CAIB 1 - Chapter 8 Questions and Answers

What is the need for travel insurance? - Answer- Provincial health plans don't cover certain costs - travel insurance provides coverage for these additional costs Discuss provincial medical plans in Canada - Answer- Most provinces have a reciprocal agreement to reimburse the province that provided the medical costs where the injury occurred What costs do medical plans NOT cover? - Answer- Ambulance charges, return of vehicle, family visitation Discuss provincial medical plans outside of Canada - Answer- provincial plans only pay the fees outlined in their plan regardless of fees charged where the injury or illness occurred or any other costs How can Insurance Policies be purchased? - Answer- policies are available for those travelling for both pleasure & business, can be purchased by individuals or families, can be purchased as a single trip or as an annual policy What is the Insuring Agreement in Travel Insurance Policies? - Answer- the insurer agrees to insure the named insured against sickness or injury sustained outside of their province or territory while on a trip What are 2 requirements to qualify for travel insurance? - Answer- must be a resident of canada & be covered under a provincial health plan When does insurance commence? - Answer- when the insured leaves their province following the application date and effective date When does insurance expire for Single Trips & Multi Trips - Answer- Single Trip: the return date on the policy. Multi Trip: the date the insured returns or 30 days after departure Define Insured - Answer- the applicant for insurance, their spouse and dependant children Define Insured Applicant - Answer- a Canadian resident under 65 who is insured under a gov't health plan and who has been named on the policy Define Spouse - Answer- legal spouse of the insured applicant residing in canada or common law spouse living with the insured for 1 year Define Dependant Children - Answer- any natural, step, adopted or legal ward of the insured applicant and who lives in canada Discuss Dependant Children Requirements - Answer- must be one of the following: under 20 years old, unmarried and receiving full support. Under 26 years old, unmarried, receiving full support and attending school or receives full support due to mental or physical conditions Define Extended Family - Answer- a dependants child, their spouse, grandparent Define Accident - Answer- an unforeseen and unintended occurrence due to external, violent, sudden, fortuitous causes beyond the insureds control Define Injury - Answer- Bodily injury caused be an accident - not a personal injury Define Sickness - Answer- bodily sickness or disease contracted and commencing after the policy is issued and while it is still in effect Define Supervised Condition - Answer- a diagnosed condition, illness or injury for which the you require diagnostic testing, investigation or where a referral is not yet complete and is controlled with medication without change for 3 months before application date if under 60; atleast 6 months if over 60, or if you have taken medication for cardiac conditions within 6 months What is the maximum payment in insurance policies? - Answer- $1,000,000 Canadian Discuss Emergency Hospital Insurance - Answer- this section will reimburse the client for the necessary emergency medical & health care expenses following insured events that fall within the scope of coverage while confined to a hospital Discuss Emergency Medical Insurance - Answer- if injury or sickness of an insured requires treatment on an emergency basis the insurer will reimburse actually reasonable & necessary expenses Identify 3 expenses insured as an outpatient - Answer- emergency room charges, treatment by a legally qualified surgeon or physician, x-rays and lab examinations required for diagnostic purposes Discuss Emergency Dental - Answer- if an insured suffers injury to whole or sound teeth by an accident the insurer will reimburse the expense of necessary treatment up to $2500 per incident Describe what teeth will be insured and what type of teeth will not be insured - Answer- Sound teeth will be insured. Sound teeth include teeth where some part of the tooth is natural including capped teeth and teeth that have undergone root canal. Teeth considered not insured include f