Term
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Definition
Generally a disability is a physical or mental inability to work. People can be disabled due to:
Accidents & Sickness |
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Term
| Indicate who would purchase an individual Accident & Sickness Insurance policy. |
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Definition
People who are good candidates include:
* Self-employed persons
* People who do not have a group plan at their place of work
* High income employees
* People seeking better coverage terms than those provided through their own group plan |
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Term
| Identify three work-related benefits provided by Workers Compensation plans. |
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Definition
1. Any necessary health care costs
2. Any necessary medical and vocational rehabilitation programs
3. Replacement for lost earnings for time missed from work
4. A death benefit |
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Term
| Define Elimination Period |
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Definition
| This is the period of self-insurance between the onset of the disability and the commencement of disability benefits. In general, the longer the elimination period the lower the premium. |
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Term
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Definition
| This is the period for which benefits are payable. They can range from one year, two years, five years, ten years, or "to age 65". |
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Term
| Identify three types of information about the applicant which are important in determining the premium to be charged. |
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Definition
1. Type of policy
2. Applicant's Personal Information
3. Type of benefits requested |
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Term
| Identify who has insurable interest under an individual contract of Accident & Sickness insurance. |
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Definition
A person has an insurable interest in his or her own life and well-being, including that of:
- Child or grandchild
- Spouse
- Employee
- Any person in whom they have a pecuniary interest
- Any person upon whom they depend for support or education |
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Term
| What is the effect on coverage when such interest is not present? |
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Definition
| The contract is void if the applicant has no insurable interest at the time when the contract would otherwise take effect. |
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Term
| Summarize the "incontestability" provision. |
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Definition
Statements made on the application form a part of the policy and are incontestable after two years except:
i) Fraudulent statements - the insurer can challenge an insured that deliberately withheld information relating to previous illness, or disease, at any time. In such case, the insurer would likely opt to void the contract.
ii) Misstatement of age - When the age of the insured has been misstated, the benefits or premium will be adjusted to reflect the true age. |
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Term
| Indicate the term(s) of travel accident policies. |
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Definition
Travel accident policies can be purchased for a:
1. Single Trip - Single trip policies cover only one specific trip lasting no longer than 180 days.
2. Annual basis - An annual policy can be purchased covering an unlimited number of trips lasting for up to 30, 60, 90 or 180 days per trip depending on the option selected by the insured. |
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Term
| Indicate the factors used to rate travel accident policies. |
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Definition
The premium charged will depend upon many factors including, but not limited to:
* whether it is an individual or family plan.
* single or annual policy
* the number of trips
* the duration of the trip(s)
* area of travel
* policy limits
* age & health of the individuals |
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Term
| Indicate who would qualify as a dependent. |
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Definition
| Children are considered dependent if they are under the age of 20 (26 if attending an accredited educational facility), unmarried, residing with and receiving full support from the applicant because of mental or physical infirmity. |
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Term
| Summarize the pre-existing condition provision. |
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Definition
Coverage does not automatically extend to hospitalization or medical treatment required for any illness or injury that existed prior to the commencement of travel.
**Some policies will respond if the condition had been under control for a period of time either three or six months depending on the condition. |
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Term
| Sickness is the leading cause of disabilities. TRUE or FALSE |
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Definition
| TRUE - As they become older, the number of people disabled due to sickness far exceeds those disabled due to accident. |
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Term
| Role of workers compensation plans re: accident & sickness claims. |
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Definition
| To provide medical treatment and salary protection for employees in the case of a work-related injury or occupational disease. |
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Term
| Benefits provided under provincial workers compensation plans. |
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Definition
| Generally, provincial legislation requires that employers in certain industries, participate in the workers compensation plan. All premiums to support the plan are payable by employers only and will vary according to the degree of occupational risk. |
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Term
| Individual Accident & Sickness Insurance |
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Definition
| Individuals can purchase their own Accident & Sickness Insurance contracts. Good candidates would be self-employed persons, people that do not have a group plan at their place of work, high income employees, people seeking better coverage terms than those provided in their own group plan. |
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Term
| Most common type of policy. |
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Definition
| The Disability Income policy is the most common individual Accident & Sickness Insurance policies. It is specifically designed to provide a monthly income to the insured during a period of disability that is caused by sickness or accident. |
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Term
| Own Occupation vs. Any Occupation coverage |
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Definition
1. Own Occupation Coverage: treat claimants as disabled once their condition prevents them from carrying out the duties associated with the role they had immediately prior to the onset of their claim. So, even if they're capable of working in another position, they'll be able to file a successful claim as long as their doctor confirms you can no longer do the tasks associated with your previous occupation.
2. Any Occupation Coverage: In these policies, there is no benefit payable if the insured is able to engage in any occupation for which they are reasonably fitted by education, training, experience or income. |
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Term
| Characteristics of Individual Accident & Sickness Insurance contracts. |
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Definition
1. Application Forms Part of Contract
2. Insurable Interest Required
3. Incontestability
4. Unpaid Premiums |
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Term
Group Insurance
The two types of disability coverages available. |
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Definition
1. Weekly Indemnity - short-term coverage only and payments are typically made for 13, 26, or 52 weeks.
. Long Term Disability - Eligibility for LTD benefits starts at the end of the Weekly Indemnity benefit period and could continue as long as required, often up to age 65. If insured is still disabled and still qualifies under the definition of the policy.
2. Group Insurance |
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Term
Group Insurance
Optional coverages |
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Definition
i) Major Medical (Extended Health Care)
- prescription drugs, difference between standard ward care & semi-private or private room hospital accommodation, special duty nursing costs, local ambulance costs, Prosthesis limbs or implants, vision care, paramedical services, employee counselling
ii) Dental Plan
iii) Accidental Death & Dismemberment |
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Term
Travel Insurance
Terms of Travel Accidental policies |
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Definition
| Most policies almost always cover both accidents and illnesses. Many policies do not define accident or illness, but instead define and cover expenses for emergencies. Emergency can be defined as a sudden and unforeseen occurrence of a medical condition that begins during the period of insurance, and requires immediate treatment. |
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