The best way to predict the

future is to create it
Einstein
The Faculty of I nternational Business and
Economics
Employee Benefits
insurance policies
Cosmin Jolde, 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 Companys employee
Beneficiary - the person designated to cash the indemnity
in the event of the Insureds 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 persons 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!