Insurance/ Reinsurance Guide to Global Business in Di Genous Insight

Total Page:16

File Type:pdf, Size:1020Kb

Insurance/ Reinsurance Guide to Global Business in Di Genous Insight Insurance/ Reinsurance Guide to Global Business In di gen ous Insight U ach nmatched Global Re 16 0 W ms orld Ready Member Fir T he L eadin g Law Firm Network In di s ge n no o us Insight ti lu o S ss le Un each am matched Global R Se s m ir 1 F 60 s er Worl Firm b d Ready Member em M dy Rea rld Wo 160 T he L eadi o ng Law F on irm Network o B Pr ide ldw Wor Your World Ready Partner Lex Mundi is the world’s leading network of independent law firms with in-depth experience in 100+ countries. Our member firms are able to offer their clients preferred access to more than 21,000 lawyers worldwide – a global resource of unmatched breadth and depth. Each member firm is selected on the basis of its leadership in – and continued commitment to – its local market, and each brings comprehensive knowledge and understanding of the business climate, laws, culture, politics and economy of its respective jurisdictions. Working with Lex Mundi member firms you can be assured that you will be connected to: Quality Representation Seamless Service Our top-tier member firms are committed to Our global network is an unrivaled resource for clients providing not only exceptional legal work but superior seeking solutions to cross-border transactions, matters client service as well. Each firm is admitted only and disputes across multiple jurisdictions. Member after substantial due diligence and must undergo firms are accustomed to working together according regular quality and peer review procedures to retain to our seamless service protocols, which provide membership in the network. basic guidelines, procedures and best practices for how members collaborate on behalf of a common Preeminent Law Firms client. This assures that clients benefit from the broad, Lex Mundi member firms are among the most deep local expertise, know-how and connections experienced, most knowledgeable in their of multiple Lex Mundi member firms while still jurisdictions. They deliver indigenous insight, a experiencing the ease of working with a single firm. market-specific focus and global connections to a diverse range of domestic and international clients. Global Reach Lex Mundi’s broad international coverage, including Local Market Knowledge and Industry 21,000 lawyers in 160 member firms spanning Sector Experience 100+ countries, assures that clients receive the fullest possible range of services from legal professionals Our member firms deliver unmatched who have in-depth, region-specific expertise in every “on-the-ground” expertise to clients. Through their major jurisdiction. indigenous insight – local knowledge built from hands-on, accrued experience of how markets develop and the forces and factors that affect them – Lex Mundi firms have the connections and capabilities to help shape innovative strategies for clients in any industry, at any level, virtually anyplace in the world. Expertise for Complex Legal Challenges Member firms have the local-market knowledge, experience and understanding necessary to handle clients’ complex challenges and opportunities, including mergers and acquisitions; private equity; project finance; capital markets (debt and equity); litigation and dispute resolution; corporate governance; intellectual property; real estate; and labor and workforce issues in a wide variety of industry sectors. Lex Mundi – the law firms that know your markets. Introduction | 4 Table of Contents Introduction 4 Africa 7 Angola 8 Mozambique 16 Asia and the Pacific 24 Australia 25 India 38 Japan 49 Singapore 54 Taiwan 59 Thailand 67 Europe 73 Belgium 74 England 85 Germany 96 Ireland 106 Luxembourg 116 Malta 125 Poland 136 Portugal 141 Russia 152 Slovenia 160 Turkey 171 Latin America 177 Argentina 178 Chile 185 Colombia 195 Panama 210 Peru 216 North America 221 Bermuda 222 Canada, Manitoba 230 USA, California 237 Puerto Rico 242 Leadership Page 249 Lex Mundi – the law firms that know your markets. Introduction | 5 Insurance/Reinsurance Guide to Global Business The Insurance/Reinsurance Guide to Global Business is meant to be a quick reference for in-house counsel conducting business across the world. Lawyers in the Lex Mundi Insurance/Reinsurance Practice Group agree that one of the biggest day-to-day challenges their clients face is the need to find footing quickly when issues arise in less familiar markets. In this guide, the group provides practical advice on a range of common scenarios, including market entry, local regulations, distribution requirements, contract law, dispute resolution and major legislative changes on the horizon. This publication is not intended to represent a comprehensive guide nor legal advice on the matters covered but rather provide a general overview on the subject. It may only be used as an indication and advice should always be sought from the appropriate Lex Mundi member law firm. Please note that each response was provided on a different date, and therefore the answers to the survey refer to laws and regulations in force on that specific date. Lex Mundi – the law firms that know your markets. Introduction | 6 Africa Angola Prepared by Morais Leitão, Galvão Teles, Soares da Silve & Associados, Sociedade de Advogados, R.L. Angola Lex Mundi Member Firm for Portugal Overview What are the categories of insurance licenses that exist? Which government bodies/agencies regulate insurance and reinsurance In Angola, insurers may be granted two different types of licenses to carry out insurance activities, companies? in the terms provided for by the Law 1/2000, of In Angola, the entity in charge of the regulation and February 3 (the “General Insurance Law”). The supervision of insurance and reinsurance companies definition, names, types and areas of insurance to is currently the Agência Angolana de Regulação e be open for business in the Angolan territory are Supervisão de Seguros (“ARSEG”) which was created set out in Schedule II to the General Insurance Law. by Presidential Decree 141/13, of 27 September The Minister of Finance has authority to approve the (subsequently amended by Presidential Decree general and special conditions, the technical bases and the rates for compulsory insurance and other 190/13, of 19 November 2013). ARSEG replaced insurance requiring standardization, as well as to Instituto de Supervisão de Seguros (the “Insurance approve policies and other technical instruments. Supervisory Institute” or “ISS”). The ISS was created by Decree Law 4/98, of January 30. All ISS attributions Under the General Insurance Law only companies and personnel were transferred to ARSEG. ARSEG’s whose incorporation has been authorized may main attributions are the supervision of the insurance, engage in the business of insurance and insurance reinsurance, insurance mediation and pension fund mediation. It is within the Minister of Finance’s management activities under the superintendence of authority to grant, for all national territory, the President of the Republic and Holder of Executive authorization for the incorporation of the companies Powers and, organically, the Ministry of Finance. The carrying out insurance and insurance mediation aforesaid superintendence powers manifest, most activities. The incorporation of companies having as notably, in the fact that the members of the board of shareholders non-resident individuals or companies directors of ARSEG are nominated by the President of that, in whole or in part, hold more than 50 the Republic. percent of their share capital, requires the Council of Ministers’ authorization, subject to the Minister In general, ARSEG defines the rules necessary for of Finance’s prior opinion. Authorization shall only the good functioning of the insurance sector and for be granted for joint operation of the compulsory the carrying out of the abovementioned activities. It and optional lines of insurance, both for direct controls and supervises the insurance sector as well as insurance and for reinsurance, except for engaging the activities mentioned above implementing, to that exclusively in life insurance or in a single insurance end, actions aiming to normalize the legal, technical line, where this is advisable for reasons relating and financial functioning of the insurance market, to insurance practice and appropriate approval is namely solvability criteria, the prudent management obtained. The Minister of Finance also has authority of technical provisions and their financial applications to determine which insurance lines may be pursued. and of the products made available to consumers. Finally, Insurance contracts entered into by a foreign insurer in Angola or relating to Angolan residents On the particular matter of supervision, ARSEG’s or assets located in Angola are null and void, as attributions comprehend, most notably: per Article 25 of Decree 7/02, of 9 April 2002 • To issue opinions concerning the incorporation of (“Insurance Related Infringements”) and Article 33 insurance and reinsurance companies as well as of Executive Decree 5/03, of 24 January 2003 the cancellation of the authorizations to carry out amended by Executive Decree 70/06, of 7 June 2006 insurance and reinsurance activities in Angola; (“Insurance Regulations”). Moreover, under Article 9 of the General Insurance • To initiate and oversee misdemeanor procedures, Law and Article 26 of the Insurance Related enforce the respective sanctions or advise Infringements, insurance contracts entered into in the Minister of Finance on the enforcement Angola or relating to Angolan residents or assets of any sanctions within the scope
Recommended publications
  • The Changing Regulatory Landscape for Stop Loss Insurance by Fred E
    The Changing Regulatory Landscape for Stop Loss Insurance by Fred E. Karlinsky, Richard J. Fidei and Erin T. Siska EDITORIAL NOTE: Commentary Background offered by the authors does not Although stop loss insurance is not addressed in the Patient Protection and necessarily represent the views of SIIA. Affordable Care Act of 2010 (the “Affordable Care Act or “ACA”), the National Association of Insurance Commissioners (“NAIC”) recently reviewed proposed ecent developments at the action with regard to the regulation of stop loss insurance. The NAIC adopted federal and state levels of a Stop Loss Insurance Model Act (#92) (the “Model Act”) in 1995, which was government, taken together, amended in 1999 to clarify that the law applied only to insurers and did not impose portend changes in the obligations on employer benefit plans directly. In essence, the Model Act provides Rregulation of stop loss insurance, which could lead more and more small and certain minimum standards for stop loss insurance coverage. Specifically, it prohibits mid-size firms to self-insure than ever an insurer from issuing a stop loss insurance policy that has an annual attachment before. Although neither state nor point for claims incurred per individual which is lower than $20,000; has an annual federal officials keep comprehensive aggregate attachment point (for groups of fifty or fewer) that is lower than the statistics on self-insurance, it appears to greater of: be growing in popularity as a feasible 1. $4,000 times the number of group members option. A recent study by the Employee 2. 120 percent of expected claims or Benefits Research institute indicates that nearly 60% of private sector 3.
    [Show full text]
  • Program Sponsored By: TABLE of CONTENTS
    Program sponsored by: TABLE OF CONTENTS Welcome .......................................................................................... 3 Thank You to Our Partners ......................................................... 5 Thank You to Our Sponsors ........................................................ 7 WIFI Instructions ............................................................................ 7 HCAA Mission, Vision and Values Statement .................... 10 Antitrust Policy/Ethics Policy/Anti-Harassment Policy .... 11 Schedule-At-A-Glance ................................................................ 13 Speakers ................................................................................ 17 - 23 Schedule of Events .............................................................. 27 - 29 HCAA Management Staff / Past Presidents ........................ 33 2019 – 2020 Officers and Board of Directors ..................... 35 HCAA Committees & Task Forces ......................................... 37 Member Companies ............................................................ 40 - 41 CSFS® Information .............................................................. 44 - 46 Notes ........................................................................................ 51 - 53 Hotel Map ................................................................................ 54 - 55 Sponsor/Partner Materials ............................. Throughout Program Notice: Videotaping and/or Photography in Progress Today’s event will be videotaped
    [Show full text]
  • President's Message
    PRESIDENT’S MESSAGE It’s been a busy and exciting time for IAIR! At the NAIC Fall National Meeting in Miami, several committees met and furthered their work, the Receivers and Guaranty Fund Relations committee meeting was well attended (See Donna Wilson –CIR-MIL Lynda Loomis’ wrap up later in this issue), Kathleen McCain conducted an educational and thought provoking Issues Forum, the Annual Meeting resulted in four directors continuing on the Board and the election of Don Roof to his first term. The IAIR’s committees have begun 2017 with very full Annual Meeting was capped off with a great celebration of agendas. Thank you to all the committee chairs and the IAIR’s 25th Anniversary where Joe DeVito captivated us with a committee members. Without you, the Board would not rendition of Unchained Melody. be able to fulfill our obligations. James Kennedy and Pat Hughes successfully co-chaired The Audit, Finance, Governance, and Membership & the 2017 Insurance Resolution Workshop February 1-3 (See Promotions Committees are working to improve our Summary in this issue). With over 160 attendees, excellent organizational processes and fulfill our duties to the topics and panels, warm Austin weather and great food and association and to you. locale, it was an event that will not soon be forgotten. Great The Ethics Committee has worked diligently to develop work gentlemen! outlines and processes to improve our professional During the Workshop, James Mills was awarded the Accredited designation program. The development, review and Insurance Receiver (AIR) designation for legal experience and discussions have been thorough and collaborative.
    [Show full text]
  • Insurance Law
    SMU Law Review Volume 51 Issue 4 Annual Survey of Texas Law Article 18 1998 Insurance Law Michael Sean Quinn Pamela D. Nielson Follow this and additional works at: https://scholar.smu.edu/smulr Recommended Citation Michael Sean Quinn & Pamela D. Nielson, Insurance Law, 51 SMU L. REV. 1131 (1998) https://scholar.smu.edu/smulr/vol51/iss4/18 This Article is brought to you for free and open access by the Law Journals at SMU Scholar. It has been accepted for inclusion in SMU Law Review by an authorized administrator of SMU Scholar. For more information, please visit http://digitalrepository.smu.edu. INSURANCE LAW Michael Sean Quinn* Pamela D. Nielson** TABLE OF CONTENTS I. INTRODUCTION ..................................... 1132 II. INSURER BAD FAITH ............................... 1133 A. COMMON LAW INSURER BAD FAITH ............... 1134 B. SCOPE LIMITED .................................... 1135 C. ELEMENTS OF COMMON LAW INSURER BAD F A ITH ............................................. 1138 1. Universe Life Insurance Co. v. Giles ............ 1138 2. State Farm Lloyds v. Nicolau ................... 1145 3. United States Fire Insurance Co. v. Williams .... 1150 D. STATUTORY BAD FAITH ........................... 1153 1. A rticle 21.21 .................................... 1153 2. D TPA .......................................... 1155 3. A rticle 21.55 .................................... 1156 III. PROPERTY INSURANCE ............................ 1157 A . A RSON ............................................. 1158 B. PLUMBING RELATED FOUNDATION DAMAGE
    [Show full text]
  • Squire Patton Boggs Reinsurance Newsletter, March 2016
    Reinsurance Newsletter March 2016 In this Issue Maine Federal Court Finds That Parties Had Contractually Agreed to Submit to Arbitration the • Recent Case Summaries Question of the Enforceability of an Arbitration Agreement • A Brief Review of Reinsurance Trends Mt. Valley Prop., Inc. v. Applied Risk Servs., Inc., No. 1:15-cv-00187- in 2015 DBH, 2015 U.S. Dist. LEXIS 171799 (D. Me. Dec. 22, 2015). • Recent Speeches and Publications A Maine federal court sent to arbitration a dispute between a property management company and a group of affiliated insurers and Recent Case Summaries administration companies, finding that the parties had contractually agreed to submit the question of arbitrability to arbitrators, and not to Wisconsin Federal Court Compels Arbitration a court of law. Over Question of Effect of Prior Arbitration Award The management company participated in an insurance program that Emplrs Ins. of Wausau v. Cont’l Cas. Co., No. 15-cv-22-wme, 2016 was marketed and sold by the defendant companies as an insurance U.S. Dist. LEXIS 18850 (W.D. Wisc. Feb. 17, 2016). alternative that integrated multiple lines of insurance and also provided A Wisconsin federal court granted a cedent’s application to compel certain payroll and tax services. The program was governed by a series arbitration and dismissed, without prejudice, a complaint by the of related agreements, one of which – a Reinsurance Participation reinsurer seeking a declaration and injunction seeking to preclude Agreement – contained an arbitration clause. None of the other the cedent from allegedly re-arbitrating the final decision of a prior transaction agreements did.
    [Show full text]
  • The Insurance Receiver”, Financially Troubled and in Need of Has Been Reimagined
    “To establish a professional organization comprised of individuals who provide services associated with the affairs of insurers that are in receivership or otherwise financially troubled and in need of restructuring; Donna Wilson –CIR-MIL “To develop educational and training PRESIDENT’S MESSAGE programs to enhance the qualifications Throughout its 25 years, IAIR has been faithful to its of professionals working in the field of mission. Our educational programs are well respected insurance company receiverships and and provide opportunities to discuss a variety of restructurings and to provide a forum subjects both during the presentations and more informally with each other, our standards are high for discussion of ideas, experiences and and our members strive to serve with expertise and subjects of common interest to them; proficiency. Where is IAIR going from here? “To establish ethical and professional IAIR will continue to uphold our mission but it must standards for professionals retained to consider new ways to do so. conduct or advise in the affairs of insurers As you know by the fact you are reading this that are in receivership or otherwise newsletter, IAIR’s publication “The Insurance Receiver”, financially troubled and in need of has been reimagined. The newsletter is an important part of fulfilling our mission to educate, to train and restructuring; and share ideas and experiences. It reaches the entire membership even when members are unable to attend “To recognize, through accreditation, the live events. The digital format allows IAIR to publish the attainment by its members of expertise and newsletter economically but also in a format that better proficiency in such pursuits.” meets the needs and expectations of our membership.
    [Show full text]
  • Understanding the Lack of Transparency in Insurance Consumer Protection
    Scholarship Repository University of Minnesota Law School Articles Faculty Scholarship 2014 Transparently Opaque: Understanding the Lack of Transparency in Insurance Consumer Protection Daniel Schwarcz University of Minnesota Law School, [email protected] Follow this and additional works at: https://scholarship.law.umn.edu/faculty_articles Part of the Law Commons Recommended Citation Daniel Schwarcz, Transparently Opaque: Understanding the Lack of Transparency in Insurance Consumer Protection, 61 UCLA L. REV. 394 (2014), available at https://scholarship.law.umn.edu/faculty_articles/572. This Article is brought to you for free and open access by the University of Minnesota Law School. It has been accepted for inclusion in the Faculty Scholarship collection by an authorized administrator of the Scholarship Repository. For more information, please contact [email protected]. Transparently Opaque: Understanding the Lack of Transparency in Insurance EVIEW R Consumer Protection Daniel Schwarcz ABSTRact UCLA LAW UCLA LAW Consumer protection in most domains of financial regulation centers on transparency. Broadly construed, transparency involves making relevant information available to consumers as well as others who might act on their behalf, such as academics, journalists, newspapers, consumer organizations, or other market watchdogs. By contrast, command-and-control regulation that affirmatively limits financial firms’ products or pricing is relatively uncommon. This Article describes an anomalous inversion of this pattern: While state insurance regulation frequently employs aggressive command- and-control consumer protection regulation, it typically does little or nothing to promote transparent markets. Rather, state lawmakers routinely either completely ignore transparency-oriented reforms or implement them in a flawed manner. While acknowledging the limits of transparency-oriented consumer protection regulation, this Article argues that the lack of transparent insurance markets reflects a pervasive and unappreciated flaw in state insurance regulation.
    [Show full text]
  • Considering Insurance Billing for College Health and Counseling Services
    January, 2013 CONSIDERING INSURANCE BILLING FOR COLLEGE HEALTH AND COUNSELING SERVICES By Stephen L. Beckley, Doreen Hodgkins, and Marc M. Tract Considering Insurance Billing for College Health and Counseling Services 1 ABLE F Abstract . T O Historical Values for Pre-Funding of College Health and CONTENTS Counseling Services . 2 The Shift Away from Pre-Paid Funding for College Health Services . 2-3 Increased Utilization of College Health and Counseling Services . 3 The ACA and Full Coverage for Preventive Care Services . 3 Increased Enrollment in Student Health Insurance/Benefit Programs . 4 Variable Success for Developing Insurance Billing Revenue . 4-5 Waiving Insurance Copayments, Deductibles, and Coinsurance Charges . 5-6 Understanding Coordination of Benefits . 6 Secondary Payor Status for Health Fees and Institutional Funding . 7 Common Components for a Secondary Payor System . 8-9 Secondary Payor System Example Charges and Out-of-Pocket Expenses . 9-10 Stephen L. Beckley, CEBS Secondary Payor System Example Communications . 10 Hodgkins Beckley Consulting, LLC Concerns for Adopting a Secondary Payor System . 11-13 3500 Carlton Avenue, #0-45 Fort Collins, CO 80525 Typical Steps for Considering a Secondary Payor System . 13-15 877-559-9800 toll free [email protected] Summary . 16 Doreen Hodgkins, MBA Appendix A . N/A Hodgkins Beckley Consulting, LLC 5435 Klipsun Lane, SW Minnesota Medical Association – Waiving Copays and Reducing Fees Olympia, WA 98512 877-559-9800 toll free Appendix B . 21-22 [email protected] Excerpts from Coordination of Benefits Model Regulation, #120 Marc M. Tract, JD Appendix C . 21-23 Katten Muchin Rosenman, LLP Credentials for Authors 575 Madison Avenue New York, NY 10022-2585 212-940-8800 Endnotes .
    [Show full text]
  • Understanding Insurance Regulation
    UNDERSTANDINGMove Over ILS? INSURANCE REGULATIONThe Rise and Rise of PriDe And Its Many Forms January 2020 @assetcohen @cohen-and-company-asset-management cohenandcompany.com TABLE OF CONTENTS 1 Introduction 2 2 Insurance - Why Does it Need Regulation? 3 3 A Deeper Dive 5 3(i) Solvency II SCR 6 3(ii) NAIC’s Risk Based Capital (RBC) 8 3(iii) Bermuda Solvency Capital Requirment (BSCR) 12 3(iv) AM Best’s Capital Adequacy Ratio 15 4 Insurance Failure 17 5 Insurance Industry Performance: An Investment Perspective 18 6 Cohen & Company 19 1 INTRODUCTION When ancient Egyptian, Indian, Greek, Roman and other civi- lizations existed, so too did a form of regulation of business- es. To an extent, standardized weights and measures existed in the ancient world in the form of business norms and customs. Insurance, in some form, dates back to ancient times, too. Chi- nese and Babylonian traders had methods to distribute risk in the second and third millen- nia B.C., with the first known written insurance policy carved in the Babylonian obelisk mon- ument known as the Code of King Hammurabi. The ancient law states that in the event of some impossible personal circumstance, such as a flood or a disability, a debtor did not have to pay back his loan. In today’s modern world there is an ever-increasing number of complex regulations that vary by jurisdiction. This paper does not explore whether regulation helps or hinders business but instead focuses on some of the insurance industry’s regulato- ry bodies, its dedicated rating agency and the differing ap- proaches to capital adequacy.
    [Show full text]
  • The Impact of the Affordable Care Act on the Content of Insurance Coverage for Persons with Disabilities, 25 Notre Dame J.L
    Notre Dame Journal of Law, Ethics & Public Policy Volume 25 Issue 2 Symposium On Health Care: Health, Ethics, & Article 16 the Law January 2014 Crossing the Rubicon: The mpI act of the Affordable Care Act on the Content of Insurance Coverage for Persons with Disabilities Sara Rosenbaum Joel B. Teitelbaum Katherine Hayes Follow this and additional works at: http://scholarship.law.nd.edu/ndjlepp Recommended Citation Sara Rosenbaum, J. B. Teitelbaum & Katherine Hayes, Crossing the Rubicon: The Impact of the Affordable Care Act on the Content of Insurance Coverage for Persons with Disabilities, 25 Notre Dame J.L. Ethics & Pub. Pol'y 527 (2012). Available at: http://scholarship.law.nd.edu/ndjlepp/vol25/iss2/16 This Article is brought to you for free and open access by the Notre Dame Journal of Law, Ethics & Public Policy at NDLScholarship. It has been accepted for inclusion in Notre Dame Journal of Law, Ethics & Public Policy by an authorized administrator of NDLScholarship. For more information, please contact [email protected]. CROSSING THE RUBICON: THE IMPACT OF THE AFFORDABLE CARE ACT ON THE CONTENT OF INSURANCE COVERAGE FOR PERSONS WITH DISABILITIES SARA ROSENBAUM* JOEL B. TEITELBAUMt KATHERINE HAYEST I. INTRODUCTION The Patient Protection and Affordable Care Act,' as amended by the Health Care and Education Reconciliation Act' (hereinafter referred to collectively as the "Affordable Care Act" or "PPACA"), has been heralded' as the most important set of changes to American health insurance since the 1965 enactment of Medicare' and Medicaid.5 Building on the public and private health insurance coverage systems in existence at the time of pas- * Harold and Jane Hirsh Professor of Health Law and Policy and Chair, Department of Health Policy, The George Washington University School of Public Health and Health Services.
    [Show full text]
  • Delta Dental ID Cards  Member Handbook  Evidence of Coverage
    Member Welcome Kit Your Delta Dental ID Cards Member Handbook Evidence of Coverage VPC BENFFITS CONSORTIUM-HIGH PLAN PREVENTION FIRST Group Number: 000700100 Delta Dental of Virginia 4818 Starkey Road MEMBER WELCOME KIT Roanoke, Virginia 24018-8510 MH_EOC#01.2019 This page intentionally left blank. TABLE OF CONTENTS I INTRODUCTION HOW TO DELTA DENTAL 1 HOW TO USE YOUR BENEFITS 2 ELIGIBLE DEPENDENTS 2 CHOOSING YOUR DENTIST 2 HOW TO ESTIMATE YOUR COST 3 PREDETERMINATION OF BENEFITS 6 FILING CLAIMS 6 COMPLAINT AND APPEALS PROCEDURES 7 COORDINATION OF BENEFITS 7 COMMON DENTAL TERMINOLOGY 7 II EVIDENCE OF COVERAGE (EOC) PLAN PROVISIONS SCHEDULE OF BENEFITS LIMITATIONS 1.0 HOW DELTA DENTAL PAYS FOR COVERED BENEFITS 2.0 ELIGIBILITY AND ENROLLMENT 3.0 COVERED BENEFITS, DEDUCTIBLE AND BENEFIT WAITING PERIOD 4.0 EXCLUSIONS 5.0 OTHER PAYMENT RULES THAT AFFECT MY COVERAGE 6.0 WHEN COVERAGE ENDS 7.0 CLAIMS, APPEALS AND GRIEVANCES 8.0 NONDISCRIMINATION NOTICE 9.0 NONDISCRIMINATION GRIEVANCE POLICY 10.0 COORDINATION OF BENEFITS (COB) WITH OTHER PLANS 11.0 ORAL HEALTH INFORMATION 12.0 MEMBER RIGHTS AND RESPONSIBILITIES 13.0 DEFINITIONS 14.0 ADDITIONAL BENEFITS IN HEALTHY SMILE, HEALTHY YOU® PROGRAM 16.0 PROTECTING YOUR PRIVACY 16.0 IMPORTANT INFORMATION REGARDING YOUR INSURANCE 17.0 LANGUAGE ASSISTANCE SERVICES This page intentionally left blank Introduction The Virginia Private Colleges Benefits Consortium, Inc. dental plan (the “dental plan”) shall be effective January 1, 2012. The dental plan may be amended at any time, in whole or in part, by the Board of Directors. The dental plan has been approved by the Board of Directors of the Virginia Private Colleges Benefits Consortium, Inc.
    [Show full text]
  • Full Briefing Book
    CENTER FOR JUSTICE & DEMOCRACY 185 WEST BROADWAY NEW YORK, NY 10013 TEL: 212.431.2882 [email protected] http://centerjd.org BRIEFING BOOK MEDICAL MALPRACTICE: BY THE NUMBERS Emily Gottlieb, Deputy Director for Law and Policy Joanne Doroshow, Executive Director March 2021 Update ii CENTER FOR JUSTICE & DEMOCRACY 185 WEST BROADWAY NEW YORK, NY 10013 TEL: 212.431.2882 [email protected] http://centerjd.org BRIEFING BOOK MEDICAL MALPRACTICE: BY THE NUMBERS Table of Contents PART 1: MEDICAL MALPRACTICE LITIGATION 1 Experts agree that when cases are filed, they are not “frivolous”; few injured patients file claims or lawsuits. 1 The number (“frequency”) and size (“severity”) of medical malpractice claims, lawsuits and payouts are low. 3 A small number of doctors are responsible for most malpractice payouts; incompetent physicians are rarely held accountable by state medical boards or the federal government. 7 Sexual abuse of patients goes largely unpunished. 15 Medical malpractice payments are not arbitrary; they reveal negligence and fortell future claims. 19 "Tort reforms” keep legitimate cases from being filed. 21 Physicians greatly misperceive the risk and consequences of being sued; personal assets not at risk. 22 Compensation is for serious injuries or death; high verdicts are almost always slashed; and punitive damages are extremely rare. 24 Medical malpractice cases are not clogging the courts; juries resolve few cases and strong cases settle. 29 iii Lawsuits filed for medical negligence are not frivolous yet it is still difficult for patients to prevail. 30 Experts say and data show that, even with its problems, the current medical malpractice system works.
    [Show full text]