Premium Protector. Terms and Conditions

Transcription

1 Premium Protector Terms and Conditions

2 Welcome to Admiral s Premium Protector This booklet describes your contract for Premium Protector. Please read it carefully along with your current Policy Schedule. This is important, as the agreement to insure you is based on this information. This policy meets the demands and needs of an individual wishing to ensure that their monthly motor insurance premium payments are covered in the event of accident, sickness, unemployment or hospitalisation. As with any insurance, it does not cover all situations and you should read the terms and conditions of this policy to make sure that it meets your specific needs. Admiral does not make personal recommendations as to the suitability of the policy to individual circumstances. You are solely responsible for deciding whether the policy is suitable for your needs. Important Phone Numbers To make a claim or for further information - Please call

3 Premium Protector i Policy Summary This policy summary does not contain full terms and conditions of the cover, which can be found in the policy booklet. It is important that you read the policy booklet which follows this policy summary. Who the cover is underwritten by Admiral Insurance (Gibraltar) Limited. Type of insurance and cover This is designed to protect your monthly motor insurance premium payments in the event of accident, sickness, unemployment or hospitalisation. Unemployment cover also includes giving up work to become a full time carer. Significant features and benefits We will cover your full 3 month s premium (including any optional extras that are shown on your policy on our database at point of claim). This policy will be paid for up to 10 or 12 months, depending on the duration on your associated motor policy. For MultiCar, we will cover the full 3 month s premium for all cars on the MultiCar policy (including any optional extras that are shown on our database on the claim date). As the quarterly benefit under MultiCar Premium Protector covers the full motor insurance premium, only one person can claim at any one time. Significant or unusual exclusions and limitations You must be aged between 18 and 64 and in full time employment at the start date to be eligible for cover. Please see Eligibility in Section 2 of the policy booklet, which tells you the full eligibility requirements. Premium Protector has a claim waiting period of 14 days (5 days for hospitalisation claims). Once the claim waiting period is over and your claim has been accepted, you will be entitled to the quarterly benefit.

4 ii Premium Protector Policy Summary (cont.) Duration of the cover From the date Premium Protector was added to the associated motor policy until its renewal or cancellation, up to a maximum of twelve months. As long as the policyholder remains eligible, this policy will automatically renew with the associated motor policy unless you inform EUI Limited otherwise. Cancellation You may cancel this product and receive a full refund, subject to you not making a claim, if you inform us within 30 days from the receipt of the confirmation letter or . Should you cancel outside the 30 day cancellation period, you will be charged on a daily pro rata basis for the time you have been on cover. For further information on cancellation please refer to section 6 the policy booklet. How to make a claim To make a claim, please call If you are unsure as to whether or not a claim can be made, please speak to us, we will be happy to help you. Alternatively you can contact us via premiumprotector@admiralgroup.co.uk How to make a complaint Any enquiry or complaint regarding this policy should be addressed to: The Quality Manager, EUI Limited, Ty Admiral, David Street, Cardiff CF10 2AA. Tel: quality@admiral.com If you have complained to us and we have been unable to resolve your complaint, you are entitled to refer your complaint to the Financial Ombudsman Service. Financial Services Compensation Scheme (FSCS) Admiral Insurance (Gibraltar) Limited is covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation if Admiral Insurance (Gibraltar) Limited is unable to meet its obligations to you under this contract. Further information is available by phone on and on their website at

5 Premium Protector 1 Contents 2 About your Premium Protector policy 2 Section 1: Definitions 5 Section 2: Eligibility 6 Section 3: What is covered 8 Section 4: Conditions of your policy 9 Section 5: How to make a claim 12 Section 6: Cancellation 13 Section 7: How to make a complaint 14 Section 8: Extra information about your Policy

6 2 Premium Protector About your Premium Protector policy Thank you for taking out Premium Protector. We are confident our friendly, fast and efficient service will ensure you remain a satisfied customer now and for years to come. This booklet explains the cover you have bought, but if you have any queries, please contact us on or alternatively you can us - premiumprotector@admiralgroup.co.uk We will be happy to help. Your policy Whenever a word appears in this policy booklet and is defined in Section 1 Definitions, it takes on that special meaning. This policy booklet sets out the details of your insurance cover, please read it carefully. Provided the eligibility requirements (section 2) are met, this policy provides the claim benefit to you in the event of accident, sickness, unemployment or hospitalisation. Section 1: Definitions Associated motor policy The valid motor insurance arranged by EUI Limited which has been taken out by the policyholder. Award notice The letter that you receive from the Benefits Agency, confirming that you have successfully been awarded Carer s Allowance. Accident/Sickness Being unfit to work because of an accident or sickness. This must be certified by a doctor and leave you totally unable to carry out your normal occupation. Carer Being a full-time carer and in receipt of Carer s Allowance from the Department of Work and Pensions.

7 Premium Protector 3 Claim date The date your claim starts. y For accident and sickness claims it is the date you are first issued with a medical certificate by a doctor y For hospitalisation claims it is the date you are first admitted to a hospital on the recommendation of a doctor y For unemployment claims it is the date you first registered as unemployed with a Jobcentre within the United Kingdom, or any other relevant government Employment Office. Please note that if you receive a payment instead of completing a notice period, your claim cannot start until the notice would have come to an end. If your unemployment claim is due to you giving up work to become a full-time carer, it is the effective date shown on your award notice Claim waiting period Claims for accident, sickness or unemployment will not be considered until the policyholder has been affected for 14 consecutive days immediately following the claim date. Claim for hospitalisation will not be considered until the policyholder has been in hospital for 5 consecutive days after the claim date. Doctor A Medical Practitioner registered or licensed to practice medicine under the laws of the country in which they practice who is neither: y the insured person, or y a relative of such insured person unless approved by us y an employee of the insured person y a Medico-Legal Expert Employment/Work/Working Receiving payment for working at least 16 hours per week. A period of maternity or paternity leave will still count as work.

8 4 Premium Protector EUI Limited Admiral is a trading name of EUI Limited. Hospital An institution which has accommodation for in-patients and facilities for diagnosis, surgery and treatment. It does not include a convalescence home, an extended care facility, geriatric home, long term nursing home or rehabilitation home. Hospitalisation/Hospitalised Being confined to a hospital for more than 24 hours following the recommendation of a doctor to receive necessary medical or surgical treatment. Maximum claim amount Up to 12 months benefit in each policy term. Policy Schedule The document that shows the car insured on the associated motor policy and the level of cover you purchased. Quarterly benefit An amount equal to 3 monthly instalments payable to us under your associated motor policy as shown on our database at point of claim. Self-employment/Self-employed A sole trader, director or partner or a shareholder of 25% or more in a company which employs you. We will also consider you to be self-employed if you are employed in a company or business where your husband, wife, partner under a Civil Partnership, parent, child, brother or sister meet any of these conditions. Start date The date your cover starts. This date is shown on your associated motor policy.

9 Premium Protector 5 Underwriters Admiral Insurance (Gibraltar) Limited Unemployment/Unemployed You are classified as being unemployed, for the purpose of this insurance if you: are y not working for payment of any kind; and are y available for work and registered as such with the relevant government agency; and y are in receipt of the appropriate class of National Insurance Contribution Credits; and y continually, throughout the period of a claim, can provide any material proof requested to support the fact that you are available for and actively seeking work If your unemployment follows self-employment, then in addition to the above, you must also have permanently ceased to trade (as confirmed by your Accountant to HM Revenue & Customs). We/Us/Our EUI Limited trading as Admiral and/or the underwriters. You/Your/Policyholder The person(s) named as the policyholder on your current Certificate of Motor Insurance. Section 2: Eligibility To qualify for cover you must have an associated motor policy and that, on the start date, you are: 1. Over 18 and under 64 years of age; 2. Working a minimum of 16 hours per week within the UK and not currently off sick; 3. Permanently resident within Great Britain, Northern Ireland, the Isle of Man, Alderney, Guernsey and Jersey. We recommend that you periodically review your personal circumstances to make sure that this insurance is still suitable for you and that you would still be able to claim.

10 6 Premium Protector Section 3: What is covered Benefit limits We will cover your full 3 month s premium (including any optional extras that are shown on your policy on our database at point of claim). This will be paid for up to 10 or 12 months, depending on the duration on your associated motor policy. For MultiCar, we will cover the full 3 month s premium for all cars on the MultiCar policy (including any optional extras that are shown on your policy on our database on the claim date). As the quarterly benefit under MultiCar Premium Protector covers the full motor insurance premium, only one person can claim at any time. Unemployment cover Unemployment or being unemployed, in this policy means that you: y are not working for payment of any kind; and y are available for work and registered as such with the relevant government agency; and y are in receipt of the appropriate class of National Insurance Contribution Credits; and y continually, throughout the period of a claim, can provide any material proof requested to support the fact that you are available for, and actively seeking work If your unemployment follows self-employment then, in addition to the above, you must also have permanently ceased to trade (as confirmed by your accountant to HM Revenue & Customs). What if I give up work to become a full-time carer? In this policy the benefits available for unemployment also apply if you give up work to become a carer.

11 Premium Protector 7 Hospitalisation cover Claim for hospitalisation will not be considered until the policyholder has been hospitalised for 5 consecutive days after the claim date. You will be entitled to one quarterly benefit on the 6th day after the claim date. You will be entitled to further quarterly benefits following continuous periods of 90 days that you remain in hospital. Accident and sickness cover Accident and sickness, in this policy means that you: y are unfit to work because of an accident or sickness y this must be certified by a doctor and leave you totally unable to carry out your normal occupation You will be provided with the accident and sickness cover if: 1. the cause of your inability to work began after the start date shown in your associated motor policy; and 2. you are not receiving payment from any type of work (other than sick pay from your normal occupation) during the period you are unable to work As soon as the claim waiting period is over, you will be entitled to one complete quarterly benefit. You will be entitled to further quarterly benefits for each following continuous period of 3 calendar months that you remain unable to work or unemployed. Quarterly benefit payments will continue until the first of these events: 1. you return to work; or 2. you have been paid the maximum claim amount; or 3. you retire from work and have no intention of working again; or 4. if you are a carer, the date you cease to hold a valid award notice; or 5. the date you no longer have an associated motor policy with EUI Limited.

12 8 Premium Protector You will be required to provide evidence for your unemployment, accident, sickness or hospitalisation every quarter to continue your quarterly benefit. Your benefit will be paid against your associated motor policy directly once you have provided the required evidence. Please refer to the tables in section 5 to see the documents that you may be required to produce. Section 4: Conditions of your policy If your claim changes Should the nature of your claim change, for example from unemployment to hospitalisation or vice versa, this will not be treated as a new claim and will be considered a continuation of the original claim event. A new claim waiting period will not be imposed. Additional evidence may be required. The maximum claim amount will apply to the claim as a whole. For MultiCar, please note, if a new claim is submitted by a different person covered under this insurance it will be treated as a completely new claim. The claim waiting period will be applied; any benefit already paid will count towards the maximum claim amount for the claim as a whole. Please note: as the monthly benefit under MultiCar Premium Protector covers the full quarterly payment for all cars motor insurance premium, only one person can claim at any time. Claims in quick succession If you return to work before the maximum claim amount has been paid but find you need to claim again, the way we treat the subsequent period in which you are unable to work depends on how long your return to work lasted: y If it was less than 3 consecutive months it will be considered part of the original claim event. You will not have to go through the claim waiting period again. Benefit already paid will count towards the maximum claim amount for the claim as a whole

13 Premium Protector 9 y If you return to work for 3 consecutive months or more, any future accident, sickness, unemployment or hospitalisation will be treated as a new claim therefore the claim waiting period will be applicable. Benefit already paid will count towards the maximum claim amount for the claim as a whole. When you have been paid the maximum claim amount After being paid the maximum claim amount for an unemployment claim, the person who claimed will need to return to work for 6 continuous months before claiming again. After being paid the maximum claim amount for an accident, sickness or hospitalisation claim, the person who claimed will need to return to work for 6 continuous months before claiming for the same or a related condition or for one month, if the next claim is totally unrelated. Temporary earnings during an unemployment claim It is not the intention to penalise you if during an unemployment claim you have the opportunity of temporary employment. We can help at this time by simply suspending your claim. We will agree these periods of suspension with you. Please keep us informed so that you can take full advantage of Premium Protector. Fraudulent claims or misleading information We will not pay a claim which is in any part fraudulent, false, exaggerated or if you or anyone acting for you makes a claim in a fraudulent or false way, or where we have been given documents which are false or stolen. Your policy and all other policies to which you are connected through EUI Limited will be cancelled or voided. We will seek to recover any costs that have been incurred and will not return any premium. Section 5: How to make a claim To make a claim, please call us on If you are at all unsure as to whether or not a claim can be made, please speak to us, we will be happy to help you. Alternatively you can contact us via premiumprotector@admiralgroup.co.uk. The claim handler will tell you what documents you need to produce and what you should do during the course of your claim.

14 10 Premium Protector The claims procedure The charts that follow are a helpful guide to give you an idea of the sort of things you need to do throughout your claim and the documents you may need to provide. We will be there to help you through every step. Following the procedure and following the instructions and advice you are given by us will help your claim to run smoothly. If you do not follow the procedure and any other instructions or advice given by us, it may mean that we will be unable to pay your claim. Important Please note: if you are having difficulty acquiring the evidence required, please contact us to discuss your options, if evidence is not provided it will result in us closing down the claim and you will be expected to pay your instalments as normal. The cost of providing proof of your claim is your responsibility. However, if your claim is for accident, sickness or hospitalisation and we require more than just medical certificates from your doctor, we will pay the cost of any medical examiner s fee for any additional medical or psychiatric examinations they ask you to attend. CLAIMS FOR ACCIDENT AND SICKNESS What you need to do What documents you may need to produce 1 See a doctor. 2Throughout your claim you need to show that you are certified by a doctor as unfit for work. We will contact you every 3 months. Medical certificates for the period you are claiming.

15 Premium Protector 11 CLAIMS FOR UNEMPLOYMENT What you need to do 1 Register with the Employment Services in the United Kingdom as unemployed or with the Department of Work and Pensions as a carer. Have a Job Seekers Agreement and be receiving any Unemployment Benefit or National Insurance Credits you are entitled to. If you have given up work to become a carer you need to be receiving Carer s Allowance. 2 Throughout your claim you need to show that you are still unemployed and looking for new work (unless you have given up work to become a carer, in which case you need to show that you are still in receipt of Carer s Allowance) so that benefit under this policy can continue to be paid. We will contact you every 3 months. What documents you may need to produce Job Seekers Agreement in respect of Carer s Allowance. Redundancy notice/ severance letter /P45. If you were self-employed an accountant s certificate to confirm insolvency of your business and be able to show that HM Revenue & Customs are aware that you have ceased trading. Confirmation from the Employment Services that you are still registered as unemployed or confirmation from the Department of Work and Pensions that you are still a carer. Any other evidence required by us to show that you are looking for new work. CLAIMS FOR HOSPITALISATION What you need to do 1 You will need to show that you have been confined to a hospital for more than 24 hours following the recommendation of a doctor to receive necessary medical or surgical treatment. What documents you may need to produce Medical certificates for the period you are claiming. We will contact you every 3 months.

16 12 Premium Protector Section 6: Cancellation Cancellation by you You may cancel this product and receive a full refund, subject to you not making a claim, if you inform us within 30 days from the receipt of the confirmation letter or . Should you cancel outside the 30 day cancellation period, you will be charged on a daily prorata basis for the time you have been on cover. Please contact; Admiral, Ty Admiral, David Street, Cardiff CF10 2AA or call , or for MultiCar customers. Cancellation by us Your cover stops automatically upon any of these events: y Your 65th birthday: However, where you have a valid claim in progress on this date, or if an event has occurred prior to this date which leads to a valid claim, we will accept and/ or continue to pay your claim until it would otherwise have ended under the terms and conditions of your policy; or y The date you retire from work and have no intention of working again; y Your associated motor policy is declared void or ceases to be in force for any reason Your policy may be cancelled by us in the event of: y You making a claim of a fraudulent or false nature y Your associated motor policy being cancelled y If the policyholder(s) are no longer eligible for the cover We may cancel this policy at any time by sending 7 days notice in writing to your last known address if: y You fail to respond to written requests for further information or documentation y If your associated motor policy is cancelled, this product will also be cancelled. If we cancel your policy, you will be charged on a daily pro rata basis for the time you have had on cover

17 Premium Protector 13 y If you or anyone acting for you recklessly or deliberately misrepresents information we require at any time during the policy that would impact either the terms and conditions or our ability to offer cover itself In the event of fraud, we will seek to recover any costs that have been incurred and will not return any premium. If we cancel your policy, you will be charged on a daily pro rata basis for the time you have had on cover. If a claim is made or has arisen during the period of insurance, the full premium is payable and no refund will be given. Section 7: How to make a complaint EUI Limited aims at all times to provide a first class standard of service. However, there may be occasions when you feel that this has not been achieved. Any enquiry or complaint regarding this policy should be addressed to: The Quality Manager, EUI Limited, Ty Admiral, David Street, Cardiff CF10 2AA Tel: quality@admiral.com If we have given you our final response and you are still unhappy, or more than 8 weeks have passed since we received your original complaint, you may refer your complaint to the Financial Ombudsman Service (FOS). Their details are as follows: The Financial Ombudsman Service, Exchange Tower, London, E14 9SR Tel: Or: complaint.info@financialombudsman.org.uk

18 14 Premium Protector Section 8: Extra information about your Policy For information about how EUI Limited will process your personal information please visit Governing Law and Language English law will apply to your policy unless we make a written agreement saying otherwise to you. All communication is to be conducted in English. Shared information To help prevent fraudulent claims, insurers sometimes share information. Details about your insurance application, and any claims you make, may be exchanged between insurers. Please be advised that if any false or inaccurate information is provided and fraud is identified details will be passed to the fraud prevention agencies. Insurers and other organisations check and supply details to various databases and fraud prevention agencies, to which the police and other insurers have access. If false or inaccurate information is provided and fraud is identified, details will be passed to fraud prevention agencies to prevent fraud and money laundering. Further details of the fraud prevention agencies and explaining how the information held by fraud prevention agencies may be used, can be obtained by calling Providers and suppliers This policy is arranged and administered by EUI Limited, Ty Admiral, David Street, Cardiff CF10 2EH and is underwritten by Admiral Insurance (Gibraltar) Limited, 1st Floor, 24 College Lane, PO Box 575, Gibraltar GX11 1AA. EUI Limited is authorised and regulated by the Financial Conduct Authority (Registration No ). Admiral Insurance (Gibraltar) Limited is licensed and regulated by the Gibraltar Financial Services Commission under the Financial Services (Insurance Companies) Act 1987 of Gibraltar.

19 Premium Protector 15 The Financial Services Compensation Scheme We are members of the Financial Services Compensation Scheme. If we are unable to meet our obligations you may be entitled to compensation from the scheme, depending on the type of insurance and circumstances of the claim. Cover for the claim or policy is provided at 90%. You can get more information about the compensation scheme arrangements from the FSCS. The contact information is: The FSCS, 10th Floor, Beaufort House, 15 St Botolph Street, London EC3A 7QU. Tel: or

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