Pensioners Personal Accident
Insurance Plan
Policy Wording
What’s inside...
Introduction
3
Your Cover
9-10
Claims Procedure
11
Contents
Page No Pensioner personal accident insurance plan 3-4 Keyfacts 5-6 Certificate of insurance 7 Definitions 8 Your cover 9-10 Important information 11 Conditions of insurance 12 Our customer care policy 13
Table of benefits 14
Pensioners personal accident
insurance plan
When accidents happen
• Every year around 6 million people will attend an Accident & Emergency Unit as a result of an accident. *
• Every hour, in this country, 2 people die as the result of an accident. *
* Source: The Royal Society for the Prevention of Accidents. A Pensioners Personal Accident Insurance Plan cannot prevent accidents, but it can provide valuable benefits which will help to relieve the consequences of serious accidents.
• It is not designed to replace other personal insurances but provides supplementary benefits.
• Benefits are paid, tax free, in addition to any other insurance payments you may receive.
• It can provide many benefits not covered by other insurances. Loss of limb or sight, for example.
Pensioners personal accident insurance
provides cash benefits
Depending upon which Plan you select, a Pensioners Personal Accident Insurance Plan could provide:
• Up to £100,000 if an accident leaves you blind or disabled, through the loss of a limb or loss of speech or hearing.
• A wide range of benefits for other permanent disabilities resulting from accidents. For example:
– Up to £10,000 for the loss of use of a small finger – Up to £20,000 for the loss of use of an ankle.
• Up to £2,500 for accidental death.
• £50 for each night you have to stay in hospital as a result of an accident (up to a maximum of £500).
• £150 for a fractured arm suffered as a result of an accident.
• £300 for a fractured leg suffered as a result of an accident.
The benefits indicated above are for Plan number 4. You have the option to select a different Plan which
provides the same cover but at different benefit levels. Please refer to page 5 for the Keyfacts Policy Summary.
This booklet has been made available to you by your pension provider but they offer no advice, assistance or recommendation.
Frequently asked questions about the plan
How much does it cost?
The premium you pay will depend on the level of cover you select.
• Plan 1 provides a benefit level of £10,000 for accidental loss of limb, sight, speech and the corresponding benefits.
• Plan 4 (the highest available) provides a benefit level of £100,000 for accidental loss of limb, sight, speech and the corresponding benefits.
You may select cover just for yourself or, if you require, the cover may be extended to include your spouse/partner. Full details of the various Plans available and their premium levels are shown on the Application Form.
What are the benefits?
Full details of the benefits payable by each Plan option are stated in the Table of Benefits section of the Certificate of Insurance (page 14) within this booklet.
The benefits shown in the Table of Benefits are applicable to yourself and/or your spouse/partner (if insured).
Who can join?
All pensioners under the age of 79 can join but please note that cover will cease in the month that you reach the age of 80 years. Your spouse/partner must be aged under 79 years.
How can I join?
Simply choose the Plan that most suits your particular needs and complete the Application Form enclosed with this booklet. You should then send the Application Form to your pensions administration department.
You must retain this booklet, in a safe place, for your future reference. The Certificate of Insurance contained within this booklet and the Schedule will form your policy. Your Schedule will be sent to you once your Application Form has been processed.
When can cover commence?
Cover will commence on the first day of the month after your completed Application Form has been received by your pensions administration department.
How are premiums paid?
How are claims dealt with?
You deal direct with Ageas Insurance Limited. The procedure to follow is shown in the Certificate of Insurance within this booklet.
What is not covered?
Your Cover (pages 9 and 10) within this booklet fully describes what is not covered. Please read the Certificate of
Insurance carefully and ensure that you fully understand it.
Can I cancel the cover?
There is a 14-day cooling off period from the date this Policy is issued. During this period, you may return the Policy to us if it does not meet your requirements and we will give you a full refund of the premium you have paid provided you have not made a claim or intend making a claim in the future.
We will make a charge of 20% of the annual Policy premium if you have made or reported a claim.
Once the insurance is in force you can cancel your cover at any time by giving written notice to your pension administration department. Cover will continue until the end of the month for which you have paid a premium.
Who do I ask if I have any questions?
You may contact Ageas Insurance Limited in writing or by telephone.
Our address is 6th Floor, One America Square, 17 Crosswall, London EC3N 2LB.
Telephone: 0370 241 6182
Calls to 0370 numbers will cost no more than calls to 01 or 02 numbers in the UK.
Will this product meet my demands and needs?
The product meets the demands and needs of those who wish to purchase Personal Accident insurance.
The next step to ensure your protection:
Simply choose the Plan that most suits your particular needs and complete the Application Form that is enclosed with this booklet. You should then send the Application Form to your pensions administration department.
Cover will commence on the first day of the month after your completed Application Form has been received. You will be sent a Schedule confirming the level of cover in force. Premiums will be automatically deducted from your pension. Deductions begin on the first available pension payment day after your Application Form is processed.
Note: Once your Application Form has been processed you will be sent your individual Schedule confirming the cover you have chosen. When you receive your Schedule, please keep the Schedule and this booklet containing the Certificate of Insurance together in a safe place. You will need this for your future reference and as your evidence of having joined the Plan. Please read the following Certificate of Insurance carefully and ensure that the cover provided meets your requirements.
Data Protection
Please read this notice carefully as it contains important information about our use of personal information. Personal information means any information we have about
you and the other people insured under your policy, some of which is known as “sensitive personal data”. This will include information relating to health issues and criminal convictions. We need to use sensitive and personal information to provide you with quotes, arrange and manage your policy and to provide the services described in your policy documents (such as, including handling underwriting and dealing with claims). We are part of the Ageas group of companies. We may share personal information with other companies in the group for any of the purposes set out in this notice. We will also use personal information to assess your insurance application We may have to share personal information with other insurers, statutory bodies, regulatory authorities, our business partners or agents providing services on our behalf and other authorised bodies if we need to do this to manage your policy with us including settling claims, for underwriting purposes, for management information purposes, if we are required or permitted to do this by law (for example, if we receive a legitimate request from the police or another authority); and/or if you have given us permission.
We may use personal information and information about your use of our products and services to carry out research and analysis. We will only use personal information to market our products and services to you if you agree to this. We may research, collect and use data about you from publically available sources including social media and networking sites. We may use this data for the purposes set out in this notice, including fraud detection and prevention. We may record or monitor calls for training purposes, to improve the quality of our service and to prevent and detect fraud. We may also use CCTV recording equipment in and around our premises.
You are entitled to receive a copy of any personal
information we hold about you. If you would like to receive a copy, or if you would like further information on, or wish to complain about, the way that we use personal information, please write to the Data Protection Officer at Ageas Insurance Limited, giving your name, address and insurance policy number.
If we change the way that we use personal information, we will write to you to let you know. If you do not agree to that change in use, you must let us know as soon as possible by writing to us at the address above.
You have the right to complain to the Information
Commissioner’s Office at any time if you object to the way we use your personal information. For more information please go to www.ico.org.uk.
The Law applicable to this contract
This contract will be governed by English Law, and you and we agree to submit to the non-exclusive jurisdiction of the courts of England and Wales (unless you live in Jersey in which case the law of Jersey will apply and the Jersey courts will have exclusive jurisdiction).
Keyfacts
The following information provides a guide to the cover provided. It is however only a summary of the terms of cover and does not contain full details of the insurance policy terms, conditions and exclusions which are contained in the insurance policy itself. You should refer to your own policy document, your policy Schedule (which indicates operative sections) and any endorsements which apply to your own policy for full details of your cover. This insurance is underwritten by Ageas Insurance Limited.
Type of Insurance: Pensioners Personal Accident Insurance Plan.
Period of Cover: The policy will last for one month at a time providing the monthly premiums continue to be paid. We hope that you will be happy with your insurance policy. If, having examined it, you decide not to proceed, you have 14 days from the date you received your policy document to cancel the policy. To do this you should contact the intermediary or organisation that sold you your policy. Providing you have not made a claim and as long as no incidents have arisen that could result in a claim under the policy, we will refund any premium you have paid.
Making a Claim
When you become aware of an incident that could lead to a claim you must notify us as soon as reasonably possible by telephone, or in writing at the following address and request a claim form. You should then complete the claim form, sign it and return it to us as quickly as possible.
PA Claims, Travel Department, Ageas Insurance Limited, Ageas House,
Keyfacts - continued
How to complain
We are committed to treating our customers fairly. However, we realise that there may be times when things go wrong. If this happens, please use the most suitable contact from the following list.
For complaints about claims, contact the Customer Services Advisor at Ageas Insurance Limited on 0344 748 0103 or email personal.accident@ageas.co.uk
For complaints about policy administration and documents, contact the Head of Travel & Special Risks Underwriting at Ageas Insurance Limited on 0370 241 6182 or email patravel. underwriting@ageas.co.uk
If you are not happy with our final decision, you may be able to pass your complaint to the Financial Ombudsman Service. More information is available from us or the Ombudsman. The Financial Ombudsman Service is an independent organisation and will review your case.
Their address is:
Financial Ombudsman Service, Exchange Tower,
London E14 9SR.
Phone 0800 023 4567 if calling from a land line or 0300 123 9123 if calling from a mobile
You can visit the Financial Ombudsman Service website at www.financial-ombudsman.org.uk
Financial Services Compensation Scheme
We, Ageas Insurance Limited, are covered by the Financial Services Compensation Scheme (FSCS). If we fail to carry out our responsibilities under this policy, you may be entitled to compensation from the Financial Services Compensation Scheme. Information about the scheme is available at www.fscs.org.uk or by phone on 0800 678 1100 or 020 7741 4100.
Significant Features Significant Exclusions Sections of the Policy
and Benefits or Limitations that contain further details
Cover is available for you and your spouse/partner.
The policy provides compensation for accidental bodily injury that results in:
• Death
• Permanent partial disablement (loss or loss of use of hand, fingers, foot or toes)
• Loss of limb or limbs
• Loss of sight
• Loss of speech
• Loss of hearing
• Fracture of the main bones in the arm or leg
• Hospital benefit
Compensation for each night you stay as a hospital in-patient. (Up to a maximum of £500.)
Cover will not apply to anyone aged 80 or over.
The policy does not provide cover for bodily injury which arises from:
• the affect of alcohol or drugs
• committing criminal acts
• any form of sickness or disease
• existing muscular or skeletal injuries or conditions
• any form of flying other than as a passenger
• professional participation in sport
• suicide, attempted suicide or intentional self-injury
• any activity in the Armed Forces
• war or terrorist acts
• nuclear or radioactive contamination
• fractures resulting from osteoporosis or malignant disease
• admission to a nursing or convalescent home
Full details of these and the other policy exclusions are shown in the Certificate of Insurance under the heading ‘What is not covered’.
See ‘Loss of limb, speech, sight, hearing’ and ‘fracture’ under the section headed ‘DEFINITIONS’ in the Certificate of Insurance.
Certificate of Insurance
You (the Pensioner) have agreed to pay the premium and taxes due and we (Ageas Insurance Limited) agree to provide cover to you in the terms set out in this Certificate of Insurance and Schedule. The Schedule and Certificate of Insurance is evidence of a contract between us.
Certain words and phrases in the Certificate of Insurance and Schedule are defined and whenever they are used they will have the same meanings as given below. To help you identify them we have printed them in bold print.
On behalf of Ageas Insurance Limited.
François-Xavier Boisseau - CEO, Insurance Ageas Insurance Limited
Ageas House
Hampshire Corporate Park Templars Way
Definitions
You, your(s)
means the Pensioner or in the event of your death your legal representative.
We, us, our
means Ageas Insurance Limited.
Insured person
means: i you
ii your partner if a Pensioner and Partner option is selected as shown in the Schedule.
Bodily injury
means physical injury caused solely and directly by a sudden external unforeseen and identifiable accident event and shall include exposure to the elements.
Pensioner
means the pensioner named in the Schedule.
Pension Provider
means your previous employer who provides you with a pension and who arranges for your Pensioner
Personal Accident Plan premium payments to be made to us.
Expert medical specialist
means a person other than you or a member of your immediate family or an employee of yours who is qualified as a consultant in the branch of medicine to which the bodily injury relates.
Fracture
means the break of an elbow, wrist or one or more bones in the arm being either the Humerus, Radius or the Ulna or break of an ankle or one or more bones in the leg being either the Femur, Patella, Tibia or Fibula where a medical practitioner confirms established non-union.
Hospitalised
means an insured person being admitted to a hospital as an in-patient as a consequence of bodily injury for medical, surgical or other remedial attention, treatment or diagnosis by a medical practitioner.
Loss of hearing
means the total loss of hearing in one or both ears to the extent that the hearing loss in one or both ears is greater than 95 decibels across all frequencies using a pure tone audiogram that has lasted 52 consecutive weeks and that in the opinion of an expert medical specialist will not be recovered.
Loss of limb or limbs
means the permanent and complete loss of a limb or limbs by physical separation at or above the wrist or ankle or the permanent and complete loss of use of a limb or limbs that in the opinion of an expert medical specialist will not be recovered.
Loss of sight
means the permanent and total loss of sight that will be considered as having occurred:
i in both eyes if the insured person’s name is added to the Register of Blind Persons, or
ii in one eye if the degree of sight remaining after correction is 3/60 or less on the Snellen Scale (meaning that an insured person sees at 3 feet what they should see at 60 feet).
Loss of speech
means the complete loss of speech that has lasted for 52 consecutive weeks and which in the opinion of an
expert medical specialist will not be recovered.
Medical practitioner
means a person other than you or a member of your immediate family or an employee of yours
who is qualified and licensed to practice medicine.
Partner
means the person named in the Schedule being your spouse or partner who permanently resides with you.
Period of insurance
means the period shown in the Schedule.
Permanent partial disability
What is covered What is not covered
If an insured person suffers bodily injury as a result of an accident during the period of insurance which within 104 weeks of the date of the incident solely and independently of any other cause results in their death or injury we will pay you the benefit applicable to the Plan you have selected and as specified in your Schedule and in the Table of Benefits. If an insured person should disappear for a period longer than 52 consecutive weeks in circumstances which indicate that the insured person has sustained bodily injury from which we regard it as reasonable to believe that the insured person has died we will pay you the death benefit applicable to the Plan you have selected and as specified in your Schedule and in the Table of Benefits.
In addition if an insured person is hospitalised as a direct result of bodily injury sustained in an accident during the period of insurance we will pay you the hospitalisation benefit shown in the Table of Benefits for each night the insured person is hospitalised.
We will not pay benefit for bodily injury directly or indirectly caused by or contributed to or arising from:
i an insured person being under the influence of or being affected by alcohol or drugs other than drugs taken under the direction of a medical practitioner
ii an insured person committing a criminal or unlawful act iii bodily injury directly or indirectly consequent upon
sickness, illness or disease not itself resulting from sudden violent and visible external means during the period of insurance
iv an insured person’s muscular or skeletal condition or injury unless caused directly by sudden, violent and visible external means during the period of insurance and not aggravated by any previous muscular or skeletal condition or injury
v an insured person committing or attempting to commit suicide or intentional self-injury
vi an insured person engaging in any sport in a professional capacity
vii an insured person engaging in flying except as a fare paying passenger in a licensed passenger aircraft viii an insured persons participation in active service in
any armed forces the Territorial Army and other reserve services whether war be declared or not
ix any fracture resulting from osteoporosis or a malignant disease where the condition has been diagnosed prior to the fracture occurring
x an insured person being admitted to a mental institution or an establishment primarily for the treatment of psychiatric conditions, drug addiction or alcoholism, the psychiatric unit of a hospital or a nursing, rest or convalescent home
xi any act of war, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power
What is covered What is not covered
xii any act of terrorism of any kind including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons whether acting alone or on behalf of or in connection with any organisation(s) or government(s) committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public or any section of the public in fear
Important information
Claims procedure
When you become aware of an incident that could lead to a claim you must notify us as soon as reasonably possible in writing or by telephone at the address below and request a claim form. You should then complete the claim form, sign it and return it to us as quickly as possible.
PA Claims, Travel Department, Ageas Insurance Limited, Ageas House, Hampshire Corporate Park, Templars Way, Eastleigh Hampshire SO53 3YA.
Tel 0344 748 0103.
Email personal.accident@ageas.co.uk
Claims conditions
i An insured person must place themselves under the care of a medical practitioner and follow his/her advice. ii An insured person must at their expense provide us with
any reports, certificates, information and evidence that we ask for and do so in the manner we request.
iii If we request it, an insured person must undergo a medical examination(s) at our expense.
iv Any disability that exists or existed prior to an incident will be taken into account in considering a claim under this insurance.
v If a benefit is payable for the loss of, or loss of use of, a whole limb or member of the body then no benefit is payable in respect of parts of that limb or member. vi If a death benefit becomes payable we will make payment
to you or your partner as the case may be or otherwise to your legal representative.
vii No amount payable will bear interest.
viii We will not pay any claim if it is in any respect dishonest or fraudulent.
Cooling off period
There is a 14-day cooling off period from the date this Policy is issued. During this period, you may return the Policy to us if it does not meet your requirements and we will give you a full refund of the premium you have paid provided you have not made a claim or intend making a claim in the future. We will make a charge of 20% of the annual Policy premium if you have made or reported a claim.
Data protection
Please read this notice carefully as it contains important
We need to use sensitive and personal information to provide you with quotes, arrange and manage your policy and to provide the services described in your policy documents (such as, including handling underwriting and dealing with claims). We are part of the Ageas group of companies. We may share personal information with other companies in the group for any of the purposes set out in this notice. We will also use personal information to assess your insurance application We may have to share personal information with other insurers, statutory bodies, regulatory authorities, our business partners or agents providing services on our behalf and other authorised bodies if we need to do this to manage your policy with us including settling claims, for underwriting purposes, for management information purposes, if we are required or permitted to do this by law (for example, if we receive a legitimate request from the police or another authority); and/or if you have given us permission.
We may use personal information and information about your use of our products and services to carry out research and analysis. We will only use personal information to market our products and services to you if you agree to this. We may research, collect and use data about you from publically available sources including social media and networking sites. We may use this data for the purposes set out in this notice, including fraud detection and prevention. We may record or monitor calls for training purposes, to improve the quality of our service and to prevent and detect fraud. We may also use CCTV recording equipment in and around our premises.
You are entitled to receive a copy of any personal
information we hold about you. If you would like to receive a copy, or if you would like further information on, or wish to complain about, the way that we use personal information, please write to the Data Protection Officer at Ageas Insurance Limited, giving your name, address and insurance policy number.
Conditions of insurance
Observance
Our liability is conditional on the observance of the terms and Conditions of this insurance.
Assignment
Unless we agree to do so we will not be bound to accept or be affected by any trust, charge, lien assignment or other dealing with or relating to this insurance.
Cancellation
1 We reserve the right to cancel the insurance by giving you 30 days notice in writing at your last known address. Valid reasons may include but are not limited to:
i Where we suspect fraud on this or any other related policy.
ii Where a misrepresentation has been made that means we longer wish to provide cover.
2 You may cancel the insurance by giving written notice to your pensions administration department. Your cover will cease on the last calendar day of the month immediately following your last premium payment.
3 In the event of your death, cover for your partner (where such cover applies) will remain operative until the last calendar day of the month immediately following your last premium payment.
4 All cover will cease on the last calendar day of the month following your 80th birthday.
5 If we cease to operate the Pensioners Personal Accident Plan facility with your pension provider, you will be notified and your cover will cease on the last calendar day of the month, following your last premium payment.
The Contracts (Rights of Third Parties)
Act 1999
It is not intended that The Contracts (Rights of Third Parties) Act 1999 should confer any additional rights under this insurance in favour of any third party.
Jurisdiction
This contract will be governed by English Law, and you and we agree to submit to the non-exclusive jurisdiction of the courts of England and Wales (unless you live in Jersey in which case the law of Jersey will apply and the Jersey courts will have exclusive jurisdiction).
Misrepresentation or misdescription
This Policy may be voidable in the event of misrepresentation or misdescription of answers you give to any questions we ask.
Arbitration
If any dispute arises between you and us over the amount payable it will be referred to an arbitrator jointly appointed by you and us in line with the law at the time. The decision of the arbitrator will be final and binding on both you and us and judgement of the award made by the arbitrator may be entered in any court that has jurisdiction. Whoever loses the arbitration will pay the costs of arbitration. If the decision is not totally in favour of either you or us, the arbitrator will decide who will pay the costs.
Language
Unless agreed otherwise, the contractual terms and conditions and other information relating to this contract will be in the English Language.
Ageas Logo
Our customer-care policy
We are committed to treating our customers fairly. However, we realise that there may be times when things go wrong. If this happens, please use the most suitable contact from the following list. Please tell us your name and your claim number or policy number and the reason for your complaint.
We may record phone calls.
For complaints about claims, contact Customer Services Advisor
Ageas Insurance Limited Ageas House
Hampshire Corporate Park Templars Way Eastleigh Hampshire SO53 3YA Phone: 0344 748 0103 Email: personal.accident@ageas.co.uk
For complaints about policy administration and documents, contact the Head of Travel & Special Risks Underwriting
Ageas Insurance Limited 6th Floor
One America Square 17 Crosswall London EC3N 2LB Phone: 0370 241 6182 E-mail: patravel.underwriting@ageas.co.uk We promise to:
• acknowledge your complaint within five working days of receiving it;
• have your complaint reviewed by a senior member of staff;
• tell you the name of the person managing your complaint when we send our acknowledgement letter; and
• respond to your complaint within 20 working days. If this is not possible for any reason, we will write to let you know when we will contact you again.
Financial Ombudsman Service
You may be able to pass your complaint to the Financial Ombudsman Service. The Financial Ombudsman Service is an independent organisation and will review your case. Their address is:
Financial Ombudsman Service Exchange Tower
London E14 9SR
Phone 0800 023 4567 if calling from a land line or 0300 123 9123 if calling from a mobile.
You can visit the Financial Ombudsman Service website at www.financial-ombudsman.org.uk
The ombudsman’s service is available to personal policyholders. Their service is also open to charities, trustees and small businesses with income or assets within defined limits. You can get more information from us or the ombudsman.
If you take any of the action mentioned above, it will not affect your right to take legal action.
Regulation
We, Ageas Insurance Limited is authorised and regulated by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.
You can check their website (www.fca.org.uk), which includes a register of all the firms they regulate. Or you can phone them on 0800 111 6768.
Financial Services Compensation Scheme
We, Ageas Insurance Limited, are covered by the Financial Services Compensation Scheme (FSCS).
Table of benefits
This Table of Benefits should be read in conjunction with your Schedule. Benefits payable for you and your partner (if insured)
Condition resulting from the bodily injury: Plan 1 Plan 2 Plan 3 Plan 4
Death £2,500 £2,500 £2,500 £2,500 Loss of sight £10,000 £20,000 £50,000 £100,000 Loss of speech £10,000 £20,000 £50,000 £100,000 Loss of hearing: • in both ears • in one ear £10,000 £2,500 £20,000 £5,000 £50,000 £12,500 £100,000 £25,000 Loss of limb or limbs £10,000 £20,000 £50,000 £100,000 Permanent partial disability resulting in
loss of or loss of use of:
• one thumb
• one forefinger
• any other finger
• one big toe
• any other toe
• a shoulder or elbow
• a wrist hip knee or ankle
£2,000 £1,500 £1,000 £1,000 £500 £2,500 £2,000 £4,000 £3,000 £2,000 £2,000 £1,000 £5,000 £4,000 £10,000 £7,500 £5,000 £5,000 £2,500 £12,500 £10,000 £20,000 £15,000 £10,000 £10,000 £5,000 £25,000 £20,000 Fracture benefit • breakage of an arm • breakage of a leg £150 £300 £150 £300 £150 £300 £150 £300 Hospitalisation benefit
• per overnight stay up to a maximum of £500
£50 £50 £50 £50
Special provisions
1 If payment is applicable under more than one of the benefits as a result of a single accident the total benefit we will pay will not exceed the amount payable for loss of limb or limbs.
Ageas Insurance Limited
Registered office address
Ageas House, Hampshire Corporate Park, Templars Way, Eastleigh, Hampshire SO53 3YA www.ageas.co.uk
Registered in England and Wales No 354568
Ageas Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.
