“The best way to predict the

future is to create it”

Einstein

The Faculty of International Business and

Economics

Employee Benefits

insurance policies

Cosmin Joldeş, Associate Professor

Contents

1. Employee Benefits

2. Personal Accidents Insurance

3. World Business Travel Insurance

4. Life Insurance

5. Health Insurance

6. Major Exclusions

7. Claims Procedure

8. Recommendations and Observations

Glossary

Employee Benefits programs are flexible insurance

programs tailored on the specifics of the Human

Resources policy of each company.

1. Employee Benefits

Human Factor / Specific risks

- death

- loss of work capacity

- age

- loss of working place

Romanian Insurance System

State Insurance:- social health insurance system

- pension fund

- unemployment aid

Private Insurance:- Personal Accidents

- Life

- Pension Funds

- Health

1. Employee Benefits

Insurance Protection

Guaranteed payment of the sum insured by

the Insurance Company, in case of occurrence

of an insured event (accident, sickness, death

etc.)

Why Employee Benefits

- protection of staff

- benefit - fidelity of employees

- strong point in the negotiation of the Collective

Labour Contract

- market image

1. Employee Benefits

Insurance Conditions

a) Policy holder / Insured / Beneficiary

Policy Holder - the Company

Insured - the Company’s employee

Beneficiary - the person designated to cash the indemnity

in the event of the Insured’s death

b) Period / Long Term Agreement

1. Employee Benefits

c) Operational Time of Cover

- working hours

- working hours & commuting to/from working place

- 24 h / 24 h

d) Territory

- World Wide

- Romania

1. Employee Benefits

e) Sum Insured

- usually the limits of indemnity are calculated on basis of the gross average salary of the employees, on each level

f) Currency

- ROL / foreign currency

g) Premium Payment

- The insurance premiums are paid by the employer on behalf of its employees.

- Premium payment can be flat or in installments.

2. Personal Accidents Insurance

Covered Risks

The basic covers are Death by Accident andPermanent Disability by Accident. These canbe combined with the following optional covers:

Daily Hospital Indemnity,Daily Home Leave Indemnity,Broken Bones,BurnsSurgical Interventions,Medical Expenses andCritical Illness Indemnity.

3. World Business Travel Insurance

Covered RisksThe basic covers are Emergency Medical Expenses occurredduring business travels by the employees. The optional coversare:

24 hours Medical Assistance: Telephone Medical Advice Medical Service Provider Referral Arrangements of Appointments with Doctors Arrangements for Hospital Admission Emergency Medical Transportation Medical Repatriation Body Repatriation Reimbursement of Coffin Expenses Loss of Checked- In Luggage Delay of Checked-In Luggage Third Party Personal Liability Abroad (bodily injury) Bail Bond (following a car accident)

4. Life Insurance

Covered Risks

Basic covers are Death by Any Cause andPermanent Disablement. They can be extendedwith:

Daily Hospital Indemnity, Broken Bones Indemnity, Surgical Interventions Indemnity

5. Health Insurance

Covered Risks

The purpose of the health Insurance is to insure medicalcare at high standards. The covers may be:

Medical Care Telephone Medical Advice Emergency Medical Care Emergency Transportation Laboratory Tests Dental Care Maternity Indemnity (all conditions related to thestate of pregnancy or childbirth are excluded onthe Personal Accidents, Life or Travel insurancepolicies) Emergency Evacuation Repatriation to country of residence

6. Major Exclusions

Intentioned bodily injuries, suicide or suicidal tentativeof the insured person;

Bodily injuries caused by insured person’s participationin criminal action, riot, war;

Bodily injuries produced while under the influence ofalcohol, drugs or medicines that were not prescribed bya medical authority;

Bodily injuries produced while participating in anyprofessional sports;

All sicknesses having first manifested and notdefinitely cured before the period of insurance;

Illness, death, loss of expense attributable to HIVand/or AIDS;

Cosmetic surgery, apart from reconstructive surgeryrequired by a covered accident;

Ophthalmologic care, eye glasses, dental care (Exceptfor Health Insurance);

The pregnancy of an insured person within 3 months ofexpected date of birth (except for Health Insurance)

7. Claims Procedures

• Written notice of the event• Employment document• Identification document• Legalised copy of the Death Certificate in case of death)• Legalised copy of the Inheritor Certificate in case there is no

named Beneficiary on the policy• Specific Claims Declaration• Copy of the police / fire department etc. Report, if the case• Copy of the Labour Protection Authority findings in case of a

labour related accident• Medical documents (certificates, admission / release from the

hospital note, medical leave certificate etc.)• Legalised copy of the permanent disablement certificate, if

the case• All medical expenses bills and invoices, if the case• Bank account of the Beneficiary / Insured

8. Recommendations & Observations

• Conclusion of insurance policies in foreign currency

• Different groups of employees may be provided with different kinds of benefits and limits of indemnity

• Civil Firefighters must be covered for “professional diseases, accidents and death during or caused by their attributions during interventions” according to Government Ordinance no. 60 / 1997, art. 40.

Glossary

• Accident - any occurrence due to a fortuitous,

violent and external action that causes bodily injury

that can be set objectively

• Illness - any functional or organic modification of

the normal status, showing signs for the first time after

the beginning of the insurance. Pre-existing illnesses

and that were not cured, are excluded from insurance.

• Deductible - part of loss that lays on the Insured.

Thank you!