Critical
Five Plan
This policy from Combined Insurance offers protection for you and your family in the event of a serious illness.Key
Features
Document
Customer Services Freephone: 0800 169 7733 Main switchboard: 020 8546 7733 Office hours: Monday to Friday, 9am to 6pm E-mail [email protected] Website www.combinedinsurance.co.uk HeadquartersThe ACE Building 100 Leadenhall Street London
EC3A 3BP
Combined Insurance is a trading name used by The ACE Group of Companies including ACE European Group Limited (AEGL) & ACE Europe Life Limited (AELL). Combined Insurance’s general insurance products are provided by AEGL and its life assurance and permanent health products by AELL. AEGL (company number 1112892) & AELL
Contents page
Critical Five Plan 5
• Its aims
• Your commitment • Risk factors
The cover we provide 6
• What is the Critical Five Plan? • What conditions are covered? • How much does the policy pay out? • What other features are there? • Who can the plan cover? • Can children have cover?
• After the policy starts, is there anything I need to do?
What we do not cover 9
• When will the policy not pay out?
Paying your premiums 10
• How much does the policy cost?
Ending or changing your cover 10
• When will the policy end? • Your right to cancel • Our right to cancel
Making a claim 12
Complaints procedure 12
Financial Services Compensation Scheme 12
Other important information 13
• Terms and conditions • Tax
• Law
• A guide to critical illness cover
Summary of benefits 14 Personal example 15
Important information
Customer Services Freephone: 0800 169 7733 E-mail: [email protected] Website: www.combinedinsurance.co.ukFinancial Ombudsman Service
Phone: 0800 023 4567 or 0300 123 9 123 E-mail: [email protected] Website: www.financial-ombudsman.org.uk
Its aims
The policy aims to do the following.
• Provide the amount of cover you choose.
• Pay out a lump sum if you are diagnosed with a critical illness that meets our definition and then survive for at least 28 days. We only cover the critical illnesses we define in our policy and no others. Your policy ends after we pay the lump sum.
Your commitment
You must do the following.• You must give us any important information about you which may affect our decision about the cover we offer you or the level of premium we charge. If you do not, it could mean that we will not pay any claims or that we may cancel your cover. You should not assume that we will write to your doctor – it is your responsibility to fill in the Application Form accurately.
• You must pay the regular premium during the period of the cover. You can pay your premiums every month, three months, six months or year.
• You should tell us about any claim within the time limits set out in the Policy Provisions.
Risk factors
The policy carries the following risks.
• If you stop paying your premiums your cover will end 30 days after the date you should have paid your premium.
• We will not pay out in the circumstances described in this booklet under ‘When will the policy not pay out?’
• The policy has no cash-in value at any time.
• Your premium may increase or decrease when we review our premium rates (which we do every year). Your premium will only change if we change the premiums of all groups of similar policies. We will give you at least 60 days’ notice if we want to change your premium.
This document explains the Critical Five Plan. Please read it.
Did you know that?
• Every five minutes someone in the UK has a stroke. That’s an estimated 150,000 people every year. (Information from the Stroke Association, 2009.)
• It is estimated that more than one in three people will develop some form of cancer at some point during their lifetime.
(Information from Cancer Research UK, 2006.) • Every year around 146,000 people suffer
a heart attack. There are 1.4 million people
over 35 in the UK who have survived a
heart attack. (Information from British Heart Foundation, 2008.)
Today, you are more likely to survive a serious illness than to die, but the effect on your life can be significant.
The Critical Five Plan can help with the financial strain for you and your family by providing a tax-free lump-sum. You could pay for medical expenses, cut your mortgage or take a family holiday – it’s up to you.
You can also use the Best Doctors® service – a leading service providing medical advice.
The cover we provide
What is the Critical Five Plan?
This policy pays out a lump-sum if you are diagnosed with a critical illness that meets our definition after the policy has been in force for 90 days and then survive for at least 28 days. We only cover the critical illnesses we define in our policy and no others. See below for the full list of critical illnesses we cover.
Other important facts about your Critical Five Plan.
• You choose the level of cover you need – the amount of the lump sum we pay out after a valid claim. Nine levels of cover are available. • You may take out this policy if you are between 16 and 64 years old. • You must have been living in the United Kingdom for tax purposes
for at least 12 months before you take out your cover. You must then continue to live in the United Kingdom for at least 40 weeks of any 52-week period after that.
• You can continue your cover until your 70th birthday if you do not make a claim. Children’s cover ends on their 16th birthday.
• After we pay the lump sum, your policy ends and you pay no more premiums.
• You must pay regular premiums to keep your cover going.
What conditions are covered?
The complete list of conditions we cover is set out below. • Cancer (depending how severe it is).
• Coronary artery bypass grafts with surgery to divide the breastbone.
• Heart attack.
• Kidney failure that needs dialysis treatment.
• Stroke that results in permanent symptoms.
Please remember that the heading of each critical illness is only a guide to what we cover. For example:
• we do not cover some types of cancer; and
• to make a claim for some illnesses, you need to have permanent symptoms.
• to make a claim for heart attack you need to have specific symptoms.
How much does the policy pay out?
The policy pays out a lump-sum. You decide how much you would like this to be when you take out the policy. The summary of benefits table shows all the possible levels of cover.
Cancer benefits are double those paid for other conditions under
The personal example on page 15 shows the amount of cover and the premium payment you have chosen.
What other features are
there?
Best Doctors‰
While your policy is in force, you have access to leading medical advisory service Best Doctors‰if you suffer from one of the following conditions.
• AIDS • Alzheimer’s disease • Blindness • Cancer • Cardiovascular conditions • Coma • Deafness • Kidney failure • Loss of speech
• Major organ transplant • Motor neurone disease • Multiple sclerosis • Paralysis
• Parkinson’s disease • Severe burns • Stroke
You will have access to:
Best Doctors InterConsultation™ service
Best Doctors will pick an expert from a database of over 50,000 specialists worldwide to review your case and help answer two questions.
• Is your diagnosis correct?
• What are the best treatment options? Best Doctors FindBestDoc™ and FindBestCare® services
What we do not cover
When will the policy not pay out?
We will not pay for any claim for you or your children resulting directly or indirectly from the following.
• An illness that does not meet our definition of one of the critical illnesses we cover. For example, we do not cover some types of cancer.
• Inappropriate use of alcohol or drugs, including:
• taking an overdose of drugs, whether legally prescribed or not; and • taking controlled drugs (as defined by the Misuse of Drugs Act
1971) other than in line with a legal prescription. • Bodily injuries.
• Conditions excluded by name or specific description on an endorsement.
• Infection with human immunodeficiency virus (HIV).
• Conditions due to any acquired immune deficiency syndrome (AIDS).
• Pre-existing conditions.
• Unreasonable failure to ask for or follow medical advice. As well as these exclusions, we will also not pay if:
• the condition or any initial consultation with symptoms that leads to its diagnosis happens:
• before your policy has been in force for 90 days or more; or • within 10 days of reinstating a policy that had previously ended; • you die within 28 days of the diagnosis of the critical illness; • you live outside of the UK for more than 12 weeks in any
52-week period;
• you do not tell us about your claim within six months of your diagnosis or surgery, or as soon after that is reasonably possible; • we do not receive medical reports and evidence from a suitably
qualified consultant physician or hospital in Europe, the United States of America, Canada, Australia or New Zealand (this evidence must be in a form which our Chief Medical Adviser approves); or • you do not tell us the information we ask for when you take out your
policy. You should not assume that we will write to
your doctor, it is your responsibility to fill in the Application Form properly.
All these exclusions apply to any child named on your cover. access to these services at all times. If we end our arrangements with
Best Doctors, we will write to you with a full explanation, giving as much notice as is possible. We will then do our best to find a suitable
replacement service.
Best Doctors, InterConsultation, FindBestDoc and FindBestCare are registered trademarks and service marks of Best Doctors, Inc. in the United States and other countries.
Who can the plan cover?
You can apply for the plan to cover: • just you; or• you and any eligible children as described below.
Can children have cover?
Yes. We can cover your children from age three up to their 16th birthday at no extra cost. You can include your children on your policy when you take it out.
While your policy is in force, we can consider any of your children at no extra cost. Please see the Policy Provisions for instructions on how to add children after you have taken out your cover.
The amount we pay for a child diagnosed with a critical illness we cover is 50% of your benefit.
We only pay one claim for each child then cover for that child will end. However, cover will continue as normal for you and any other children covered under your policy.
After the policy starts, is there anything I need
to do?
We will send you confirmation of your policy in the post together with your Policy Schedule. This will include some details about your personal circumstances which you will need to check. If the details are not
correct, you must tell us immediately.
Paying your premiums
How much does the policy
cost?
You pay a regular premium to keep your cover in force.
The amount you pay depends on:
• personal details – for example, your age and whether you smoke; and
• the level of cover and payment option you choose.
You can pay your premiums every month, every three months, every six months or every year. You will have to pay insurance premium tax on all premiums. This is currently 5%, but may change.
If you stop paying your premiums, your cover will end 30 days after the due date of the unpaid premium. The policy has no cash-in value at any time.
We will review your premiums every year. Please see the Policy Provisions for full details. Your premium will only change if we change the premiums of all groups of similar policies. We will give you at least 60 days’ notice if we want to change
your premium.
Ending or changing
your cover
When will the policy end?
Your policy will end when:• you choose to cancel the policy; • you reach age 70;
• you stop paying premiums;
• we pay you one of the benefits listed under sections A1, A2 or B on the
• you die;
whichever happens first.
An eligible child’s cover will end when: • your cover ends;
• they no longer qualify as an eligible child;
• we pay one of the benefits listed under sections C1, C2 or D on the summary of benefits (on page 14); or
• they die;
whichever happens first.
Your right to cancel
If you are not satisfied with your policy for any reason, you may cancel it within 30 days of the date we issue it by phoning us on 0800 169 7733 or by contacting our Customer Services Department in writing. You can find full contact details on the back page.
If this happens, we will refund any premiums you have paid.
If you cancel the policy after this 30-day period, it will stay in force until the next premium is due and we will then cancel it.
Our right to cancel
We will give you 60 days’ notice if we want to cancel your policy. This will not affect any claim which starts before the cancellation date. We will not cancel your policy just because of:
• any change in your health or physical condition; or • the amount of benefit we pay you for valid claims. Some examples of why we may cancel your policy are if:
• within the first 30 days of taking cover, we find that we have allowed you to go over the maximum amount of cover we allow;
• you fail to reveal to us any material information you could reasonably have been expected to reveal;
• you act with anyone else to get cover from us in circumstances where we would not normally have granted you cover;
• we decide to cancel all policies which have been issued under the Critical Five Plan; or
• within the first 90 days of taking cover, we find that your medical details do not meet the policy’s requirements. In this case, we will return all your premiums.
Key Features Document 13
Making a claim
If you have any questions or want to make a claim, please contact the Customer Services Department on 0800 169 7733. You can also contact us by letter or e-mail. You can find full contact details on the back page. Please quote your policy number and, if possible, a daytime phone number.
Complaints procedure
We are dedicated to providing a high-quality service and want to maintain this at all times. If you are not satisfied with our service, please contact the Customer Services Department on 0800 169 7733 so we can deal with your complaint as soon as possible. You can also contact us by letter or e-mail. You can find full contact details on the back page. If you are not satisfied with our response to a complaint, please write to the Complaints Manager. They will review the complaint to see if our decision was correct and that we gave you a clear explanation. If you find our final decision unacceptable, you can ask the Financial
Ombudsman Service to investigate. Financial Ombudsman Service
Exchange Tower, Harbour Exchange Square, London, E14 9SR
Phone: 0800 023 4567 or 0300 123 9 123 E-mail: [email protected] Website: www.financial-ombudsman.org.uk
This does not affect your right to take legal action at a later stage.
Financial Services Compensation
Scheme
If we cannot pay all claims due to customers, you may be entitled to compensation under the Financial Services Compensation Scheme (FSCS).
Their contact details are:
Financial Services Compensation Scheme
10th Floor Beaufort House, 15 St Botolph Street, London, EC3A 7QU
Phone: 020 7741 4100 Website: www.fscs.org.uk
Other important
information
Terms and conditions
This Key Features Document gives a guide to the Critical Five Plan. It does not include all the definitions, exclusions, terms and
conditions.
If you would like a copy of the full terms and conditions, please contact us direct.
Tax
Present UK law and HM Revenue & Customs practice means that:
• you pay Insurance Premium Tax on your premiums; and
• benefit payments are free of UK income tax and capital gains tax.
Law
The law of England and Wales applies to the policy.
A guide to critical illness
cover
The ABI (Association of British Insurers) give general information about
critical illness cover in their booklet ‘A guide to critical illness cover’.
You can ask us for a copy or you can get a copy at www.abi.org.uk or by writing to: The Association of British Insurers,
There are nine benefit levels. (We have circled the option you chose.)
Please refer to your Policy Provisions for a full definition of each condition
1 2 3 4 5 6 7 8 9
Section A
A1 – Cancer
We will pay a lump sum of:
£10,000 £20,000 £30,000 £40,000 £50,000 £60,000 £70,000 £80,000 £90,000
A2- Heart attack, kidney failure or stroke
We will pay a lump sum of:
£5,000 £10,000 £15,000 £20,000 £25,000 £30,000 £35,000 £40,000 £45,000
Section B
B - Coronary artery bypass grafts
We will pay a lump sum of:
£5,000 £10,000 £15,000 £20,000 £25,000 £30,000 £35,000 £40,000 £45,000
Benefits for eligible children
Section C
C1– Cancer
We will pay a lump sum of:
£5,000 £10,000 £15,000 £20,000 £25,000 £30,000 £35,000 £40,000 £45,000
C2- Heart attack, kidney failure or stroke
We will pay a lump sum of:
£2,500 £5,000 £7,500 £10,000 £12,500 £15,000 £17,500 £20,000 £22,500
Section D
D- Coronary artery bypass grafts,
We will pay a lump sum of:
Summary of benefits
Important conditions for all claims under all sections
• The covered condition, its diagnosis and any initial consultation with symptoms that lead to it being diagnosed must take place after your policy has been in force for at least 90 days.
• You must survive for at least 28 days after diagnosis or surgery. • We will pay benefit for the first valid claim you make. We will pay
this only once.
