9.

Employee Benefits
insurance policies

“The best way to predict the

future is to create it”
Einstein
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
1. Employee Benefits

Employee Benefits programs are flexible insurance

programs tailored on the specifics of the Human
Resources policy of each company.

Human Factor / Specific risks Romanian Insurance System

- death State Insurance:
- loss of work capacity - social health insurance system
- age - pension fund
- loss of working place - unemployment aid
Private Insurance:
- Personal Accidents
- Life
- Pension Funds
- Health
1. Employee Benefits

Guaranteed payment of the sum insured by

Insurance Protection the Insurance Company, in case of occurrence
of an insured event (accident, sickness, death
etc.)

- protection of staff
- benefit - fidelity of employees
- strong point in the negotiation of the Collective
Why Employee Benefits
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 and
Permanent Disability by Accident. These can
be combined with the following optional covers:
•Daily Hospital Indemnity,
•Daily Home Leave Indemnity,
•Broken Bones,
•Burns
•Surgical Interventions,
•Medical Expenses and
•Critical Illness Indemnity.
3. World Business Travel Insurance

Covered Risks
The basic covers are Emergency Medical Expenses occurred
during business travels by the employees. The optional covers
are:
• 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 and

Permanent Disablement. They can be extended
with:
• Daily Hospital Indemnity,
• Broken Bones Indemnity,
• Surgical Interventions Indemnity
5. Health Insurance
Covered Risks

The purpose of the health Insurance is to insure medical

care 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 the
state of pregnancy or childbirth are excluded on
the Personal Accidents, Life or Travel insurance
policies)
• Emergency Evacuation
• Repatriation to country of residence
6. Major Exclusions
➢ Intentioned bodily injuries, suicide or suicidal tentative
of the insured person;
➢ Bodily injuries caused by insured person’s participation
in criminal action, riot, war;
➢ Bodily injuries produced while under the influence of
alcohol, drugs or medicines that were not prescribed by
a medical authority;
➢ Bodily injuries produced while participating in any
professional sports;
➢ All sicknesses having first manifested and not
definitely cured before the period of insurance;
➢ Illness, death, loss of expense attributable to HIV
and/or AIDS;
➢ Cosmetic surgery, apart from reconstructive surgery
required by a covered accident;
➢ Ophthalmologic care, eye glasses, dental care (Except
for Health Insurance);
➢ The pregnancy of an insured person within 3 months of
expected 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!