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Initial Disclosure Document
1. The Financial Service Authority (FSA)
The FSA is the independent watchdog that regulates financial services. Use this information to decide if our services are right for you.
2. Whose products do we offer?
We can only offer products from St. Andrew's Insurance plc for Accident and Sickness Cover, Unemployment Cover, Critical Illness Cover, Carer Cover and Prudential Assurance Company Limited for Life Cover.
3. Which service will we provide you with?
You will not receive advice or a recommendation from us. We may ask you some questions to narrow down the selection of products that we will provide details on. You will then need to make your own choice about how to proceed.
4. What will you have to pay us for our service?
No fee
You will receive a quotation which will tell you about any other fees relating to any particular insurance policy.
5. Who regulates us?
Egg Banking plc, Citigroup Centre, Canada Square, London, E14 5LB is authorised and regulated by the Financial Services Authority. Our FSA Register number is 205621.
Our permitted business is to offer for sale and arrange general insurance and pure protection contracts.
You can check this on the FSA's Register by visiting the FSA's website www.fsa.gov.uk/register or by contacting the FSA on 0845 606 1234.
6. Ownership
Egg Banking plc is a wholly owned subsidiary of Citigroup Inc.
7. What to do if you have a complaint
If you wish to register a complaint, please contact us:
…in writing
Customer Relations Office, Egg Banking plc, Pride Park, Derby DE99 3GG
…by phone
Telephone 08451 233 233
…by e-mail
complaints@egg.com
Please note that this will not be a secure e-mail and you should not disclose any account specific information such as account numbers or passwords.
If you cannot settle your complaint with us, you may be entitled to refer it to the Financial Ombudsman Service.
8. Are we covered by the Financial Services Compensation Scheme (FSCS)?
We are covered by the FSCS. You may be entitled to compensation from the scheme if we cannot meet our obligations. This depends on the type of business and the circumstances of the claim.
Insurance advising and arranging is covered for 100% of the first £2,000 and 90% of the remainder of the claim, without any upper limit.
Further information about compensation scheme arrangements is available from the FSCS.
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Policy Summary
This summary does not contain the full terms and conditions of your insurance policy. Full details of the terms, conditions and exclusions of your insurance policy are contained in the policy document a copy of which is available on request.
This insurance is underwritten by St Andrew’s Insurance plc and Prudential Assurance Company Limited for a detailed explanation about which company underwrites which element of cover please refer to the definition of 'We, Us, Our' in Part 1 of the Policy 'Meaning of Words Used' for further details.
Credit Card Payment Protection Insurance providing Life, Accident and Sickness, Unemployment, Carer and Critical Illness Cover
Eligibility
To be eligible for cover you must be the principal card holder, in employment or self-employed and paying the appropriate class of National Insurance Contributions (not applicable to Life or Critical Illness claims), over 18 and under 65, and a UK resident.
Significant Features & Benefits
Life Cover
We will pay the outstanding balance or the credit limit whichever is the lesser, up to a maximum of £25,000 if you die during the period of cover.
Accident and Sickness Cover
We will pay an amount equal to 10% of the outstanding balance at the date of your disability if you are unable to work due to accident or sickness. You will be eligible for a monthly benefit to be paid after you have been disabled for a continuous period of 28 days. Thereafter 1/30th of the monthly benefit will become payable for each day you are disabled in respect of any one claim until you return to work or the outstanding balance as at the date of your disability has been cleared whichever occurs first. The maximum Monthly Benefit payable is £2,500.
Unemployment Cover
We will pay an amount equal to 10% of the outstanding balance at the date of notification of your unemployment if you suffer involuntary unemployment. You will be eligible for a monthly benefit to be paid after you have been unemployed for a continuous period of 28 days. Thereafter 1/30th of the monthly benefit will become payable for each day you are Unemployed until you return to work or the outstanding balance as at the date of notification of your unemployment has been cleared whichever occurs first. The maximum Monthly Benefit payable is £2,500.
Carer Cover
If your work ceases due to the need for you to become a carer for a relative, we will pay the outstanding balance or the credit limit whichever is the lesser up to a maximum of £25,000. Once a payment has been made under this part of the policy the carer cover part of the policy ceases.
Critical Illness Cover
We will pay the outstanding balance or the credit limit whichever is the lesser up to a maximum of £25,000 if you suffer a critical illness and survive for a period of not less than 28 days. Critical Illness means cancer, heart attack, kidney failure, coronary artery bypass graft, stroke, major organ transplant all requiring diagnosis by a doctor.
Significant Exclusions
Life Cover
Death resulting from a pre-existing or chronic medical condition.
Details of these and other relevant exclusions can be found in the policy document Part 3 Section A Life Exclusions.
Accident & Sickness Cover
Disability resulting from a pre-existing or chronic medical condition, a mental or nervous disorder (e.g. depression) or stress related conditions unless diagnosed by a Consultant, backache and related conditions without radiological evidence.
Details of these and other relevant exclusions can be found in the policy document Part 3 Section B Accident & Sickness Exclusions.
Unemployment Cover
Unemployment that is voluntary or results from your misconduct, unemployment that you are aware of at the start of cover or that occurs or is notified of within the first 28 days of cover. Unemployment that results from the expiry of a fixed term contract of employment, unless you have been employed on a yearly renewable contract which has been renewed at least once, or you have been in employment for a total unbroken period of 2 years or more with the same employer. Unemployment if you are employed by a company, partnership or someone who is self employed who is your partner or a family member and they are a shareholder unless the company, partnership or person ceases to trade at the same time. If you are self employed your business must have ceased to trade as a direct result of being unable to pay its debts when due.
Details of these and other relevant exclusions can be found in the policy document Part 3 Section C Unemployment Exclusions.
Carer Cover
We will not pay benefit if work ceases for reasons not associated with becoming a carer, or if the sickness, disease, condition or injury of the person being cared for existed before the start date cover.
Details of these and other relevant exclusions can be found in the policy document Part 3 Section D Carer Exclusions.
Critical Illness Cover
We will not pay benefit for critical illness which occurs within 84 days of the start of cover, or which results from a pre existing condition.
Details of these and other relevant exclusions can be found in the policy document Part 3 Section E Critical Illness Exclusions.
Other exclusions/Definitions/Limitations
Other exclusions, definitions and limitations apply to this policy; see the policy document for full details.
Part 1 for "Meaning of Words Used"
Part 2 for General Provisions
Part 3 Benefits, Section A for Life cover, Section B for Accident and Sickness cover, Section C for Unemployment cover, Section D for Carer cover, Section E for Critical Illness cover.
Duration & Termination
Your cover will terminate at the earliest of the following,
- your death,
- the date you reach the age of 65,
- the date a premium remains unpaid by you for a period of 3 months after it is due,
- the date you permanently retire from work
Claims
All matters relating to claims should be sent to:
Claims Management Department, PO Box 336, Esher, Surrey KT10 9WD Telephone 0845 120 5203 Fax 01372 479451
Complaints
All complaints relating to this policy should be referred to: Customer Liaison Manager, St Andrew's Group plc, St Andrew’s House, Portsmouth Road, Esher, Surrey, KT10 9SA. If you are not happy or the problem has not been resolved to your satisfaction, you may refer your complaint to the Financial Ombudsman Service who will undertake an independent and impartial review of your complaint. The address and telephone number is Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London E14 9SR Telephone 0845 080 1800
Financial Services Compensation Scheme (FSCS)
The FSCS may assist you if we were, in some circumstances, unable to meet our liability to you. For claims against insurance firms, the first £2,000 of an insurance claim or policy is covered in full, plus 90% of the balance. For further details please contact the FSCS on 0207 892 7300 or enquiries@fscs.org.uk
YOUR RIGHTS TO CANCEL
You can cancel your cover within 30 days of receiving your policy. You will receive a full refund of any premium you have paid provided that you have not made a claim. If you do not cancel your cover within 30 days, your cover will continue for the remaining period but if you subsequently cancel your cover you will not be entitled to a refund of premiums. If you want to cancel your cover, please write to Egg, Pride Park, Derby DE99 3GG or telephone Egg on 08451 233 233
OTHER IMPORTANT INFORMATION
This insurance is underwritten by St Andrew's Insurance plc (Registered in England No 3104671) (The Insurers) whose head and registered office is at St Andrew's House, Portsmouth Road, Esher, Surrey KT10 9SA, and Prudential Assurance Company Limited (registered in England No 15454) whose head and registered office is at Laurence Poutney Hill, London, EC4R 0HH.
The main business of the Insurers is underwriting insurance risk, claims administration and claims settlement. St Andrew's Insurance plc and Prudential Assurance Company Limited are authorised and regulated by the Financial Services Authority. You can check this on the FSA register by visiting the FSA website www.fsa.gov.uk/register or by contacting the FSA on 0845 606 1234.
You incur no additional costs by arranging your insurance by this method.
English law will apply to the negotiations that take place prior to the conclusion of your insurance contract.
English law applies to the insurance contract unless you ask for another law and the Insurer agrees to this in writing before the start date of the cover.
The terms and conditions of your policy and the information provided in this document will be provided in English, during the term of your policy we will communicate using the English Language.
Telephone calls may be monitored or recorded to assist with staff training and for quality control purposes.
You may contact St Andrew's using TypeTalk, 18001 0845 120 5203.
FRAUDULENT CLAIM PREVENTION
Information about you and your insurance cover will be held by the insurers in their records for the purpose of your insurance. This includes underwriting, processing, claims handling and fraud prevention. In the event of an insurance claim, you consent to any information that you provide, whether on the application form, the claim form or otherwise, will be put onto a Register of Claims through which insurers share such information to prevent fraudulent claims. A list of participators and the name and addresses of the operator are available from the insurer. No monthly benefit is payable for any period during which the payment of the monthly payment is deferred under the terms of your agreement.
It is important that you regularly review your insurance requirements to ensure that this policy meets your needs.
This information and the policy are available in large print, audio or Braille on request.
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Policy Document
Under this Policy We agree to provide benefits in the event of Death, Disability (comprising accident & sickness), Unemployment, Carer Cover and Critical Illness on the basis of the following terms, conditions and exclusions.
If You are not in good health at the Commencement Date this may affect Your ability to claim under certain sections of this Policy.
IMPORTANT: This Policy contains general provisions and specific exclusions which define the extent of insurance cover. It is particularly important that You check that You are eligible to be covered under this Policy by carefully reading the following summary of requirements.
On the Commencement Date You: -
- must be the principal Cardholder;
- must be a U.K. Resident;
- must be between the ages of 18 and under 65
- be in Work (not applicable to Life cover or Critical Illness cover)
Please note You must have been in Work immediately prior to the incident which results in You submitting any claim under the Disability, Unemployment or Carer cover sections of this policy.
If You have any enquiry regarding Your eligibility please contact Your Coverholder Tel. No. 08451 233 233
Telephone calls may be monitored or recorded to assist with staff training and for quality control purposes.
The words in bold typeface have particular meanings which are set out in Part 1 of this Policy.
PART 1
MEANING OF WORDS USED IN THIS POLICY
These words are listed in alphabetical order and whenever they are used in the Policy in bold typeface they have the meanings set out below.
"AGREEMENT" : Your credit agreement with the Coverholder.
"CANCER": Any malignant tumour characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue. The term cancer includes leukaemia and Hodgkin’s disease but the following are excluded:
- All tumours which are histologically described as pre-malignant, as non-invasive or as cancer in situ.
- All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least TNM classification T2N0M0.
- Any skin cancer other than invasive malignant melanoma.
"CARDHOLDER" : means the principal cardholder as specified in the Agreement and any authorised user nominated by the principal cardholder under that Agreement provided that the principal cardholder and any authorised user are resident in the United Kingdom.
"CARER": You being entirely without Work as a result of You resigning or taking a temporary unpaid leave of absence from Work solely due to the need to care for a Relative and being registered with Your local Social Services Department as a carer.
"CHRONIC CONDITION" : any condition, injury, illness, disease, related condition and/or associated symptoms resulting from a chronic condition that was in existence at the Commencement Date whether it required medical attention or not.
A Chronic Condition is a condition, which has at least one of the following characteristics:
- It continues indefinitely; or
- It is constant and is controlled rather than cured; or
- It has symptoms which re-occur and have required consultation, treatment or care on more than one occasion in the past; or
- It requires long term monitoring or treatment, consultations, check ups, examinations or tests.
"COMMENCEMENT DATE" : the date You become insured under this Policy, or in the event that Your Policy has been cancelled and re-instated the latest re-instatement date.
"CORONARY ARTERY BYPASS GRAFT": the undergoing of open heart surgery on the advice of a Consultant Cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts but excluding balloon angioplasty, laser and other procedures.
"COVERHOLDER" : Egg Banking plc. The credit provider who will receive payments from Us in the event of a successful claim from You.
"CREDIT LIMIT" : the maximum amount of credit from time to time available to You under the Agreement, up to a maximum of £25,000.
"CRITICAL ILLNESS": Heart Attack, Cancer, Coronary Artery Bypass Graft, Kidney Failure, Major Organ Transplant or Stroke, all requiring diagnosis by a Doctor.
"DAILY BENEFIT": a sum equivalent to 1/30th of the Monthly Benefit
"DISABILITY" : a state of incapacity resulting solely from an accidental bodily injury or sickness or disease which occurs or starts during a period when You are in Work and which wholly prevents You from doing Your Work or other work that Your experience, education or training would allow You to do. Such Disability shall be deemed to start on the day You first consult, or receive treatment from and are certified as being unfit to work by a Doctor.
"DISABLED" : You suffering from Disability and being under the continued supervision of, and receiving treatment from, a Doctor.
"DOCTOR": a medical practitioner practising in the United Kingdom being a fully registered person under the Medical Act 1983, other than You, Your Partner or any of Your relatives.
"EMPLOYMENT": You working for remuneration under a contract of employment and paying class 1 National Insurance Contributions.
"HEART ATTACK": The death of a portion of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:
- typical chest pain;
- new characteristic electrocardiographic changes;
- the characteristic rise of cardiac enzymes, troponins or other biochemical markers;
where all of the above shows a definite acute myocardial infarction.
Other acute coronary syndromes, including but not limited to angina, are not covered under this definition.
"KIDNEY FAILURE": end stage renal failure presenting as a chronic irreversible failure of both kidneys to function, as a result of which either regular renal dialysis or renal transplant is initiated.
"MAJOR ORGAN TRANSPLANT": the actual undergoing as a recipient of a transplant of a heart, liver, lung, pancreas or bone marrow; alternatively, confirmation by an appropriate consultant of acceptance onto the official United Kingdom waiting list for one of the above transplants.
"MONTHLY BENEFIT": 10% of the Outstanding Balance or Credit Limit whichever is the lesser under the terms of the Agreement as at the date of Your Disability or Notification of Your Unemployment.
"NOTIFICATION" : in relation to:-
- Unemployment; the first intimation given to You either orally or in writing of Your impending Unemployment, given either by or on behalf of Your employer or by a trades union official.
"OUTSTANDING BALANCE" : Your total indebtedness to the Coverholder under the Agreement at the date of Your death, diagnosis of Your Critical Illness, Your Disability or the Notification of Your Unemployment.
"PARTNER": Your spouse, Your civil partner (as defined in Section 1 of the Civil Partnership Act 2004) or the person (whether or not of the same sex) who You are permanently cohabiting with in a marriage-like relationship.
"PERIOD OF COVER" : the period from the Commencement Date to the Termination Date.
"PRE-EXISTING CONDITION" : any condition, injury, illness, disease, sickness, related condition and/or associated symptoms, whether diagnosed or not about which You:-
- Knew or should reasonably have known at the Commencement Date; or
- Had seen or arranged to see a Doctor during the 12 months immediately before the Commencement Date.
"PRUDENTIAL ASSURANCE": Prudential Assurance Company Ltd
"RELATIVE": Your Partner, parent or child.
"SELF-EMPLOYED" : You actively working alone or with others (whether in a partnership or as a member of a limited liability partnership), and paying Class 2 National Insurance contributions and being assessable to Income Tax under Schedule D Case I or II.
"ST ANDREW'S INSURANCE" : St Andrew's Insurance plc.
"ST ANDREW'S LIFE" : St Andrew's Life Assurance plc.
"STROKE": a cerebrovascular incident resulting in permanent neurological damage. Transient ischaemic attacks are specifically excluded.
"TERMINATION DATE" : the earliest of the following dates:-
- the date of Your death; or
- the date You reach the age of 65; or
- the date Your permanently retire from work; or
- the date a premium has remained unpaid by You for a period of 3 months after it is due; or
- the date of termination of insurance cover under this Policy by either Us or You; or
- the date on which the Agreement is terminated or if later the date on which You pay all sums due to the Coverholder following the termination of the Agreement.
"UNEMPLOYMENT/UNEMPLOYED" : You being entirely without Work and being registered with the Job Centre. You must be actively looking for work. If You are a woman who has reached statutory pensionable age You will be considered as Unemployed if You provide evidence throughout the period of Your claim that You are looking for work.
"UNITED KINGDOM" : England, Scotland, Wales and Northern Ireland.
"U.K. RESIDENT": a person who lives lawfully in the United Kingdom for at least 40 weeks in any 52 week period throughout the Period of Cover.
"WAR AND CIVIL COMMOTION" : War, invasion, hostilities (whether war is declared or not), civil war, rebellion, revolution or taking part in a riot or civil commotion.
"WE, US, OUR": St Andrew's Insurance for Unemployment Insurance and Carer Cover and Accident and Sickness. Prudential Assurance for Life cover
"WORK" : being in Employment or Self-Employed.
"YOU, YOUR" : a U.K. Resident who has applied for this insurance and has agreed to pay the premium under this Policy and who at the Commencement Date is:-
- the principal Cardholder; and
- over the age of 18 and under the age of 65; and
- in Work.
Any reference to any statute shall be construed as a reference to that statute as amended, re-enacted or extended at the relevant time.
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PART 2
GENERAL PROVISIONS
1.This insurance shall be for monthly periods and the premium shall be due monthly on the same date as the minimum monthly amount is due to the Coverholder under the terms of the Agreement. During the Period of Cover this insurance shall be automatically renewed on the same date provided the premium is paid to the Coverholder.
2. We confirm that You will be considered by Us to have paid Your premium at such time as any sum in respect of that premium is received by the Coverholder.
3. No provision or condition of this Policy may be waived or modified except by an endorsement signed by an authorised official on Our behalf.
4. This Policy shall have no surrender value.
5. If any information provided to Us by You or anyone acting on Your behalf is inaccurate or if You fail to disclose any information which might reasonably affect decision to provide insurance to You, Your right to any benefit under this Policy shall end.
6. If any claim under this Policy is fraudulent or is intended to mislead Us or if fraudulent or misleading means are used by You or anyone acting on Your behalf to obtain benefit under this Policy, Your right to any benefit under this Policy shall end and We shall be entitled to recover any benefit paid and costs incurred as a result of any such fraudulent or misleading claim.
7. If You are not satisfied with Your cover, You can cancel Your policy within 30 days of the Start Date by giving Your Coverholder notice in writing. A full refund of Your premium will be paid provided You have not made a successful claim. If You have made a successful claim, We will not pay a refund of premium
8. Except under paragraph 7, You will not be entitled to a refund of any premium paid under this Policy unless You were ineligible at the Commencement Date for insurance under this Policy and provided that no information supplied to Us by You or on Your behalf was inaccurate.
9. We may at any time change any term or condition of this Policy including the premium payable by giving not less than 30 days written notice (including e-mail) of such change to You at Your last known address.
10. We may terminate insurance cover under this Policy by giving not less than 30 days written notice (including e-mail) to You at Your last known address. Our termination will not affect Our liability for events occurring during the Period of Cover which may give rise to a claim.
11. You may terminate Your cover under this Policy by giving not less than 30 days written notice (including e-mail) to Your Coverholder at Egg Banking plc, Pride Park, Derby, DE99 3GG or telephone Egg on 08451 233 233
12. It is not possible for You to transfer Your rights under this Policy.
13. Except where otherwise provided in this Policy, all refunds of premium and benefits payable under this Policy shall be paid to the Coverholder for the credit of the Agreement.
14. It is a general condition that You take all reasonable steps to minimise Our risk and ongoing liability under this Policy.
15. This Policy, any endorsement to it, any proposal and any other written statement made by You or on Your behalf on which We have relied when accepting You for cover under this Policy, shall constitute the entire contract between You and Us.
16. English law will apply to the negotiations that take place prior to the conclusion of your insurance contract. English law applies to the insurance contract unless you ask for another law and the Insurer agrees to this in writing before the start date of the cover. The terms and conditions of your policy and the information provided in this document will be provided in English, during the term of your policy we will communicate using the English Language.
17. Insurers share information with each other to prevent fraudulent claims via a register of claims. A list of participants is available on request. Any information You supply on a claim, together with information You have supplied on any application form and other information relating to a claim, will be provided to the register participants. Where We suspect fraud We may use surveillance to protect Our business interest.
18. The Financial Services Compensation Scheme may assist You if We were, in some circumstances, unable to meet Our liability to You. Further details are available on request.
19. You can cancel Your cover within 30 days of receiving Your policy. You will receive a full refund of any premium You have paid provided that You have not made a claim. If You do not cancel Your cover within 30 days, Your cover will continue for the remaining period but if You subsequently cancel Your cover You will not be entitled to a refund of premiums. If You want to cancel Your cover, please write to Egg, Pride Park, Riverside Road, Derby DE99 3GG or telephone 08451 233233.
PART 3
BENEFITS
(A) Life Cover
What is Covered
We will pay the lesser of either the Outstanding Balance (including up to 3 months' arrears if applicable) or the Credit Limit up to a maximum of £25,000 to the Coverholder if, during the Period of Cover, You die.
What is not covered
We will not pay benefit if the death results, directly or indirectly, from:-
- a Pre- Existing Condition (See Special Notes) or a Chronic Condition ; or
- any event which occurs whilst You are outside of the United Kingdom for a period intended to last for 84 days or more in any one year; or
- ionising radiations or contamination by radioactivity from any nuclear waste from the combustion of nuclear fuel or the radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof; or
- Your consumption of alcohol or You taking drugs otherwise than under the direction of a Doctor (provided that such direction is not given due to Your treatment for drug addiction or dependence); or
- criminal or fraudulent acts in which You are involved; or
- surgery which is not medically necessary or is undertaken solely at Your request.
- Your death is the result of War and Civil Commotion
- You committing suicide in the first year of the policy.
Special Notes
This exclusion will not apply to a Pre-Existing Condition if You have been free from symptoms and have not consulted a doctor or received treatment for a 2 year period prior to Your claim. If You had appointments to see a doctor within this period and these were not kept, the Pre-Existing Condition exclusion will apply unless You had been formally discharged.
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(B) Accident & Sickness Cover
What is Covered
We will pay Monthly Benefit to the Coverholder if, during the Period of Cover, You suffer Disability.
Please note payment of Monthly Benefit is subject to the following conditions:-
-
- You must have been Disabled for a continuous period of 28 days after which one Monthly Benefit shall become payable; and
- Daily Benefit shall then become payable in respect of each consecutive day of Your Disability until the earliest of the following dates:-
- the date on which You cease to be Disabled or fail to provide proof that You are Disabled; or
- the date on which You return to Work; or
- the date on which the lesser of either the Outstanding Balance or the Credit Limit has been paid; or
- the Termination Date.
- Where 2 periods of Disability arising from the same condition are separated by 84 days or less or less We will treat this as one continuous claim.
- Benefit shall not be payable under the Accident & Sickness Insurance Part of this Policy if You are currently receiving benefit under the Unemployment Insurance Part of this Policy.
- The maximum Monthly Benefit payable under the Accident & Sickness Insurance Part of this Policy, is £2,500.
- Subject to paragraph 2 above, You will not be entitled to any further Monthly Benefit under the Accident and Sickness Insurance part of this policy until You have returned to work for a period of at least 28 days.
- If We stop paying Monthly Benefit because the Monthly Benefits You have received have cleared the Outstanding Balance and any subsequent Disability claim results from the same condition then You will not be entitled to any further Monthly Benefit under the Accident & Sickness Insurance Part of this Policy until You have returned to Work for a continuous period of 84 days.
What is not covered
We will not pay benefits if the Disability results, directly or indirectly, from:-
- an episode of self-harm; or
- Your consumption of alcohol or You taking drugs otherwise than under the direction of a Doctor (provided that such direction is not given due to Your treatment for drug addiction or dependence); or
- any psychotic or psychoneurotic illness, mental or nervous disorder or stress or stress related condition, unless the condition has been diagnosed by a Consultant Psychiatrist and You are under continued supervision and receiving treatment from a Consultant Psychiatrist; or
- backache and related conditions unless there is radiological evidence of medical abnormality resulting in Disability; or
- a Pre- Existing Condition (See Special Note) or a Chronic Condition.
- any event which occurs whilst You are outside of the United Kingdom for a period intended to last for 84 days or more in any one year; or
- criminal or fraudulent acts in which You are involved; or
- ionising radiations or contamination by radioactivity from any nuclear waste from the combustion of nuclear fuel or the radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof; or
- surgery which is not medically necessary or is undertaken solely at Your request
Special Note
This exclusion will not apply to a Pre-Existing Condition if You have been free from symptoms and have not consulted a doctor or received treatment for a 2 year period prior to Your claim. If You had appointments to see a doctor within this period and these were not kept, the Pre-Existing Condition exclusion will apply unless You had been formally discharged.
(C) Unemployment Cover
What is covered
(If You are Self-Employed and wish to make an Unemployment claim We will only pay benefit if You are without Work due to the business in which You were Self-employed totally and permanently ceasing to trade as a direct result of it being unable to pay its debts as and when they fell due).
Unemployment benefits are only payable for your first claim if You have been in continuous Work for at least 6 months immediately prior to the date of Your Unemployment. This conditions does not apply for any subsequent claim.
We will pay:-
Monthly Benefit to the Coverholder if, during the Period of Cover, You suffer Unemployment.
Please note payment of Monthly Benefit is subject to the following conditions:-
-
- You must have been Unemployed for a continuous period of 28 days, after which one Monthly Benefit shall become payable; and
- Daily Benefit shall become payable in respect of each consecutive day of Your Unemployment until the earliest of the following dates:-
- the date on which You cease to be Unemployed or fail to provide proof that You are Unemployed; or
- the date on which the lesser of either the Outstanding Balance or the Credit Limit has been paid; or
- the Termination Date.
- Where You are Unemployed for two periods separated by less than 84 days We will treat this as one continuous claim.
- If whilst You are Unemployed You wish to commence temporary work then, provided You have first contacted Us and have given Us full details of the temporary work and have received Our agreement, if the temporary work does not continue for more than 6 months We will not, during that period, pay Monthly Benefit but will treat Your claim as suspended and will, thereafter, commence or resume payment of Monthly Benefit as if You had one continuous claim.
- If You cease to be entitled to Monthly Benefit under the Unemployment Insurance Part of this Policy, then You will not be entitled to any further Monthly Benefit under the Unemployment Insurance Part of this Policy until You have returned to Work for a continuous period of at least 6 months.
- The maximum Monthly Benefit payable under the Unemployment Insurance Part of this Policy, is £2,500.
- Benefit shall not be payable under the Unemployment Insurance Part of this Policy if You are currently receiving benefit under the Accident & Sickness Insurance Part of this Policy.
- If, during payment of an Unemployment claim, You are not able to actively seek Work only because of a Disability, We may consider continuing to pay Monthly Benefit.
What is not covered
We will not pay benefit if:-
- Your Unemployment occurs within 28 days of the Commencement Date or Notification of Unemployment was given to You (or if, in Our reasonable opinion You were aware of a forthcoming Notification) prior to the Commencement Date; or
- Your Unemployment is in any manner voluntary; or
- You are, at the date of Your Unemployment:-
- engaged in an occupation of which unemployment is a regular or recurrent feature; or
- working under a fixed-term contract of employment, the term of which will expire before the Repayment Date, (see Special Notes below); or
- employed by:-
a limited liability partnership or a company of which You or Your Partner, parent, child, brother or sister were a director and/or shareholder (other than by way of bona fide investment if a company quoted on a recognised stock exchange); or
someone who is self-employed or by a partnership, where the person who is self-employed, or any of the partners of the partnership, is Your Partner, parent, child, brother or sister.
This exclusion will not apply where the company, partnership or person by whom You were employed ceases totally and permanently to trade at the same time or immediately following You becoming Unemployed; or
- employed on a temporary basis or employed by an employer for a specific task or job and the completion of this task or job has resulted in Your Unemployment; or
- outside of the United Kingdom for a period intended to last for 84 days or more in any one year
- Unemployment occurs after You have reached the earlier of normal or statutory pensionable age for the occupation in which You were engaged; or
- You become Unemployed as a result of
- Your own act, omission or negligence
- criminal or fraudulent acts in which You are involved; or
- ionising radiations or contamination by radioactivity from any nuclear waste from the combustion of nuclear fuel or the radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof
- If You are in receipt of a payment in lieu of notice, Your Unemployment will not be deemed to have started until the day after the period covered by the payment in lieu of notice and Your entitlement to benefit will not start until 28 days after the expiry of the period for which You have received payment in lieu of notice.
Special Notes:
Exclusion iii b will not apply in the following circumstances:-
- You become Unemployed due to the expiry of, or during, a fixed term contract and immediately prior to Your Unemployment, You have been employed for at least 12 consecutive months and Your contract has been renewed at least once.
- You become Unemployed due to the expiry of, or during, a fixed term contract and immediately prior to Your Unemployment, You have been in employment for a total unbroken period of 24 months or more with the same employer.
- You become Unemployed due to the expiry of, or during, a fixed term contract and You have previously been employed by the same employer on a permanent basis but were transferred to a fixed term contract without a break in employment.
In addition, if You are unable to meet the employment criteria in 1, 2 and 3 above, and Your contract has been terminated before the due expiry date, You may be eligible to claim benefit for the period until the original expiry date of the fixed term contract.
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(D) Carer Cover
What is covered
We will pay the lesser of either the Outstanding Balance or the Credit Limit up to a maximum of £25,000 to the Coverholder if, during the Period of Cover You become a Carer.
Payment of benefits is subject to the following requirements:-
- Prior to any benefit being paid under this section of the Policy, You will have to provide a letter from the Doctor of Your Relative to confirm the nature and start date of the condition suffered. This will include details of when the patient first consulted for this condition and when it was first diagnosed.
- If You were employed We will write to Your last employers to confirm that You did not leave Your Employment for reasons other than to become a Carer.
- If You are a Self-Employed business owner, You will need to provide evidence that Your Business has totally and permanently ceased to trade and that You have filed cessation accounts with the Inland Revenue and that this did not occur for reasons other than You having to become a Carer.
What is not covered
We will not pay benefits if:-
- The sickness, disease, condition or injury of the person being cared for existed prior to the Commencement Date (this exclusion will not apply if, in the opinion of Our Chief Medical Officer, the sickness, disease, condition or injury would not have normally deteriorated or was not considered likely to deteriorate to the extent that full time care is required during the Period of Cover); or
- Your Work ceases for any other reason not associated with the need to become a Carer; or
- Your resignation /temporary unpaid leave of absence is from Employment, which is of a casual or temporary nature.
- You are currently receiving benefits under the Accident and Sickness Insurance or Unemployment Insurance Part of this Policy.
(E) Critical Illness Cover
What is covered
We will pay the lesser of either the Outstanding Balance (including up to 3 months' arrears if applicable) or the Credit Limit up to a maximum of £25,000 to the Coverholder if, during the Period of Cover, You suffer Critical Illness from which You survive for a period of 30 days or more from the date of diagnosis.
Exclusions:-
- Pre existing Conditions Exclusion
No benefit will be payable in respect of a claim arising in connection with a Critical Illness condition which was diagnosed before the Commencement Date of this Policy. In addition, no benefit will be payable for any Critical Illness condition which, in the opinion of Our Chief Medical Officer, has resulted directly or indirectly from a condition for which You have previously received treatment or of which You were aware at the Commencement Date of the Policy.
NB for the purposes of this exclusion, the suffering or undergoing of a Heart Attack or Stroke is considered to be the same disease.
What is not covered
We will not pay benefits if the Critical Illness:-
- is suffered by You within 3 months of the Commencement Date;
- results directly or indirectly from:-
- an episode of self-harm; or
- Your consumption of alcohol or You taking drugs otherwise than under the direction of a Doctor (provided that such direction is not given due to Your treatment for drug addiction or dependence); or
- ionising radiations or contamination by radioactivity from any nuclear waste from the combustion of nuclear fuel or the radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof.
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PART 4
HOW TO MAKE A CLAIM
Written notice of any claim should be given within 120 days of the date of the event giving rise to that claim together with, at Your expense, such information and proof as We may reasonably require. If such notice and information is not given within this 120 day period then, other than in exceptional circumstances, no benefits will be paid in respect of the claim.
In the event of Your death, to enable Us to assess Your entitlement to benefit, additional information may be required from a medical practitioner who has treated You. In the event that additional medical information is required, You agree to Us requesting and obtaining medical information from any medical practitioner who has treated You.
Throughout any period for which Disability or Unemployment benefits are claimed You should provide, at Your expense, such proof of continued Disability or Unemployment, as may be reasonably required and other than in exceptional circumstances, no benefits shall be payable for any period for which the required substantiating proof is not provided.
In the event that You become a Carer, to enable Us to assess Your entitlement to benefit, additional information will be required from Your employer and You agree to Us requesting and obtaining such information. If You are Self Employed, You will need to provide such evidence that Your business has totally and permanently ceased to trade. You will also be asked to provide at Your expense written confirmation from the Doctor of Your Relative confirming the details surrounding their medical condition.
We may require You, at Our expense, to be examined by a medical examiner of Our choice. If You fail to attend any such examination, no further benefit shall be payable.
We may also arrange for an agent representing Us to visit You. The purpose of any such visit will be to gather details relating to Your claim in order to ensure an accurate assessment. It is essential that You make yourself available for any such visit. If You do not do this, no further benefit shall be payable unless circumstances beyond Your control have led to Your unavailability.
When making a claim for Unemployment benefit, Your claim may be selected for Back to Work Assistance. This specialised service is designed to provide guidance and assistance with Your job search and is provided at Our expense. If Your claim is selected, provided We have received Your consent, Your claim details will be provided to Our Back to Work Assistance service provider.
Completed claim forms and all matters relating to any claim should be sent to:-
Egg Claims Management Department
PO Box 336
Esher, Surrey
KT10 9WD
Telephone 0845 120 5203*
*Telephone calls may be monitored or recorded to assist with staff training and for quality control purposes.
You may contact us using Typetalk, telephone 18001 0845 120 5203
Confidential and Independent Counselling
Your Policy includes a confidential and independent counselling programme. The service provides You and Your immediate family with assistance, practical help and guidance on:
i. medical information;
ii. stress counselling.
Telephone: 0845 300 2081 and quote 'Egg Card Care'. Lines are open 24 hours a day 365 days a year.
There is also an unemployment support helpline available which includes:
i. access to a job vacancy database;
ii. practical help and guidance on returning to work;
iii. personal and legal advice.
Telephone: 0845 300 2082 and quote 'Egg Card Care'.
Lines are open 9 to 5 Monday to Friday.
Fully trained professional and advisory staff operate these helplines.
These services are free of charge except for the cost of Your telephone call.
PART 5
CUSTOMER SERVICE
Any enquiry or complaint regarding this Policy should in the first instance be addressed to:-
Customer Liaison Manager
St Andrew's Group
St Andrew's House
Portsmouth Road
Esher, Surrey
KT10 9SA
Please supply details of Your Agreement Number to enable the enquiry to be dealt with promptly.
If You have any reason to complain to Us, We will deal with Your complaint in the following way:
- We will try Our best to resolve Your complaint to Your satisfaction straight away and in any event before the end of the next working day.
- If We cannot do this, We will send You an Acknowledgement Letter within 5 working days and tell You who will be handling Your complaint and how to contact them. We will also tell You how We will deal with Your complaint.
- If We can resolve Your complaint in less than 5 days, We will send You a Final Response Letter which will inform You whether We:
- accept Your complaint and will tell You what We will offer You to make amends; or
- reject Your complaint and will explain the reasons for doing so; or
- reject Your complaint but in some circumstances We will offer You some form of compensation and We will explain in full why this is being offered to You.
- If We cannot resolve Your complaint within 5 working days We must within 4 weeks of receiving Your complaint either send a Final Response Letter as detailed above, or send You a Holding Response Letter explaining why We are not in a position to resolve Your complaint and indicate when We will make further contact.
- If within a further 4 weeks (i.e. 8 weeks from the date We first received Your complaint) We are still unable to resolve Your complaint, We will at this time:-
- Either send You a Final Response Letter; or
- If We cannot make a final response We will tell You why and indicate when We will make further contact.
- After 8 weeks, or whenever We send You a Final Response Letter if that is sooner, You can refer Your complaint to the Financial Ombudsman Service if You are not satisfied with the outcome of Your complaint or the delay in resolving it. When We write to You, We will send You a copy of the leaflet telling You how to complain to the Financial Ombudsman Service and that You can do this within 6 months of Our sending You the leaflet.
The Financial Ombudsman Service is at:-
South Quay Plaza
183 Marsh Wall
London E14 9SR
Telephone 0845 080 1800
None of the above affects any right of action You may have.
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