Personal Accident Insurance Policy Summary. From 1st March 2013

Transcription

1 Personal Accident Insurance Policy Summary From 1st March

2 Personal Accident Who can apply for this insurance? Cover is available to members of HM Forces (except SAS or SBS) and civilians attached to or connected to HM Forces. Demands and Needs JBI Personal Accident insurance will meet the typical demands and needs of members of HM Forces who wish to insure for financial benefits in the event of suffering accidental bodily injury, needing emergency dental treatment or acquiring HIV from medical treatment. Please keep this summary with your insurance documents. Policy Summary This is a Policy Summary and does not contain the full terms and conditions of the cover, which can be found in the Policy booklet. It is important that you read the Policy booklet and Schedule carefully when you receive them. Insurer The policy is underwritten by a consortium of Lloyd s Syndicates on behalf of Kiln Syndicate 510, HCC International Insurance Company plc, Beazley Syndicate 3623, Arch Syndicate 2012, Brit Syndicate 2987 & Amlin Syndicate Type of Insurance and Cover This is a multi-section insurance. All sections are automatically included in the policy; you cannot opt in or out of particular sections. Section 1 - Personal Accident Section 2 - Hospital Cash Section 3 Dental Injury and Emergency Dental Treatment Section 4 Infection with HIV There are three levels of cover to choose from. Benefits per section vary according to the level of cover taken. Cover is available to individual applicants or you can select family cover. Family includes your spouse/ cohabitee (provided residing with you at the same address for at least six months) and dependent children aged over 30 days and under 18 years who normally live with you. Significant and unusual exclusions or limitations applying to ALL sections Deployment: Restrictions apply to new applications for cover if you have been notified that you are to be deployed within the next 12 months. If this applies to you, call us on to discuss your eligibility for cover. In addition to the Significant and Unusual Exclusions or Limitations noted in each section that follows, the following apply to ALL sections of this insurance. For a full explanation, see the Policy booklet. There is no cover for 1. Service with the SAS or SBS 2. War between China, France, the Russian Federation, the UK, the USA and war in Europe 3. Participation in professional sport and hazardous pursuits (other than whilst on duty as a member of HM Forces) 4. Self-injury or suicide 5. Death or injury whilst under the influence of drugs or alcohol 6. Criminal acts by the insured person

3 7. Post-traumatic stress disorder 8. Pre-existing conditions, defects, infirmities, illnesses or injuries which you are aware of or have received medical treatment for in the previous twelve months 9. Any person aged over 60 at inception 10. War, terrorism or civil war involving the use of chemical, biological or nuclear weapons 11. Radioactive contamination 12. Claims arising from any medical or surgical procedure or any gradually developing bodily deterioration other than as provided under Section 4 HIV Infection. Section 1 - Personal Accident Benefits Sum Insured Per Insured Person Section 1 - Personal Accident Level 1 Level 2 Level 3 1. Accidental death 4,000 10, (i) Paraplegia (ii) Quadriplegia (iii) Permanent Total Disablement from any and every occupation (iv) Permanent Total Disablement from usual occupation 5,000 12,500 25, Loss of (i) one limb (ii) two limbs 15,000 37,500 75, Loss of (i) one eye (ii) both eyes 15,000 37,500 75, Loss of speech 6. Loss of hearing (i) in one ear (ii) in both ears 8,000 40, Permanent Disability Continental Scale See Extension 3 up to 6,000 up to 15,000 up to 30, Burns - See Extension 4 up to 5,000 up to 12,500 up to 25, Fracture Benefit - See Extension ,000 Section 2 Hospital Cash (per day) up to a maximum of 365 days in all 15 per day to a maximum of 5, per day to a maximum of 13, per day to a maximum of 27,740 Section 3 Dental Injury Emergency Dental Treatment , , Section 4 HIV Infection 15,000 37,500 75,000

4 Significant features and benefits The maximum payable depends on the benefit Level selected. Please see the Policy booklet for a full explanation of how claim payments are calculated. Significant and Unusual Exclusions or Limitations In addition to the Significant and Unusual Exclusions or Limitations that apply to all sections of the insurance, the following apply to this section. 1. If compensation is payable under more than one of Benefits 1-9 in respect of any one accident the total compensation payable shall not exceed the Sum Insured for Benefit 2 (iii). 2. Compensation under Benefit 2(iii) will only be paid upon proof that such disablement has lasted for twelve calendar months and is beyond hope of improvement. 3. Compensation under Benefit 2(iv) will only be paid upon proof that such disablement is likely to continue for the remainder of the Insured Person s life and has necessitated medical discharge from HM Forces within twelve months of the date of the accident. 4. Compensation shall only be payable under one of Benefits 2 (i) to 2 (iv). 5. No compensation will be payable unless there is substantiating medical evidence from a Medical Practitioner 6. Where the amount of compensation under Benefits 2 to 8 is greater than that under Benefit 1, Death, no more than the amount of the death benefit will be paid until thirteen weeks after the accident. If the Insured Person dies due to that accident during those thirteen weeks no further compensation will be paid. 7. The payment of compensation under one of Benefits 1 to 7 will terminate all further benefits. 8. In respect of an Insured Person under the age of 16 years, Benefit 1 Death will be limited to No compensation will be payable for further deterioration of injuries beyond twelve months of the date of the accident. Section 2 Hospital cash Payable in the event that you are hospitalised due to accidental bodily injury or sickness, after the first five days of hospitalisation, dependent on the level of cover you have selected. Benefit Level 1 Level 2 Level 3 Hospital Cash (per day, to a maximum of 365 days in all) 15 per day to a maximum of 5, per day to a maximum of 13, per day to a maximum of 27,740 Significant and Unusual Exclusions or Limitations In addition to the Significant and Unusual Exclusions or Limitations that apply to all sections of the insurance, the following apply to this section. See the Policy booklet for further details. No payment will be made for: 1. Pregnancy or childbirth 2. HIV/AIDS 3. Elective or cosmetic surgery 4. Any medical condition diagnosed as chronic prior to inception. A condition shall be deemed chronic if it is a condition, which reoccurs following treatment and for which there is no permanent cure. 5. Stress, anxiety, depression, mental anguish, mental disorder, neurosis or the like. 6. Hospitalisation occurring more than twelve months after the date on which bodily injury is sustained or sickness first manifests itself.

5 Section 3 Dental Injury and Emergency Dental Treatment Dental Injury Cover for dental costs, dental call out fees and dental prescription charges in the event of accidental injury or damage to your teeth. Payment will be dependent on the level of cover you have selected. All treatment must commence within 60 days of the accident causing the dental injury. Emergency Dental Treatment In the event of a dental emergency, payment up to 300 for dental treatment provided at the initial emergency appointment. Benefit Level 1 Level 2 Level 3 Dental Injury 500 1,250 2,500 Emergency Dental Treatment Significant and Unusual Exclusions or Limitations In addition to the Significant and Unusual Exclusions or Limitations that apply to all sections of the insurance, the following apply to this section. See the Policy booklet for further details. No payment will be made for: 1. Injury from consuming food 2. Damage from brushing or other oral hygiene procedures 3. Injury from contact sports (as defined) unless recommended mouth protection is worn 4. Claims arising in connection with mouth jewellery 5. Treatment not deemed medically necessary 6. Costs relating to implants 7. Treatment received more than twelve months after the date of the accident causing dental injury. Section 4 Infection with HIV Payment in the event you contract HIV as a result of medical treatment received during the period of insurance. Payment will be dependent on the level of cover you have selected. Benefit Level 1 Level 2 Level 3 HIV Infection 15,000 37,500 75,000 Significant and Unusual Exclusions or Limitations In addition to the Significant and Unusual Exclusions or Limitations that apply to all sections of the insurance, the following apply to this section. See the Policy booklet for further details. No payment will be made in respect of: 1. Any process of self-medication 2. Application or removal of tattoos, piercings or other body art 3. Cosmetic surgery 4. Claims arising from non-emergency treatment unless received in a recognised hospital 5. Persons involved in intravenous drug abuse

6 Duration of policy The policy will remain in force for 12 months from the date of commencement, or as otherwise shown in your Schedule. Your Duty of Disclosure You must take reasonable care not to make a misrepresentation to the Underwriters. This means that all the answers you give and statements you make as part of your insurance application, including at renewal and when an amendment to your policy is required, should be honest and accurate. If you deliberately or carelessly misinform the Underwriters, this could mean that part or all of a claim may not be paid. How to claim Claims under the scheme are administered by Davies Managed Systems Limited. If you wish to make a claim please contact Davies Managed Systems Limited on or as soon as you become aware that you may have a claim under one of the benefits listed in the Schedule. You must advise us of your intention to claim within 90 days of the accident giving rise to the possible claim. If you do not notify us within this period, we may not pay compensation in respect of that claim. Documentary evidence will be required for all claims All claims must be substantiated by a Medical Practitioner Cancellation rights You have the right to cancel your policy during a period of 14 days after the later of the day of purchase of the contract or the day on which you receive your policy documentation. If you wish to do so and the insurance cover has not commenced, you will be entitled to a full refund of the premium paid. You are entitled to cancel your Certificate at any time after the cooling off period has expired but doing so will not entitle you to any refund of premiums paid. We, or any agent we appoint and who acts with our specific authority, may cancel this Insurance by sending 30 days notice to your last known address. The premium paid for the period up to cancellation shall be returned to you on a pro rata basis. No return of premium shall be made to you if any claim has been paid or is outstanding under this insurance.

7 Complaints You are important to us but we do recognise that there may be times when you feel dissatisfied with our service. If your complaint is regarding the sale of your policy, you should contact; JBI International Insurance Brokers Hercules House Calleva Park Aldermaston Reading Berkshire RG7 8AR Tel: +44 (0) Fax: +44 (0) In all other respects, including claims, you should contact Complaints Department Kiln Group 1st Floor, 106 Fenchurch Street London EC3M 5NR Tel: +44 (0) Fax: +44 (0) If you remain dissatisfied or you feel your complaint remains unresolved please contact: Policyholder & Market Assistance Lloyd s 1 Lime Street London EC3M 7HA complaints@lloyds.com Tel: +44 (0) Fax: +44 (0) If you are still unhappy you should then contact: The Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London, E14 9SR The existence of these internal arrangements does not affect your right to seek legal advice and take legal action. Financial Services Compensation Scheme The consortium of Lloyd s syndicates is covered by the Financial Conduct Compensation Scheme (FSCS). If they are unable to meet their obligations you may be entitled to compensation from the scheme, depending on the type of insurance and the circumstances of the claim. Further information about compensation scheme arrangements is available from the FSCS - Tel: +44 (0)

8 Premium Information Premiums are payable by monthly direct debit, as follows. Premiums in brackets represent the amount payable over 12 months. INDIVIDUAL COVER BASED IN THE UK BASED OVERSEAS Level ( 77.04) 6.11 ( 73.32) Level ( ) ( ) Level ( ) ( ) FAMILY COVER BASED IN THE UK BASED OVERSEAS Level ( ) 8.65 ( ) Level ( ) ( ) Level ( ) ( ) Premiums include: Insurance Premium Tax at 6% (for UK-based applicants) 1 per month administration fee 3.3% instalment facility fee (APR = 7.4%) Towergate House, 7 Dominus Way, Meridian Business Park, Leicester LE19 1RP JBI and JBI International Insurance Brokers are trading names of Towergate Underwriting Group Limited. Registered in England No Registered Address: Towergate House, Eclipse Park, Sittingbourne Road, Maidstone, Kent ME14 3EN. VAT Registration Number: Towergate Underwriting Group Limited are authorised and regulated by the Financial Conduct Authority /15408