AUTOMOBILE INSURANCE TOOLKIT Automobile Insurance Toolkit

Total Page:16

File Type:pdf, Size:1020Kb

AUTOMOBILE INSURANCE TOOLKIT Automobile Insurance Toolkit Florida Department of Financial Services AUTOMOBILE INSURANCE TOOLKIT Automobile Insurance Toolkit Insurance coverage is an integral part of a solid financial foundation. Insurance can help us recover financially after illness, accidents, natural disasters or even the death of a loved one. There are a wide variety of insurance products available and choosing the correct type and amount of coverage can be a challenge. This toolkit provides information to assist you with insuring your automobile and tips for settling an automobile insurance claim. TABLE OF CONTENTS Click a title or page number to navigate to a section. 01 Coverages & Minimum Requirements - 4 Coverage Descriptions - 5 Insurance Requirements for Special Cases - 8 02 Underwriting Guidelines - 11 Underwriting Factors That Cannot Affect Your Ability to Purchase Insurance - 11 Underwriting Factors That Affect Your Insurance Policy Premium - 12 Other Factors Affecting Your Premiums - 13 Shopping for Auto Insurance - 13 03 Automobile Claims - 14 Actions to Take Before and After an Auto Accident - 14 Disputing Claim Settlements - 16 04 Shopping for Coverage Checklist - 17 01 Coverages & Minimum Requirements In Florida, vehicle owners may be required to The second type of auto insurance is outlined in the purchase two types of auto insurance. Florida Financial Responsibility Law. It requires drivers The first type of auto insurance is outlined in the who have caused accidents involving bodily injury/death Florida Motor Vehicle No-Fault Law (s. 627.736, Florida or received certain citations, to purchase bodily injury Statutes). It requires every person who registers a liability (BI) coverage with minimum limits of $10,000 vehicle in Florida to provide proof they have personal per person and $20,000 per accident, referred to as injury protection (PIP) and property damage liability split limits. You may purchase a policy that covers both (PD), with minimum limits of $10,000 each. PIP covers types of insurance required with a single limit of at injuries you and certain others may incur in an auto least $30,000. Drivers convicted of driving under the accident, regardless of fault. PD covers your liability influence must purchase BI coverage in the amount of if you damage property belonging to someone else in an auto accident. Examples might include another $100,000/$300,000 and $50,000 in PD liability. person’s vehicle, a telephone pole or a building. The reason for the Florida Financial Responsibility Individuals who are in the State of Florida with their Law is to require owners or operators of motor vehicle for more than 90 days in the last 365 days vehicles to be financially responsible for damages must carry these minimum limits of coverage. It is and/or injuries they may cause to others in an auto important to note that the 90 days do not need to be accident. The failure to be financially responsible consecutive in order for the law to apply. Questions may result in the loss of driving privileges in Florida. about titling or registering your vehicle or further clarification on how Florida’s auto insurance laws apply Although there are other ways to prove financial to you should be directed to the Florida Department responsibility that are acceptable to the Florida of Highway Safety and Motor Vehicles. You may visit Department of Highway Safety and Motor Vehicles, them online at www.flhsmv.gov or call (850) 617-2000. our publication deals strictly with insurance. 4 | Automobile Insurance Toolkit Table of Contents When referring to BI limits of liability, the first number Coverage Descriptions represents the maximum amount of coverage you have Bodily Injury Liability (BI) for each individual injured in a given accident and the second number is the maximum amount of coverage This coverage protects you for injuries or death to available to all injured persons in that accident. someone else that you are legally liable for resulting from a motor vehicle accident. As the owner of a Let’s look at an example. vehicle, anytime an accident occurs involving your You cause an accident and there are two people insured vehicle (whether or not you are driving), the in the other vehicle. You chose to carry BI possibility exists that you may be held financially limits of $10,000 per person and $20,000 per responsible for any damages. This coverage not occurrence. Person “A” sustained $25,000 dollars only covers the actual loss incurred, it can also in injuries and Person “B” sustained $15,000 provide coverage for your defense if you are sued. in injuries. How will your policy respond? EXAMPLE Person “A” Person “B” Total Injuries: $25,000 $15,000 Their PIP Coverage: $10,000 $10,000 Your Responsibility: $15,000 $5,000 Payment from Insurer: $10,000 $5,000 Making a decision about the amount of coverage you should carry is a personal decision based on many factors. Discussing your coverage needs with a qualified insurance agent can help you better understand your options. It is important to remember that if an accident occurs, and the injuries sustained by another party are beyond the limits of your insurance policy and the injured party has a permanent injury, scarring, disfigurement or is killed, they or their beneficiary may pursue recovery from you through the court system. Property Damage Liability (PD) You may wonder why you need to purchase UM coverage if you have PIP and health insurance since in PD liability pays for damage to another person’s most cases, after your PIP coverage is exhausted, your property caused by you or someone else operating health insurance may pay some of your medical bills. your insured vehicle. Most often this coverage will Most health insurance policies include deductibles and be used to repair the other automobile(s) involved in copayments which are out of pocket expenses for you. an accident with your insured vehicle. It can also be Health insurance normally does not provide coverage used to pay for damage to street signs, mailboxes, for expenses you may incur if you or a covered family buildings or other property owned by another party. member must stay in a convalescent center. In some cases when an injury is severe, permanent, or requires a longer recovery time, it can be important for your Uninsured/Underinsured Motorist (UM) quality of life and financial health to have coverage This coverage is optional but provides very important that will continue to pay for lost wages. Replacement benefits to you and certain others who sustain injuries services may be required like lawn maintenance from an auto accident caused by an uninsured or or housekeeping. Due to your injuries, your home underinsured motorist. The coverage allows you to may require modifications like a wheelchair ramp collect amounts from your own insurance carrier that or your vehicle may require special equipment. you would have been able to collect from the at-fault When purchasing UM, you must make two decisions. party if they had insurance or sufficient insurance You must decide the limits you need and whether limits. It can provide additional medical expenses, lost or not you want stacked or non-stacked coverage. wages, pain and suffering and other expenses that All insurance companies are required to provide might arise when an injury occurs. Once coverage stacked UM with the same limits as your Bodily has been triggered, benefits will be paid directly Injury coverage. Some insurance companies offer the to the injured person, normally in a lump sum. option to purchase lower limits and/or non-stacked Table of Contents Automobile Insurance Toolkit | 5 coverage. Stacked UM coverage means that the limit there are many variables which ultimately determine will increase by the number of vehicles you own, how your policy will respond in a claim situation. regardless of whether or not the vehicles are insured on the same policy. In other words, if you have stacked The following describes situations UM limits of 50/100 and own three vehicles, your when coverage applies: actual coverage is multiplied times three or 150/300. 1. Injuries to named insured: If you elect non-stacked UM at 50/100, that is the maximum coverage available in an accident regardless a. If the accident occurs in Florida, while of how many vehicles you own. Another important occupying any defined motor vehicle or if coverage difference between the stacked and non- struck by a defined motor vehicle while not stacked form is how the policy will respond if you occupying any self-propelled vehicle. are injured by an uninsured/underinsured motorist in a vehicle you own, but do not have insured. In b. If the accident occurs outside of Florida, that case, only the stacked form would respond. while occupying the insured motor vehicle or a vehicle owned by a resident relative, if it is insured for PIP. Personal Injury Protection (PIP) You will often hear Florida referred to as a “No-Fault 2. Injuries to resident relatives of named insured: State.” This means that any time you are injured in a. Covered the same as the named insured. an auto accident you will file your injury claim with For accidents outside of Florida, the your own insurance company, regardless of who is named insured’s benefits apply to the at-fault. However, once an injured person pierces relative only when the relative is occupying the tort threshold, they may seek recovery for costs the named insured’s motor vehicle. not duplicated by PIP from the at-fault party. 3. Persons other than named insured and relatives: Section 627.737, Florida Statutes, states the threshold has been pierced when an injury from a car accident a. If the person is not an owner of a motor results in significant and permanent loss of important vehicle or entitled to benefits from another bodily function, permanent injury, significant or owner’s insurance company and if the accident permanent scarring, disfigurement or death.
Recommended publications
  • Auto –Accidents - What Is “No-Fault” Insurance?
    AUTO –ACCIDENTS - WHAT IS “NO-FAULT” INSURANCE? If you are injured in a car accident who pays your medical bills? Believe it or not, your medical insurance carrier does not have the primary responsibility to pay your medical bills for injuries sustained in an automobile accident - The applicable automobile insurance carrier does. But remember, if your injuries or above a certain threshold you can still sue the person who cause your injuries for money damages above what the applicable automobile insurance carrier provides. In New York State each automobile insurance policy must provide coverage known as Personal Injury Protection (“PIP”) and typically referred to a “No-Fault” insurance. Medical bills, some or all of the injured party’s lost wages and other expenses are paid from this portion of the policy, whether or not the injured party caused the accident. So if were in a car accident driving your own vehicle and you are injured as a result of another person's negligence, the no-fault portion of your automobile insurance policy will cover your medical bills to the extent that you have coverage. If your coverage runs out other insurance will kick in. The New York State Insurance Law, requires that all automobile insurance policies issued in this state contain a Personal Injury Protection (“PIP”) or “No-Fault” endorsement with a minimum of $50,000.00 in coverage. Generally speaking, this coverage extends to the driver and passengers in a covered vehicle, as well as to a pedestrian struck by the covered vehicle. The coverage “kicks in” regardless of fault in connection with an accident; under most circumstances, a covered individual will be afforded certain enumerated benefits regardless of that individual’s fault in connection with the happening of the accident.
    [Show full text]
  • What You Need to Know
    What AutoAuto you InsuranceInsurance need to know A consumer information publication The Minnesota Department of Commerce has prepared this guide to help you better understand auto insurance. It gives you information on shopping for insurance, the different types of coverage, and a basic understanding of “no fault” coverage. The Minnesota Department of Commerce regulates insurance agents, agencies, adjusters, and companies operating in Minnesota. If they are licensed to do business in the State, they are responsible for adhering to the laws and rules that govern the industry. This guide does not list all of these regulations. If you have a question about your insurance, please contact the Department’s Consumer Response Team at 651-296-2488, or toll free 800-657-3602. Duplication of this guide is encouraged. Please feel free to copy this information and share it with others. Department of Commerce Auto Insurance can protect you from the financial costs of an accident or injury, provided you have the proper coverage. Yet many people are unclear about what their insurance policy cov- ers until it is too late. They may have difficulties settling a claim or face rate increases or termination of coverage. Auto Insurance I s ... Protection. Insurance is a way of transferring risk for a loss among a certain group of people. You, and others, pay premiums to an insurance company to be reimbursed if you have an acci- dent. The amount you can collect and under what circumstances are outlined in your policy. Required. Under most circumstances, a licensed vehicle in the state of Minnesota must have liability, personal injury protection, uninsured motorist, and underinsured motorist coverage.
    [Show full text]
  • The RAM Health Insurance Cooperative Is NOW Thriving
    Health Insurance Cooperative The RAM Health Insurance Cooperative is NOW thriving – and growing – in 2020! The program offers RAM members: A 3% DISCOUNT OFF PREMIUM RATES FOR SMALL BUSINESSES IN THE SMALL GROUP MARKET (Groups of 1-50 employees) ACCESS TO EVERY SMALL GROUP PLAN OFFERED BY BCBSMA & ALMOST ALL SMALL GROUP PLANS OFFERED BY FALLON HEALTH DEFINED CONTRIBUTION OPTIONS TO ADDRESS THE NEEDS OF BOTH YOUR BUSINESS AND YOUR EMPLOYEES And for those members who choose a BCBSMA plan, the program also offers additional value-added benefits including: A WELLNESS PROGRAM WITH POTENTIAL EMPLOYEE INCENTIVES OF UP TO $300 AND AN OPPORTUNITY TO EARN 7.5% IN BACK END EMPLOYER INCENTIVES A FREE SUPPLEMENTAL HOSPITALIZATION POLICY FOR ALL SUBSCRIBERS, WHICH COVERS $750 FOR A HOSPITAL ADMISSION AND $150 EACH ADDITIONAL DAY UP TO 10 DAYS A FREE $10,000 LIFE INSURANCE POLICY FOR ALL SUBSCRIBERS Visit www.retailersma.org or call us at (617) 523-1900 to learn more! Health Insurance Cooperative Dear RAM Member, RAMHIC is a service of the Retailers Association of Massachusetts—the leading voice for more choice and fairer premiums for small businesses and their employees in the Massachusetts insurance market. RAMHIC is an important example of our efforts to deliver economic equality for Main Street. Since the adoption of universal healthcare in Massachusetts, small businesses have received disproportionate increases in their health insurance premiums compared to their large competitors and government programs. In response, RAM fought for the creation of small business group purchasing cooperatives designed to allow like-minded businesses to join together and negotiate with carriers for reduced premium rates based on the projected experience of the group.
    [Show full text]
  • Lloyd's Policy Signing Office, Quoting the Lloyd's Policy Signing Office Number and Date Or Reference Shown in the Table
    Lloyd’s Policy of the Syndicates whose definitive numbers We, Underwriting Members and proportions are shown in the Table attached hereto (hereinafter referred to as 'the Underwriters'), hereby agree, in consideration of the payment to Us by or on behalf of the Assured of the Premium specified in the Schedule, to insure against loss, including but not limited to associated expenses specified herein, if any, to the extent and in the manner provided in this Policy. The Underwriters hereby bind themselves severally and not jointly, each for his own part and not one for another, and therefore each of the Underwriters (and his Executors and Administrators) shall be liable only for his own share of his Syndicate's proportion of any such Loss and of any such Expenses. The identity of each of the Underwriters and the amount of his share may be ascertained by the Assured or the Assured's representative on application to Lloyd's Policy Signing Office, quoting the Lloyd's Policy Signing Office number and date or reference shown in the Table. If the Assured shall make any claim knowing the same to be false or fraudulent, as regards amount or otherwise, this Policy shall become void and all claim hereunder shall be forfeited. In Witness whereof the General Manager of Lloyd's Policy Signing Office has signed this Policy on behalf of each of Us. LLOYD'S POLICY SIGNING OFFICE General Manager If this policy (or any subsequent endorsement) has been produced to you in electronic form, the original document is stored on the Insurer's Market Repository to which your broker has access.
    [Show full text]
  • Understanding How Insurance Works: a Case Study About Lucy (Guide) Cfpb Building Block Activities Understanding-How-Insurance-Works-Lucy Guide.Pdf
    BUILDING BLOCKS TEACHER GUIDE Understanding how insurance works: A case study about Lucy Students read about how insurance works, then review a case study to see how insurance choices can affect personal finances for a rural young adult. Learning goals KEY INFORMATION Big idea Building block: When you purchase insurance, you are Executive Function transferring financial risk from yourself to an Financial knowledge and insurance company. decision-making skills Essential questions Grade level: High school (9–12) § What is the main benefit of choosing to Age range: 13–19 purchase insurance? Topic: Protect (Managing risk) § How do the insurance company and the policyholder share risks and costs? School subject: CTE (Career and technical education), Math, Physical education or Objectives health, Social studies or history Teaching strategy: Cooperative learning, § Understand how insurance works Simulation § Apply insurance policy specifics to a case study to evaluate costs and benefits Bloom’s Taxonomy level: Understand, Apply, Evaluate What students will do Activity duration: 45–60 minutes § Read about how the insurance process works and discover what roles the insurance STANDARDS company and the policyholders play. § Review information about specific types of Council for Economic Education Standard VI. Protecting and insuring insurance policy coverage and costs. Jump$tart Coalition Risk management and insurance – Standard 1 To find this and other activities go to: Consumer Financial Protection Bureau consumerfinance.gov/teach-activities 1 of 7 Winter 2020 § Evaluate a case study to see how one policyholder’s insurance choices affected her financially. § Write an advice email about the value of insurance in that policyholder’s life.
    [Show full text]
  • My Insurance Doesn't Cover What?
    MYMY INSURANCE INSURANCE DOESN’T DOESN’T COVER COVER WHAT? WHAT? AvoidAvoid surprises surprises by understanding by understanding your homeowners your insurance insurance policy policy DepartmentDepartment of Commerceof Commerce & Consumer & Consumer Affairs Affairs InsuranceInsurance Division Division CCA.HAWAII.GOV/INS @INSURANCEHI TABLE OF CONTENTS 1 My Insurance Doesn’t Cover What? . .2 2 Home Inventory . 4 3 Theft . 5 4 Fire . 6 5 Flooding . 7 6 Natural Disasters . 8 7 Preventative Measures and Actions . 10 8 What Isn’t Typically Covered . 12 9 The Claims Process . 13 The State of Hawaii Department of Commerce and Consumer Affairs (DCCA) is a regulatory agency that promotes a strong and healthy business environment by upholding fairness and public confidence in the marketplace. The department also strives to increase knowledge and opportunity for businesses and individuals, and to protect consumers against unfair and deceptive business practices. The DCCA Insurance Division oversees the insurance industry in the State of Hawaii. Its regulatory functions include: issuing licenses, examining the fiscal condition of Hawaii-based companies, reviewing rate and policy filings, and investigating insurance-related complaints. The National Association of Insurance Commissioners (NAIC) is the U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. The NAIC’s website is a great source of consumer information at www.naic.org. This guide was created to equip you with information to better prepare for an emergency and understand what may or may not be covered by their insurance policy or policies.
    [Show full text]
  • Writeinsure Program Frequently Asked Questions
    WriteInsure Program Frequently Asked Questions Who developed the WriteInsure program and who underwrites this coverage? The WriteInsure program was developed by AXIS PRO® in conjunction with the Authors Guild. AXIS PRO, formerly known as Media/Professional Insurance or Media Pro, is a business unit within the Professional Lines division of AXIS Insurance, a publicly traded specialty property and casualty insurance holding company and subsidiary of AXIS Capital Holdings Limited. AXIS PRO has been a leading underwriter of specialty professional liability insurance for media organizations for over 35 years. In addition to the Authors Guild, AXIS PRO provides coverage for other leading media associations, such as the National Association of Broadcasters and the American Association of Advertising Agencies. More information about AXIS PRO can be found at www.axisproinsurance.com. More information about AXIS Insurance Company can be found at www.axiscapital.com. Do I have to be a member of the Authors Guild in order to apply for this coverage? You must be a member of the Authors Guild in order to be eligible for this coverage under this program. AXIS PRO’s partnership with the Authors Guild provides a means for identifying those writers who have taken the time and shown the seriousness of purpose to meet membership criteria and join a professional trade association. The goal of the WriteInsure program is to provide writers with affordable, quality insurance for their writing activities. Each member is individually underwritten by AXIS. Authors Guild membership does not guarantee an offer of insurance by AXIS. Who is insured under this program? The insured can be either an individual person, i.e.
    [Show full text]
  • Veteran's Health Insurance and Copays at VA
    Veteran’s Health Insurance and Copayments at VA YOUR HEALTH INSURANCE AND VA Why VA Bills Your Health Insurance VA is required by law to bill any health insurance carrier that provides coverage for you, including policies held by your spouse. Only Veterans treated for non service-connected conditions should see their insurance company billed for their treatment. Veterans who are treated for service-connected conditions should not have their insurance company billed for treatment. VA does not bill Medicare or Medicaid. Please note: VA may bill High Deductible Health Plans (HDHPs) for medical care and services provided to Veterans for non service-connected conditions. (HDHPs are usually linked to a Health Savings Account that can be used to pay VA copayments.) VA may also accept reimbursement from Health Reimbursement Arrangements (HRAs) for care provided for non service-connected conditions. Where the Money Goes Money collected from health insurance reimbursements is returned directly to the medical centers and used to enhance the health care services provided to Veterans. For this to happen, information must be obtained regarding your health insurance coverage. VA staff may call you at home to obtain this information or they may ask you for it when you check in for an appointment at the medical center. Always bring your insurance card with you when you come to VA. This will provide the facility with your current insurance information. IB 10-77 July 2019 Page 1 of 2 Insurance Coverage and Eligibility for VA Health Care Your insurance coverage or lack of insurance coverage does not determine your eligibility for treatment at a VA health care facility.
    [Show full text]
  • Force Majeure Clause Won't Apply to Coronavirus Death Claims in Life Insurance Policies
    Force majeure clause won't apply to coronavirus death claims in life insurance policies 07th April, 2020, Economic Times The Life Insurance Council of India has announced that all life insurance companies, both public and private, will process all coronavirus-related death claims, at the earliest. According to a press release from the Life Insurance Council, "The Council also confirmed that the clause of „Force Majeure‟ will not apply in case of COVID-19 death claims. This step was taken to reassure customers who had reached out to individual life insurance companies seeking clarity on this clause in their contract as well as to dispel rumours to the contrary. All life insurance companies have also communicated to their customers individually in this regard." Life Insurance Council is a forum that connects various stakeholders of the insurance sector. It develops and coordinates all discussions between the Government, Regulatory Board and the public. What is force majeure? Typically, force majeure events include an Act of God or natural disasters, war or war-like situations, labour unrest or strikes, epidemics, pandemics, etc. Santosh Agarwal, CBO-Life Insurance, Policybazaar.com said, "Force majeure clause is basically a clause for unforeseen circumstances that makes the contract null or invalid, for the situations like natural disasters, war or war like situations, etc., that life insurance companies can‟t plan for. Recently, the Life Insurance council issued a statement for both state-run and private life insurance players that the “force majeure” clause will not be applicable in any of COVID-19 death claims. "However, many insurers do not have this clause in their contract and everyone will cover death caused due to COVID-19 given that the policyholder declared all the details correctly while buying the policy.
    [Show full text]
  • Insuring Your Business... the Basics of Property & Liability Coverage
    Insuring Your Business... The Basics of Property & Liability Coverage Property Insurance; Replacement Cost and Actual Cash Value; Factors affecting Coinsurance; Other Valuation Options; Pro‐rata distribution; Liability Insurance; Cancellation or Nonrenewal of Policy; Other Types of Insurance to Consider Although Maine law does not require you to have property and liability insurance on your business, you may want to buy coverage to protect you, your property, and your financial investment. Without insurance protection your business could face financial ruin either because of a property loss or a lawsuit. Although there are various types of coverage that a small business owner can or must buy, this brochure describes only property and liability coverage. If you have questions concerning coverage, check with your insurance agent or call the Maine Bureau of Insurance at (800) 300‐5000 (in Maine) or (207) 624‐8475. Depending on the type of business, the best policy for you might be a commercial package policy or a businessowners (BOP) policy. With a commercial package policy you and your agent choose the coverages you will buy, whereas businessowner policies contain pre‐packaged coverages. All policies contain exclusions and other limitations of coverage. It is important to review your entire policy to determine if you have exposures that may not be covered. It is also very important to note the coinsurance requirements of your policy. (Coinsurance is the minimum amount of insurance that you must carry before most companies will fully reimburse you for a partial loss.) You may want to discuss with your agent optional coverages such as Building Glass, Outdoor Signs, Boiler and Machinery or Mechanical Breakdown, Business Interruption, Extra Expense (to continue operations after a covered loss), Worker’s Compensation, Earthquake, Flood, or Peak‐Season coverage.
    [Show full text]
  • Lloyd's Credit Report
    AM Best September 2020 Lloyd’s Best’s Rating of Lloyd’s 2020 Lloyd’s September 2020 Lloyd’s Credit Report One Lime Street Best’s Credit Ratings: Rating Effective Date: July 15, 2020 London EC3M 7HA United Kingdom Best’s Financial Strength Rating: A Outlook: Stable Action: Affirmed Best’s Issuer Credit Rating: a+ Outlook: Stable Action: Affirmed Web: www.lloyds.com AMB#: 85202 AIIN#: AA-1122000 Assessment Descriptors Rating Unit - Members Rating Unit: Lloyd’s | AMB #: 085202 Balance Sheet Strength Very Strong AMB # Rating Unit Members Operating Performance Strong 078649 Lloyd’s Ins Co (China) Ltd Business Profile Favorable 095926 Lloyd’s Insurance Co. S.A. Enterprise Risk Management Appropriate Rating Rationale Balance Sheet Strength: Very Strong • The market has the strongest level of risk-adjusted capitalisation, as measured by Best’s Capital Adequacy Ratio (BCAR). • A robust capital-setting regime, which incorporates a risk-based approach to setting member-level capital, helps protect risk- adjusted capitalisation from volatility. • Member-level capital is subject to fungibility constraints as it is held on a several rather than joint basis. • Balance sheet strength is underpinned by a strong Central Fund that is available, at the discretion of the Council of Lloyd’s, to meet the policyholder obligations of all Lloyd’s members. • An offsetting factor is the market’s significant exposure to catastrophe risk and its dependence on reinsurance to manage this risk. Operating Performance: Strong • Lloyd’s is expected to report strong operating performance across the underwriting cycle, Contents taking into account potential volatility due to its catastrophe exposure.
    [Show full text]
  • Cooperative Health Insurance Policy Approved.Pdf
    Cooperative Health Insurance Policy As Approved by Ministerial Decision No. R/1/18/3 dated 12/05/1439 H Table of Contents Section 1 - Definitions ........................................................................................... 3 Section 2 - Recoverable Expenses / Benefits ....................................................10 Section 3 - Limitations and Exclusions ..............................................................13 Section 4 - General Conditions ........................................................................... 16 CCHI Schedule of Benefit (SOB) ........................................................................24 Cooperative Health Insurance Policy 2 Section 1 Definitions Cooperative Health Insurance Policy 3 The following terms, wherever mentioned in the policy, its annexes or endorsements shall have the meanings assigned thereto: 1. Insurance: Proof insurance coverage under the policy with its schedule, annex or endorsements. 2. Insurance Term: The period stated in the policy schedule during which the insurance is valid. 3. Grace Period: The number of days during which the policy remains valid in case of non-payment of the total contribution shown in the schedule. 4. Inception Date: The date stated the policy schedule on which insurance coverage commences. 5. Effective Date: The date chosen by the policyholder and approved by the Company to commence coverage of an insured individual under the policy or to add or remove an insured person from the policy. 6. Benefit: The costs of providing health services included in the insurance coverage within the limits specified in the policy schedule. 7. Insurance Coverage: The basic health benefits available to the beneficiary as specified in the policy. 8. Coverage Limits: the maximum amount of the Company’s liability as specified in the policy schedule with respect to any insured person before applying the deductible. 9. Insurance Parties: Policyholders, health Insurance Companies, TPAs & health service providers.
    [Show full text]