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Fundamentals of Insurance > Chapter 11: Accident & Sickness and Travel Insurance > Flashcards

Chapter 11: Accident & Sickness and Travel Insurance Flashcards

1
Q

3 work-related benefits provided by Workers Compensation plans

A
  1. health care costs
  2. medical & vocational rehab programs
  3. lost earnings from missing work
  4. death benefit (paid to dependents)
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2
Q

2 types of accident & sickness contracts

A
  1. individual

2. group

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3
Q

Indicate who would purchase an individual Accident and Sickness insurance policy

A
  1. self-employed
  2. people without a group plan
  3. high income employees
  4. people seeking better coverage
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4
Q

Disability Income Policy is…

A

provides monthly income during period of disability

disability = inability to work in either any/regular/own occupation

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5
Q

What is the elimination period?

A

period of self-insurance (pay short disabilities by yourself instead of claiming it)

longer period = lower premium

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6
Q

What is the benefit period?

A

period where insurance is payable (range from 52 weeks to age 65)

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7
Q

3 factors that affect how premiums determined

A
  1. claim costs: policy type + personal info + types of benefits
  2. operating expense: insurer’s cost of doing business
  3. investment earnings: insurer will invest a portion of premiums, rate of return influences amount charged to clients (higher return = cheaper insurance)
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8
Q

Characteristics of individual accident & sickness insurance contracts

A
  1. application forms part of contract (any amendments must be signed off)
  2. insurable interest required: otherwise VOID
  3. incontestability: can’t change application after 2 years
  4. unpaid premium: insurer deducts unpaid premiums from payout
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9
Q

Group Insurance

A

bought by employer to cover employees & ends when employment ends

includes 2 types of disability income coverage: weekly indemnity and long term disability

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10
Q

Weekly indemnity is…

A

short term coverage and short benefits period (13-52 weeks)

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11
Q

Long term disability is…

A

starts after weekly indemnity, ends at age 65

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12
Q

Optional group insurance plans

A
  1. major medical (extended health care): pays expenses not covered in health care plans
  2. dental plan: routine maintenance + orthodontics
  3. accidental death and dismemberment: same as individual policy
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13
Q

The importance of accident & sickness insurance

A
  1. loss of health
  2. loss of future earnings
  3. loss of insurability
  4. loss of assets
  5. loss of prestige with associates
  6. loss of peace of mind
  7. loss of credit rating
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14
Q

Identify 3 types of information about the applicant which are important in determining the premium to be charged.

A
  1. age
  2. sex
  3. occupation
  4. personal history
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15
Q

Identify who has insurable interest under an individual contract of Accident and Sickness insurance. What is the effect on coverage when such interest is not present?

A

a person has insurable interest in their own life and…

  • immediate family
  • employee
  • any person they have financial interest in
  • anyone you depend on for support
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16
Q

Indicate the terms of travel accident policies

A
  1. single trip (less than 180 days)

2. annual (unlimited trips, 30-> 180 days each)

17
Q

Indicate the factors used to rate travel accident policies

A
  1. individual or family
  2. single or annual
  3. number of trips
  4. duration of the trip
  5. area of travel
  6. policy limits
  7. age and health of individuals
18
Q

Indicate who would qualify as a dependent under travel insurance policies

A

children under the age of 20 (26 if at college), unmarried, residing with and receiving full support

any age if disabled (mentally/physically)

19
Q

Travel insurance policies coverage…

A
  1. no standard policy
  2. coverage territory: stated on policy
  3. accident, illness, emergency: most policies cover accident, illness (some will list emergency expense)
  4. pre-existing condition: coverage isn’t automatic (might cover if under control for 3-6 months (ie. for heart condition)
  5. coverage generally available for all emergency costs
  6. incidental coverage (ie. trip interruption/cancellation)
  7. optional coverage (ie. accidental death, non-medical expenses such as lost baggage, lost tickets/passports, etc)
  8. all policies are subject to provincial statutory conditions
20
Q

Exclusions in travel policies…

A
  1. pregnancy related issues within 8 weeks of expected due date (ie. miscarriage/childbirth)
  2. war
  3. (attempted) suicide
  4. (attempted) criminal act
  5. alcohol or drug misuse/disease
  6. from hazardous activity (ie. professional sports)
  7. AIDS
  8. covered by Workers Compensation

Fundamentals of Insurance (13 decks)

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