CAIB 1 Chapter 8 Slides PDF

 Important Terms So Far Students take two minutes to write down one important term that has been discussed so far in the course, in the chat window. Remember the Forgetting Curve! Insurance Graphic Organizer  Why is there a need for E&O Insurance? How would you advise someone wh...

 Important Terms So Far Students take two minutes to write down one important term that has been discussed so far in the course, in the chat window. Remember the Forgetting Curve! Insurance Graphic Organizer  Why is there a need for E&O Insurance? How would you advise someone who is thinking of not getting E&O insurance? How can it affect a client and how can it affect a brokerage? The following slides contain the information needed to answer this question.  Need for Errors/Omissions Insurance Most brokers can’t withstand a large E&O claim (financial consequences) Brokers can buy E&O Insurance to insure legal liability for financial loss caused by negligence to clients/insurers ○ Some broker associations provide coverage (national program) ○ Principles of brokerage buy coverage THEN All brokers working for firm are insured ○ Similar to malpractice claims (doctors/surgeons/other)  Need for Errors/Omissions Insurance Cont’d 1) Coverages Insurance pays for what broker is legally liable because of E&O (subject to limit) Coverage is for claims due to negligent act, error, omission of insured OR ○ Person whose actions insured is legally liable for Coverage: for claims from conduct of business of insured (as insurance broker) ○ Most policies: claims made basis (only for claims during policy period) Defence cost coverage (may be a lot) = included ○ Sometimes defence costs paid as part of (not in addition to) policy limit  Need for Errors/Omissions Insurance Cont’d 2) Exclusions Covers honest E&O ○ Not dishonest/fraudulent/criminal/malicious act ○ Not failure to collect/pay/return premiums 3) Deductible Ensures that brokers are trying to prevent/control E&O losses (big deductible) ○ Deductible based on management/what they can financially accommodate Brokers: if there’s a chance of a claim against brokerage/individual broker, let insurer know ASAP ○ If issue isn’t addressed, insurer may deny coverage because they were prevented  Why is there a need for E&O Insurance? How would you advise someone who is thinking of not getting E&O insurance? How can it affect a client and how can it affect a brokerage? Answer  Chapter 8 - Travel Insurance Section 1 - Provincial and Private Medical Plans The Need for Travel Insurance Provincial Medical Plans in Canada ○ Provincial/territorial health plans: Reciprocal agreements but may have varying conditions ○ Reciprocal agreements might reimburse province that provided medical costs (injury/illness), BUT many plans do not cover: Ambulance charges Family visitation costs Repatriation costs Return of vehicle costs Regardless of location of injury/accident costs ○ Provincial/territorial health plans won’t respond when resident is away for a time  Section 1 - Provincial and Private Medical Plans The Need for Travel Insurance Provincial Plans Outside Canada ○ When accident/illness is outside of Canada: Provincial/territorial health plans only pay a “prescribed fee,” regardless of: Fees charged Other costs ○ If someone is injured in another country: There may be a short between what is charged in location and what the provincial/territorial health plans provide  The Need for Travel Insurance Who Can Purchase Travel Insurance Travel Policies: parties traveling away from permanent residence in Canada for ○ Business or pleasure Policies purchased for Individuals OR individual + family members Policies vary: ○ Terms of coverage ○ Age ○ Health ○ What client needs Policies can cover: ○ Individual trips from 2 weeks - 180 days ○ Multiple trips 30-45 days throughout a year (from date policy is issued)  Section 1 - Provincial and Private Medical Plans Cont’d The Need for Travel Insurance No Standard Policy Major Sections of the Policy Overview ○ Insuring Agreement ○ Term of Insurance ○ Definitions ○ Policy Coverage & Limitations ○ Add’l Exclusions & Limitations  Major Sections of the Policy Insuring Agreement Company agrees to insure Named Applicant/spouse/dependent children Policy insures against ○ Injury/sickness contracted during trips outside Province/Territory of residence during policy ○ Loss (expenses) while insurance is in force due to injury/sickness to extent that is limited/provided Insured must be ○ Permanent resident of canada ○ Covered by provincial/territorial health care plan  Major Sections of the Policy Cont’d Insuring Agreement: Insuring agreement indemnifies the insured (on policy) whether this is for an individual or includes family members Coverage applies outside province/territory of residents Some policies respond to (eligible) expenses when “insured” is more than 500kms from home Advantages ○ Ambulance charges, family visitation, repatriation expenses, vehicle return  Major Sections of the Policy Cont’d Terms of Insurance: Coverage Conditions ○ Coverage commences when Insured leaves province/territory of residence following the application date/effective date of coverage Coverage terminates (whichever is sooner) ○ a) Other than annual plans/policies: Return date on application No later than days in application after departure date (application) ○ b) Annual plans: The date insured returns to province/territory of residence 30 days after departure date  Major Sections of the Policy Cont’d Terms of Insurance: Term of insurance: start/end of coverage ○ Coverage starts when insured has left province/territory AND departure date is after effective date on application Purpose: make sure policy is bought before departure ○ (not after trip has started) Annual policy ceases when… ○ a) Client returns to province ○ b) Client returns to territory of residence after each trip within policy period ○ Some insurers limit max days in ANY trip to 30  Major Sections of the Policy Cont’d Terms of Service: Single trip ceases when... a) Insured has returned to province/territory of residence b) Not later than # of days after departure date policy was purchased for Ex. Insured buys policy for 60-day trip. Client’s departure date is delayed 2 weeks. Coverage ends 60 days from original stated departure date Client should contact broker if there is a travel delay to adjust insurance  Create a “What” question Students take two minutes to create a “What” question based on the concepts covered so far, in the chat window. No question is too simple! Remember the Forgetting Curve!  Definitions DEFN Spouse Legal spouse of Insured Applicant residing in Canada No legal separation No individual of opposite sex residing with Insured Applicant for MIN one year Only legal spouse that client resides with DEFN of Legal Spouse Varies - recent court decisions have amended def’n A person client is living with (conjugal relationship) no less than 12 consecutive months - Resides with applicant Many couples live together for less than 12 consecutive months but still go on vacation together  Definitions DEFN Dependent Child/Children Any natural/stepchild/legally adopted child/legal ward of Insured Applicant Who (resides in Canada) is: a) 20 years and under, unmarried, insured applicant is paying for full support/maintenance, residing with Insured Applicant b) Less than 26 years, unmarried, Insured Applicant is paying for full support/maintenance due to full-time attendance at Canadian accredited institute/college/university c) Insured Applicant is paying for full support/maintenance due to mental/physical infirmity Also includes Child of Insured Applicant’s spouse, in  Definitions DEFN Dependent Natural child/stepchild/legally adopted child/legal wards of Insured Applicant Insured if ONE of these conditions are met: a) Child is single, under 20 years (or 21), living with/dependent for full support/ maintenance (must have all of the above conditions) b) Child is single, under 26 years, dependent for full support/maintenance (attending Canadian accredited institute/college/university) ○ This isn’t always provided by insurers: child needs own travel insurance c) Child must receive full support/maintenance from client due to mental/physical infirmity (insured regardless of age)  Definitions DEFN Extended Family Dependent child, spouse, parent, guardian, brother, sister, grandparent of Insured Applicant/Spouse Very important under Trip Cancellation coverage IDs medical conditions may affect cancellation of trip AND when client gets compensated by insurer  Definitions DEFN Accident Unforeseen/unintended occurrence from external/violent/sudden/fortuitous causes outside of Insured’s control Policy responds when events are sudden/violent beyond client’s control ○ Clients participate in dangerous activities on vacation that they wouldn’t normally do at home: Ex. bungee jumping/skydiving ○ Bungee jumping is within client’s control: policy may not respond due to participating in these high risk activities and accident occurs DEFN Injury Bodily injury (accident) while insured is insured  Definitions DEFN Hospital Institution operating for care/treatment of sick/injured people with organized facilities able to diagnose, provide major surgery, with 24 hour nursing service Doesn’t include: convalescent/nursing home/home for aged/health spa/facility for treatment of alcoholism/drug addiction/mental illness Coverage responds to emergency medical health care NOT ○ Long-term health care/clinics/facilities Ex. Client not compensated for cost of checking into detoxification center/nursing home  Definitions DEFN Supervised Condition Diagnosed medical condition/illness/injury needing diagnostic testing/investigation/referral (not yet complete) OR ○ Results aren’t known that needs constant/consistent treatment/is controlled with medication (without change) for: a) Min 3 months before date of departure IF person is UNDER 60 years b) Min 6 months before date of departure IF person OVER 60+ years c) If have taken cardiac condition medication/related condition within last 6 months  Definitions DEFN Supervised Condition Condition also under “pre-existing condition exclusion.” No coverage: ○ Medical condition isn’t/hasn’t been under control for 3 months before departure date Qualification: ○ Due to medical advances, some clients who weren’t able to qualify before now may be able to qualify Insurers don’t want to cover medical conditions that would certainly result in claim(s)  Definitions DEFN Traveling Companion Persons sharing SAME travel arrangements (with Insured) Reimbursement of specific unrecoverable expenses ○ May be due to client’s traveling companion after trip interruption after insured accident/sickness Some insurers: reimburse expenses up to 4 traveling companions (not family) ○ No limits on dependent family members DEFN Professional Sport Any sport participant is receiving remuneration (Sponsorship, endorsements, other monetary compensation) Travel insurance discussed here are for non-professional athletics  Definitions DEFN Whole or Sound Teeth Appears to be whole ○ Some part is natural (can’t be artificial) ○ Capped/crowned teeth are whole/sound ○ Teeth that have had root canal are sound Ex. If clients receives a hit to the jaw, damaging false teeth ○ Cost to repair plates NOT covered ○ If NATURAL teeth, then WOULD be covered DEFN Trip Termination Date Date under “Term of Insurance.”  Policy Coverage and Limitations Max Payment Max aggregate amount payable by Insurer (to Insured) = CDN $1,000,000 Limit in CDN dollars Limits vary: client’s wishes, insurer underwriting requirements Some insurers: limit per person ○ Higher aggregate limit for ALL insured persons  Policy Coverage and Limitations Cont’d 1. Emergency Hospital Insurance Company reimburses Insured Applicant ○ FOR actual/reasonable/necessary emergency hospital expenses ○ Up to/including semi-private accommodations (confinement) Insurer pays expenses due to Injury/sickness (of insured) Ends in confinement (inpatient) If Insured is confined before/remains confined to hospital on/after Trip Terminate Date and prevented from returning to residence location: ○ Insurance continues for period of confinement If insured is discharged from hospital on/after Trip Terminate Date: ○ coverage extends for MAX 72 hours  Policy Coverage and Limitations Cont’d 1. Emergency Hospital Insurance Reimburses NECESSARY emergency medical/health care expenses after insured events have confined client to hospital ○ Expenses: surgery, operating room, semi-private room, nursing care, laboratory tests, x-rays, any other necessary medical inpatient services that physician may order Coverage continues confinement exceeds normal terminate date If client hospitalized→ discharged after normal termination date ○ Covered for 72 hours after discharge Continued coverage during travel back to home province/territory (possible another accident could occur when traveling home)  Policy Coverage and Limitations Cont’d 2. Emergency medical Insurance Injury/sickness of Insured needs emergency treatment for: ○ a) Outpatient emergency room charges ○ b) Treatment (legally qualified physician/surgeon_ ○ c) Employment of registered nurse (not a relative) by recommendation of a physician to MAX $5,000 ○ d) Renting wheelchair/cane/cast/brace/splint/walke r/crutches ○ e) Physiotherapist/chiropractor treatment: Max 3 treatments any one trip when recommended by physician (written)  Policy Coverage and Limitations Cont’d 2. Emergency Medical Insurance If injury/sickness of Insured needs emergency treatment for: Cont’d ○ f) X-Rays/laboratory exams necessary for diagnostic purposes ○ g) Oxygen ○ h) Whole blood/blood plasma/blood products ○ i) Service of ambulance (licensed and local) Insurer reimburses Insured Applicant for: ○ Actual/reasonable/necessary expenses during insurance period for treatment/services  Policy Coverage and Limitations Cont’d 2. Emergency medical Insurance Summary Pay for emergency medical expenses on outpatients Some insurers limit max rental payable (d) to cost of equipment purchase Some insurers limit amount payable (e) to $300 or $500 per profession AND ○ Includes chiropodist, podiatrist, osteopath Other insurers don’t see a difference between (e) vs. other medical services that physician orders Client purchasing policy covering over 500kms also has ○ Ambulance coverage when provincial/territorial health plans don’t cover  Policy Coverage and Limitations Cont’d 3) Emergency Dental Expense Reimbursement Insured suffering injury to whole/sound teeth from accident ○ Company reimburses Insured Applicant for (necessary) emergency treatment while outside province/territory of residence ○ Up to $2,500/accident Summary ○ Limit varies ○ Many insurers include (lower limit) emergency treatment (dental pain relief) ○ If insured is traveling and needs emergency treatment (toothache) Policies covering emergency treatment = reimburse insured  Policy Coverage and Limitations Cont’d 4) Emergency Prescription Drug Reimbursement If injury/sickness of insured requires drugs/medicines on emergency basis ○ Must be prescribed by physician/surgeon ○ Company reimburses Insured Applicant for drugs/medicine expenses ○ Exclusions: Oral contraceptives, patent drugs, vitamins, repeat prescriptions, maintenance/chronic care drugs  Policy Coverage and Limitations Cont’d 4) Emergency Prescription Drug Reimbursement Summary ○ Covers prescriptions prescribed by doctor for injury/sickness treatment during policy ○ No Coverage: Non-prescription, “over the counter” meds, OR Normal, ongoing prescriptions required by client ○ Even if physician has suggested the “over the counter” meds, policy still does not cover  Policy Coverage and Limitations Cont’d 5) Emergency Air Ambulance Evacuation Company pays all emergency air ambulance transport expenses to province/territory of residence OR ○ To nearest (adequate) medical facility ○ Includes inter-hospital transfer Inadequate facilities: cannot treat/stabilize insured’s condition from injury/sickness starting during trip ○ Legally qualified physician must certify severity of injury/sickness and if emergency evacuation is necessary ○ Evacuation arrangements Must be verified/approved by company BEFORE evacuation  Policy Coverage and Limitations Cont’d 5) Emergency Air Ambulance Evacuation Summary Insurer pays for emergency air ambulance services ○ Move client to medical facility able to treat client Option to transport client (air ambulance) back to Canada for treatment as long as physician approves Ex. Client suffers heart attack, is stabilized, able to be transported back to Canada for surgery, company WOULD PAY for transportation costs ○ Heart surgery may be less in Canada than where injury/illness happened  Emergency Air Transport/Unexpected If injury/sicknessReturn requires emergency air transport expenses, company WILL PAY: 1) Cost (up to $10k per insured) to return home (economy class) if medical attention is needed ○ Can get first class at company’s discretion (required for comfort) ○ Includes cost of add’l seats (accommodate stretcher), return airfare for medical attendant/cost of one-way airfare for spouse/dependent child/children to return home 2) Cost of return (economy) airfare, hotel accommodation, to MAX $1,500/insured ○ For ONE spouse OR dependent child to attend insured hospitalized outside residence province ○ More than 7 days  Emergency Air Transport/Unexpected Return Cont’d If injury/sickness requires emergency air transport expenses, company WILL PAY: 3) Cost of max $2k per insured applicant to return insured (under 19 years) home WHEN accompanying parent is hospitalized/cannot attend child/children ○ All air transport expenses is arranged/approved by company before spending money  Emergency Air Transport/Unexpected Return Cont’d Summary Expenses incurred when client is injured, has to return home OR is injured while traveling and family goes to bedside OR child must return home after injury to parent ○ Ex. (1) Client suffers injury (broken leg), then insurer pays up to $10,000 for return airfare (client and family) and if needed, medical attendant ○ Ex. (b) Client injured when traveling alone, is hospitalized more than 7 days, company pays up to $1,500 for spouse or child to attend client ○ Ex. (c) Client hospitalized, company pays up to $2,000 to return children home, limits vary but can be $5,000 under (b) and (c) ○ Some policies let family member/friend attend client (b), and need hospital stay of  Policy Coverage and Limitations Cont’d Trip Interruption Expenses Insurer covers Insured Applicant for ○ Non-refundable pre-paid travel costs if Insured left province/territory of residence Trip is interrupted by sickness/injury ○ If trip is interrupted, but insured can rejoin tour/group, then company reimburses for travel to rejoin tour/group ○ Benefits subject to overall MAX $1,500  Policy Coverage and Limitations Cont’d Trip Interruption Expenses Summary ○ Client’s trip is interrupted/shortened from accident/injury ○ Insurer pays non-refundable costs, client has paid up to max $1,500 ○ Ex. Client injured in 21-day bus tour, missed 5 days of tour, company pays for client to rejoin tour, OR amount unrecoverable from Tour Company Limits vary: $2,500 - $5,000 (MAX)  Policy Coverage and Limitations Cont’d Trip Cancellation for Medical Reasons Insurer reimburses for non-refundable pre-paid travel costs, before departure, when insured cancels trip BECAUSE OF: ○ a) Death (insured/extended family member) w/in 21 days of departure date ○ b) Injury/sickness of insured stops insured from COMMENCING trip Physician verifies (written): has advised cancellation of Injury/illness NOT due to pre-existing condition Insured or extended family member ○ c) Unexpected subpoena (witness in court) OR jury duty during trip  Policy Coverage and Limitations Cont’d Trip Cancellation for medical Reasons Summary Insurer reimburses client for nonrefundable travel costs ○ Injury/illness/death some family members/client called to jury duty/witness in court proceeding Client not reimbursed if injury/sickness is from pre-existing condition/knew about jury duty/subpoena, before booking trip Some plans: ○ Cover hotel expenses of travel companion/business associate insured is traveling with  Policy Coverage and Limitations Cont’d Hotel Convalescence /Extended Stay for Medical Reasons Insurer reimburses hotel accommodation when insured is discharged from hospital and physician prohibits travel - overall MAX of $1,000/insured Summary Pay add’l costs after hospital discharge if have to stay in hotel after normal return day of trip ○ Ex. Client discharged, physician prohibits return home (x-days), costs to stay at hotel (not covered by tour package) covered by policy up to limit Limits vary - some max daily limit Policy extends 72 hours after physician permission to travel home from hotel  Policy Coverage and Limitations Cont’d Expenses for Return of Auto Insurer reimburses return of auto owned by insured TO home of insured when insured or travel companion cannot drive auto home due to insured’s injury/sickness ○ Overall max $1,000 Summary Client/traveling companion unable to drive vehicle home after event ○ Insurer pays to limit (varies) to have vehicle returned May involve transport by rail/other, pay towards cost of someone driving it back  Policy Coverage and Limitations Cont’d Repatriation Benefit, Burial/Cremation Death of insured (injury/sickness): insurer pays cost of homeward transport of deceased/cremated remains to original point of departure ○ Includes preparation/standard transport container costs ○ Up to $3,000 OR up to $1,500/insured for cremation/burial at place of death ○ Decision (burial or cremation or returned to location of origin made by close relative Summary Limits vary Purpose: ○ Pay to return client’s remains to home (burial) OR to burial at place of death  Policy Coverage and Limitations Cont’d ID of Deceased Death (injury/sickness), insurer pays cost of reasonable travel/hotel accommodation/meal expenses for ONE person to ID remains Summary If client traveling alone dies, insurer pays cost (if needed) for someone (appointed by family) to ID deceased/make arrangements for return of remains Some restrictive policies return deceased to his/her country of origin ○ If insured dies in Hawaii, home is in Halifax, limited agreement may return deceased to Vancouver and family has to contribute to return to Halifax  Policy Coverage and Limitations Cont’d Involuntary Extension Insurer extends coverage (automatic) for (up to) 72 hours without add’l premium if return is delayed beyond scheduled return date to home province/territory DUE TO: ○ a) Delay in transport (scheduled carrier) ○ b) Inclement weather/vehicle mechanical problems (if driving/had started return trip before delay)  Policy Coverage and Limitations Cont’d Summary Automatic extension: return is delayed because scheduled carrier has delayed departure time Otherwise client doesn’t have accident insurance ○ Ex. Client scheduled fly home on date on policy, but airline postponed flight so coverage extends for 72 hours without notification/add’l premium If traveling by car, after starting trip mechanical problems arose that delayed trip, insurer grants automatic extension ○ If further delay, contact broker  Additional Exclusions/Limitations Travel insurance covers sudden/unforeseeable circumstance losses DOESN’T pay/indemnify expenses in/directly OR contributed to as result of: ○ a) Pregnancy/miscarriage/childbirth/compl ications within 8 weeks of (expected) termination of pregnancy/if pregnancy is considered high risk ○ b) Un/declared war/act ○ c) Suicide (or attempt) OR intentionally self-inflicted injury ○ d) Commission/attempt to commit criminal act (by insured) ○ e) Expenses due to alcohol related illness/disease OR abuse of medication/drugs/alcohol/toxic substances/non-compliance with  Additional Exclusions/Limitations Cont’d Travel insurance covers sudden/unforeseeable circumstance losses DOESN’T pay/indemnify expenses in/directly OR contributed to as result of: f) Mental/emotional disorders (unless hospitalized) g) Participating in professional sports h) Participating in hazardous activities ○ Ex. Bodily contact sports,stunt flying, hang gliding, parasailing, scuba diving --unless person has SCUBA designation from Canadian certified school, etc. i) Expenses in/directly due to acquired immune deficiency syndrome, acquired immune deficiency syndrome complex OR other (terminal) conditions j) Covered by provincial worker’s compensation plan (or similar) unless stated  Additional Exclusions/Limitations Cont’d Insurance DOESN’T pay/indemnify expenses incurred in/directly or contributed to as result of: l) Diagnosed medical condition/illness/injury needing diagnostic testing/investigation/referral (not complete) OR results still unknown needing constant/consistent treatment AND is controlled with medication without change FOR: ○ i) Min 3 months after date left province of residence UNDER 60 years ○ ii) Min 6 months after date left province of residence OVER 60 years ○ iii) Insured takes medication for cardiac condition/related any time in 6 months before date left province of residence Exclusion DOES NOT APPLY to insured...  Additional Exclusions/Limitations Cont’d Insurance DOESN’T pay/indemnify expenses incurred in/directly or contributed to as result of: m) Not for ASAP relief acute pain/suffering could be delayed until return home n) Insured chooses to have procedure done/performed outside province of residence after emergency treatment for/diagnoses of medical condition that medical evidence would not prevent return home before treatment/surgery  Additional Exclusions/Limitations Cont’d Insurance DOESN’T pay/indemnify expenses incurred in/directly or contributed to as result of: o) Insurer WON’T cover experimental medical treatment/drug/provided by a party at no cost to insured OR already included in trip’s cost p) Parties attending institute of learning OR employed, outside province of residence ISN’T insured q) Elective (non-emergency) treatment/surgery r) Expenses before effective date of policy s) Travel booked/started against medical advice  Additional Exclusions/Limitations Cont’d Travel insurance covers sudden/unforeseeable circumstance losses DOESN’T pay/indemnify expenses in/directly OR contributed to as result of: Summary: Expenses for hazardous activities isn’t recoverable Excludes substance abuse treatment Some insurers include “injury and death” for alcohol abuse Some insurers exclude expenses related to driving while impaired Client must mitigate loss If client could have returned to Canada after first emergency/stabilization but chose not to, insured NOT liable for costs after stabilization  Termination of Insurance by an Insured Insurance (for each insured) terminates immediately on whichever is earlier: a) On date policy is terminated (insurance in force until end of period premium is paid - taking into account terms/provisions) b) On date broker receives (written) cancellation notice from Insured (no premium refund) c) Insurance (for spouse/dependent child/children) terminates on date insurance terminates OR date spouse/dependent child ceases to qualify (according to definitions) WHICHEVER IS FIRST  Coordination of Benefits Payable Classified as supplemental benefits Covers: ○ Expenses not covered under other policies If insured has other coverage with similar benefits: ○ Will be coordinated with other policies ○ Canadian Life and Health Insurance Association (CLHIA) guidelines  Coordination of Benefits Payable Cont’d Summary Travel policies = classified as “excess” over other coverages that client may have Other plans: ○ Other individual/group plans ○ provincial/territorial health plans ○ Worker’s Compensation ○ Credit card coverage ○ Private auto insurance Insurers coordinate payment of claims with other insurance plans so total paid isn’t over100%  Subrogation Agreement Insurer has right To subrogate against 3rd party Of recovery against person/organization if payment is made under policy  What To Do in the Event of an Emergency Before medical services/advice, call The Wonderful Insurance Company Of Canada If possible Some insurers include “or designated affiliate” Operator directs you to facility nearby/makes sure treatment is covered If don’t contact company, you may get inappropriate/unnecessary medical treatment that isn’t covered Summary Client should contact insurer before seeking medical treatment Varying levels of healthcare around the world  Limitations Confinement/emergency surgery: Insurer must be notified no later than 48 hours from hospitalization/emergency surgery No notification = limited coverage (MAX $10,000 of ALL expenses) Summary Limits liability if client (or rep) doesn’t contact insurer within 48 hours of hospitalization. ○ No contact, insurer only liable for amount on policy  How to File a Claim If you pay expenses, you must get original receipts/forward them to Wonderful Insurance Company of Canada with completed claim form ○ Forms at company’s claims department If a claim, must document evidence of trip duration: ○ Transport ticket/official stamp at customs office is required Wonderful Company co-ordinates claims submission to provincial medical plan/extended health care insurer (if you have it) for you  How to File a Claim Cont’d Wonderful company (or agents) aren’t responsible for availability/quality/results of medical treatment OR if insured fails to get medical treatment Contacting Wonderful Company ○ Given name, policy number ○ Call 24-hour toll free for help ○ 1-800-555-5555  How to File a Claim Cont’d Summary Insurers attempt to coordinate payments directly with medical facility/others Insurers may offer claims assistance through independent managed care specialist Claims Admin: ○ Takes lead on medical solution ○ Directs/authorizes hospitalization ○ May contact family/personal doctor for add’l consultation  Statutory Conditions Policy subject to statutory conditions of Insurance Act that respects accident/sickness policies Take provisions into account Statutory Conditions apply to policies similar to property/auto insurance Insurer must give ONLY 10 days registration of cancellation Summary Insurers constantly changing/enhancing policy wordings/adding benefits Ex. Some insurers offer Accidental Death and Dismembership coverage AND various non-medical coverage/assistance for out of pocket expenses, lost baggage, lost tickets, lost passports, referral to legal counsel, trip cancellation, babysitting listing services  Three Big Things Students have three minutes to write down three of the biggest or most important concepts we have gone over so far in class, in the chat window. Remember the Forgetting Curve!