections in this policy for the deductible that applies to each type of loss.Family Membera spouse, parent, child, sibling, legal guardian, or live-in companion.Illnesssickness or disease that begins after you are insured by this insurance policy and which causes a loss insured by the insurance policy. The maximum period for which compensation is paid is the planned period of the duty abroad for EF English First.Inpatienthealth services when you are confined to a hospital. AdmissionInsuredthe teacher on duty abroad on behalf of EF English First, for whom the applicable premium has been paid, or an accompanying Family Member, for whom the applicable premium has been paid.Lossany medical condition or incident that occurs for which you may make a claim for insurance benefits.Medicalan acute medical condition caused by an accident Emergencyor the sudden onset of a severe or suspected 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.Outpatienthealth services received when you are not confined to a hospital.Pre-existingany medical condition for which you have received Conditiontreatment 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. 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 andthe usual fees for services charged by professionals Customary chargesin the geographical area in which they practise.Sound natural teethhealthy, 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 should 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 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 notify 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 certificate, 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 (including 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 entitled 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 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 will 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 opportunity 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 and 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. Send 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 another plan or insurance company or other source, you must provide the Insurance Company with all information and documentation regarding said payment and then reimburse the Insurance Company for its payment. Failure to do so may result in legal action.BASIC INSURANCEMEDICAL AND ACCIDENT INSURANCETERMS OF COVERAGEThe Insurance Company will pay necessary, reasonable and customary charges up to USD 500,000, less your deductible, for inpatient admissions or outpatient doctors visits (and other care and supplies as described below) relating to an illness or to an accident which occurred during the duty abroad period on behalf of EF English First, subject to the limitations described in the Period of Coverage and Exclusions sections below and all other terms and conditions of this policy of insurance. Payments relating to an illness or accident will be made for a maximum period of the remaining length of the duty abroad contract, however not longer than 365 days. The illness or accident must occur during the Period of Coverage. If the insured is unable to travel due to a medical condition at the time the duty abroad ends, coverage is extended until the insured is released to travel, subject to all other policy limits and conditions. This policy does not pay for any expenses eligible for reimbursement by other means, including, but not limited to, reimbursement available under other insurance policies or government sponsored programs.The Insurance Company will not pay more than a total of USD 500,000 for any and all claims of any insured under Sections A, B, C and D combined of the Medical and Accident Insurance section of this policy.The Insurance Company has the right to decide in which country medical treatment following an illness or accident should be provided.A. Medical ExpensesAfter you pay the first USD 100 of any incurred expenses (your deductible), the Insurance Company will reimburse you, or in the event of death your estate, for the following reasonable and customary expenses up to USD 500,000 for illness or bodily injury caused by an accident:-Outpatient doctors visits - non-routine care provided during the Period of Coverage;-Inpatient hospital treatment provided during the Period of Coverage;-Prescription drugs and supplies - prescriptions written by a licensed doctor during the Period of Coverage as treatment for an accident or illness;-Chiropractic care during the Period of Coverage - if you have been referred by a licensed doctor as treatment for an accident or illness; -Dental care - if your sound and natural teeth are injured in an accident, you will receive full reimbursement for temporary treatment by a dentist during the Period of Coverage outside your place of domicile. If you are in pain, not due to an accident, you are eligible for maximum benefit of USD 500, for treatment to relieve pain only, wisdom teeth included;-Reasonable local travel expenses to a doctors office or hospital during the Period of Coverage but only when that travel was necessary to obtain necessary medical or dental treatment or care relating to an illness or accident which occurs during the Period of Coverage and which is covered by this insurance policy;-If you are unable to return home at the end of the duty abroad period because of a serious illness or accident that is covered and not excluded by this insurance policy, and if you have medical authorization from a licensed physician, you will be reimbursed for extra reasonable and necessary expenses you incur for food and lodging for up to 60 days from the first visit to a physician, or until you are medically released to travel, whichever comes first.B. Emergency Home EvacuationIf you are seriously ill or injured from an illness or accident that is covered and not excluded by this insurance policy, or if you are unable to return home on the scheduled flight due to an illness or accident that is covered and not excluded by this policy, you will be reimbursed up to USD 50,000 for the additional costs incurred if your doctor recommends that you return home earlier or later due to said illness or injury. The Claims Agent must also approve the necessity to return home and the mode of transportation.C. Family Member ReimbursementIf you have a life-threatening condition or if you decease relating to a condition that is covered and not excluded by this insurance policy, you or your estate will be reimbursed up to USD 10,000 for one round-trip ticket and accommodation for one Family Member from your home country to visit you. Accommodations will be paid for up to 60 days from the time of your first visit to the doctor or hospital, or until your doctor certifies that your condition is stable and the danger of death or deterioration is not imminent, whichever comes first. The cost for accommodation will be reimbursed at the average hotel rate for the city in which you are located. Also, a meal allowance of up to USD 15 per day will be paid.D. Home RepatriationIf you die and your death was caused by an accident or illness that is covered and not excluded by this insurance policy, your estate or your heirs will be reimbursed up to a maximum of USD 10,000 for the expenses associated with your body being sent home, or if your family so desires, the Insurance Company will pay up to a maximum amount of USD 10,000 for local burial.E. Accidental DeathIn the event of your death, as a result of an accident which occurs during the Period of Coverage and which is covered under the Medical Expenses section of this policy, the Insurance Company will pay your estate a lump sum benefit of USD 10,000.F. Accidental DisabilityIf you sustain a permanent disability as a result of an accident while an insured under this policy, and which is covered under the Medical Expenses section of this policy, you may receive up to USD 25,000 from the Insurance Company (regardless of the number of injuries you incur from the same accident), depending on the extent of your permanent disability. A permanent disability is the future permanent loss or reduction of bodily function due to an accident covered under this insurance policy.The degree of your permanent disability is determined by disability tables as per Continental Scale (Form K3 (cs) (France) (13.12.56), recognized by Lloyds of London. The amount of your benefit will be determined solely on the extent of your injury and not by your ability or inability to work.In order for you to receive benefits due to a permanent disability, an accident must lead to a permanent disability within three years from the date of the accident. No payment for any permanent disability benefit shall be due or payable until at least 12 months have passed from the date of the accident. After the first 12 months and as soon as the definite degree of permanent disability is determined, payment pursuant to this policy will be paid with a lump sum representing such a portion of the sum insured as corresponds to the degree of permanent disability.If the degree of your permanent disability can be determined and your medical treatment for that permanent disability is completely finished before 12 months have passed from the accident, the right to indemnity arises as soon as your degree of permanent disability has been determined. The determination of your definite degree of permanent disability must, if possible, be done within three years of the accident, but can be postponed as long as, according to medical experience or considering the possibilities of rehabilitation, it is necessary.If the degree of your permanent disability cannot be determined within three years of the accident, you will receive six percent (6%) of the anticipated benefit on a quarterly basis, until the degree of your permanent d