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DESCRIPTION OF THE IBERDROLA PAYMENT PROTECTION
Insurer: MetLife Europe Limited - Branch in Portugal and MetLife Europe Insurance Limited - Branch in Portugal, both with their offices in Av. da Liberdade, 36, 4th floor, in Lisbon, registered at the Lisbon Commercial Registry, with the common registration and corporate identification number 980479436 and 980479428, respectively, and with their head office at 20 On Hatch Street Dublin 2, 415123 Ireland, referred to without distinction as “MetLife”, without this restricting or changing the scope of the activity or the guarantees, hereinafter referred to as MetLife; Policyholder: IBERDROLA CLIENTES PORTUGAL, UNIPESSOAL, LDA., with its head office in Av. da Liberdade, 180A, 6th floor, Edifício Tivoli Fórum, 1250-146 Lisbon, registered at the Lisbon Commercial Registry, with the single registration and corporate identity number 502124083, responsible for paying the Premium to MetLife, hereinafter referred to as IBERDROLA. Insured Person: The person whose life is insured and who is subject to the risks covered by the Policy. Irrevocable beneficiary: The entity with which the Insured Person entered into an electricity and/or gas Supply Contract, in this case IBERDROLA ("Supply Contract"), to whom the payments shall be made in the case of a claim, within the terms of the Policy, i.e. IBERDROLA.
a) Unemployment (employed workers), “U”: situation of the Insured Person who, holding Permanent Employment, moves to a situation of total, involuntary inexistence of employment whilst having the capacity and availability to work, proven through registration at the Job Centre in their area of residence, as long as alternative employment has not be refused. Permanent Employment is understood to be a situation in which the Insured Person undertakes to carry out a professional activity, in return for remuneration, as an employee of an employer, under the authority and direction of the latter, through a permanent individual work contract with a duration of more than 12 months with a minimum of 30 hours per week, and registered with the Social Security. b) Absolute Permanent Disablement, "APD": APD is understood to be the disablement which, after a period of 12 (twelve) months, is of a definitive nature and prevents the Insured Person from carrying out any paid occupation. c) Total Temporary Disablement, “TTD”: TTD is understood to be the total, temporary physical inability of the Insured Person, susceptible to medical findings, to carry out their usual profession, as a result of illness or accident. d) Accidental Death, “AD”: AD is understood to be the death of the Insured Person as a result of Accident, as long as the death is verified within one year as from the occurrence of the accident and that it is the consequence of that accident. e) Hospitalisation due to accident, “Hosp”: Hosp is understood to be the admission of the Insured Person to a Hospital due to Accident, as an in-patient, for a period of more than 24 complete hours.
Scope and Object of the Contract
As the main cover of the Life Insurance, Metlife Europe Limited guarantees the risk of Death, "D" and the complementary covers Absolute Permanent Disablement, "APD", Total Temporary Disablement "TTD", Hospitalisation as a result of Accident, “Hosp” and Accidental Death, “AD”, and as the main cover of the Non-Life Insurance, MetLife Europe Insurance Limited guarantees the Unemployment of employed workers "U". The Insured Capital is exactly the same flat-rate for all the Insured Persons. In the case of a claim accepted by the Insurer, the Capital paid to Iberdrola shall be to cover the amounts due to Iberdrola within the scope of the Supply Contract, notwithstanding the deductible periods and the periods arising from the definition of the cover in question. Description of the Coverage:
Limits of the Cover
a) In the case of D or APD, the Insured Capital is the amount of 800€. b) In the case of TTD and U, the Insured Capital will be 800€. c) In the case of AD, the Insured Capital will be 1,200€. d) In the case of Hosp, the Insured Capital will be 300€. The above-mentioned amounts may be subject to being annually updated in accordance with the Consumer Price Index (CPI) published by the Instituto Nacional de Estatística (Portuguese Institute of Statistics), which will use as a reference the period from November to November before the application of the update, and the update will be reflected on the 1st January of the following year in which the present insurance contract is in force. Payment of the benefits by the Insurer, within the scope of TTD and U coverage, is only due if the said situation is prolonged for a period of more than 30 consecutive complete days, counting from the first day after that period for the first 400€, and for more than 210 consecutive days, counting from the first day after that period, for the remaining 400€. Payment of the benefits by the Insurer, within the Hosp cover, is only due if the said situation is prolonged for a period of more than 7 consecutive complete days. Any fees or taxes, unpaid monetary instalments and possible arrears interest are excluded from the amounts to be paid. e) D and AD cover is not accruable. f) TTD and M cover is not accruable.
To join the Insurance Contract, the applicant must comply with the following requirements as of the date of the beginning of the Supply Contract: a) Be party to an electricity and/or gas Supply Contract entered into with IBERDROLA; b) Be over the age of 18 and up to and including the age of 75; c) Be a resident in Portugal; d) Not have been hospitalised for more than 10 consecutive days in the last 24 months; e) Not be aware of an imminent surgery being performed. f) Have a paid professional activity, whether on a payroll or not, with a minimum of 30 hours per week; g) If they have a professional activity: not have been partially or totally unable to work in the last 24 months, due to illness or accident, for more than 30 consecutive or alternating days; h) The requirements provided for in sub-paragraphs f) and g) are not applicable to the Insured Person aged between 65 and 75, who joining the Policy, only had coverage for D, Hosp and AD.
Commencement and Duration of the Cover
The cover comes into effect with regard to each Insured Person a) On the date Iberdrola begins supplying electricity and/or gas, within the terms of the Supply Contract; b) On the date on which the Admission Proposal/Statement is handed over to the mediator, whenever admission takes place after entering into the Supply Contract; c) On the date on which the contractual documentation is handed over to the Insured Person, whenever joining occurs after entering into the Supply Contract and it is made over the telephone.
Termination of the Cover
The cover of the Policy will automatically terminate whenever the first of the following dates is reached or if any of the following events occur: a) On the date of the Insured Person's 65th birthday, for APD, TTD and U cover; b) On the date of the Insured Person's 80th birthday, for D and Hosp cover; c) On the date of the Insured Person's 99th birthday, for AD cover; d) Death or Absolute Permanent Disablement of the Insured Person, regardless of whether the insured capital has been paid, within the terms of the Policy; e) Whenever the maximum Insured Capital limit has been reached, as provided for in "Cover Limits", except for TTD and U cover; f) Due to termination of the Supply Contract; g) Due to terminating the Membership.
a) The reclassification period is the space of time measured between two events classified as covered claims under one cover or under different covers of the Contract. If the two claims arise from the same cause or the cause of the second claim is directly related to the cause of the first claim, the latter is considered to be the continuation of the former, except when a period of more than 6 (six months elapses between closing the first claim and opening the second. b) The reclassification period for U cover is 6 (six) months. When a second claim occurs in less than six months after the term of the first claim, the second one will always be considered to be a continuation of the first. c) Among TTD and Hosp claims, as long as arising from the same cause, the reclassification period does not apply: they will always be considered to be a single claim. Notwithstanding the occurrence of the remaining conditions above, once the total maximum Insured Capital has been paid in the case of a claim provided for in "Cover Limits", 12 (twelve) complete months of the term of the Contract must have elapsed before such cover can be actioned once again for a new TTD or U claim.
The covers are valid throughout the world. However, with regard to cover for D, AD, APD, Hosp and TTD, whenever claims occur outside the European Union, these situations must be declared by a doctor who practices in the territory in question.
In the case of D: a) Suicide during the first two years counting from the date of the Insured Person joining the scheme; b) The risk resulting directly or indirectly from any illness, accident, injury or disability in existence or that occurred before the date of the Insured Person joining the insurance scheme; c) Earthquakes or other natural phenomena; d) Acts of terrorism and sabotage, attacks, uprisings or any other changes in the public order; e) Consequences of nuclear reaction or radiation and radioactive contamination; f) The risks arising from the use of narcotics or drugs not clinically prescribed, as well as the risks arising from any action or omission by the Insured Person under the influence of alcohol or an alcoholic beverage that determines a level of alcohol in the blood higher than the limits set by law; g) Illegal act or crime directly practiced by the Insured Person, of which the latter is the material or moral author or to which they were an accomplice or in which they participated in any other form; h) Death resulting from the professional or amateur practice of dangerous sports when part of championships or respective training, as well as hunting fierce animals, winter sports, boxing, karate and other martial arts, hang-gliding, bullfighting, mountaineering, speleology, motor racing and other sports of a similar danger. In the case of APD: a) Disablement resulting from any accident, injury or disability that occurred prior to this cover coming into force, or any other existing illness on the date of the cover coming into force, or its deterioration even when caused by an accident that occurs during the term of the contract; b) Disablement as a result of attempted suicide by the Insured Person or of any other intentional act on their part; c) Disablement as a result of pregnancy and birth, abortion or miscarriage and the respective consequences, as well as in vitro fertilisation and treatments for fertility and sterility; d) Disablement as a result of psychiatric illnesses; e) Disablement due to any pathology of the spinal column; h) Disablement resulting from the professional or amateur practice of dangerous sports when part of championships or respective training, as well as hunting fierce animals, winter sports, boxing, karate and other martial arts, hang-gliding, bullfighting, mountaineering, speleology, motor racing, and other sports of a similar danger. g) All the exclusions mentioned for Death coverage. In the case of TTD: a) Total Temporary Disablement resulting from any accident that occurred prior to this cover coming into force or any other existing illness on the date of the cover coming into force, or its deterioration even when caused by an accident that occurs during the term of the contract; b) Total Temporary Disablement resulting from the professional or amateur practice of dangerous sports when part of championships or respective training, as well as hunting fierce animals, Winter sports, boxing, karate and other martial arts, hang-gliding, bullfighting, mountaineering, speleology, motor racing, and other sports of a similar danger; c) Total Temporary Disablement resulting from pregnancy and birth, abortion or miscarriage and the respective consequences, as well as in vitro fertilisation and treatments for fertility and sterility; d) Total Temporary Disablement resulting from psychiatric illnesses; e) Total Temporary Disablement due to any pathology of the spinal column; f) Total Temporary Disablement resulting from attempted suicide by the Insured Person or of any other intentional act on their part; g) Any claim occurring during the grace period; h) All the exclusions mentioned for Death coverage. In the case of AD: a) Intentional acts by the Insured Person that cause their death; b) Professional or amateur practice of dangerous sports, when part of championships or respective training, as well as hunting fierce animals, winter sports, boxing, karate and other martial arts, hang-gliding, bullfighting, mountaineering, speleology, motor racing and other sports of a similar danger; c) Natural disasters, terrorism, public unrest, participation in criminal acts and the consequence of nuclear reaction and radiation and radioactive contamination; d) Accidents occurring before joining this Contract. In the case of U: a) Notified unemployment, whatever the cause, whether as a final decision or mere intention, prior to the date of the insurance coming into effect or within the grace period of the cover; b) Retirement, early retirement or pre-retirement, even when receiving unemployment benefit; c) Termination of the work contract by mutual agreement by the parties, even when based on grounds that allow for collective dismissal or due to elimination of the job and/or that allow unemployment benefit to be attributed; d) Termination of the work contract by either party, during the experimental period; e) Termination of the work contract on the worker's initiative, even when justified as fair dismissal; f) Unemployment, whatever its cause, as long as the Insured Person was working abroad, for a period of more than 30 consecutive days in each year, or did not have a work contract governed by Portuguese law or did not benefit from the right to social benefits/unemployment benefits from the Portuguese State; g) Seasonal unemployment, normal in the activity carried out; h) Unemployment caused by criminal acts or any other reasons that constitute the fair dismissal of the worker; i) Unemployment following self-employment; j) Unemployment following part-time, fixed-term or temporary work: k) Any claim occurring during the grace period. In the case of Hosp: a) Hospitalisation for convalescence, stay in spas, shelters, rest-homes, residences or similar institutions; b) Hospitalisation due to facts or accidents caused intentionally by the Insured Person or for treatments not prescribed by a doctor, as well as the consequences of surgeries or treatments that are not strictly necessary to cure a disease or accident; c) Hospitalisation due to any accident or disease suffered by the Insured Person whilst under the effect of any drug or alcohol; d) Hospitalisation due to aesthetic or cosmetic surgery prescribed to the Insured Person which is not the consequence of an accident covered by the Policy. e) Hospitalisation due to accidents occurring to members of the security forces as a consequence of any violent action in which they participate when performing their duties. f) Hospitalisation due to an accident that occurred before admission to the insurance scheme comes into force.
Grace Period and Relative Deductible
a) Grace period With regard to U cover, the Insured Person does not benefit from this cover when the claim occurs during the 60 days following the date that the admission to the Contract comes into force. b) Relative Deductible Payment of the amounts due by MetLife in the case of TTD and U, is only due if the situation is prolonged for a period of more than 30 consecutive complete days, counting from the first day after that period for the first 400€, and for more than 210 consecutive days, counting from the first day after that period, for the remaining 400€. Payment of the benefits by the Insurer, within the Hosp cover, if the said situation is prolonged for a period of more than 7 consecutive complete days. c) The deductible periods are applied individually to each claim filed.
The Policyholder shall undertake to inform the Insured Persons in writing and within a maximum of 30 (thirty) days, of any possible amendments to the insurance following their admission. The cover of the Insured Persons will automatically vary depending on their age, within the terms described in "Scope and Object of the Contract".
Negligent or Fraudulent Omissions or Inaccuracies
The Insured Person is obliged to make an accurate statement of all the circumstances known to them and which must reasonably be considered significant for MetLife to assess the risk, namely regarding the statement(s) used as a basis for admission to the Group Insurance. In the case of omission or negligent inaccuracy, within the period of three months after its knowledge, MetLife may: a) Propose an amendment to the admission, setting a deadline of not less than 14 days for the Insured Person to accept the amendment. b) Terminate the membership, showing that in no case would it accept admission to the Contract with the cover of risks related to the omitted or inaccurately stated fact. c) In the case mentioned in b), admission terminates its effects 30 days after sending the statement of termination or 20 days after the Insured Person received the amendment proposal, should the latter not reply or reject it. d) Should the membership terminate, the premium is returned pro rata temporis. e) If prior to the termination or amendment of the admission a claim takes place that has been influenced by or the consequence of a fact regarding which there have been omissions or inaccuracies, MetLife will cover the claim for the proportion of the difference between the premium paid and the premium that would be owed should, at the time of joining the scheme, the omitted or inaccurately stated fact have been known; however, the claim will not be covered and the premium will be returned pro rata temporis if, no case whatsoever, MetLife would have accepted the admission if it knew of the omitted or inaccurately stated fact. In the case of omission or fraudulent inaccuracy: a) Membership may be made void through a declaration by MetLife to the Policyholder within a period of 3 months counting from its knowledge of the breach; b) If any claim has occurred before MetLife becoming aware of the breach or within the period mentioned in a), MetLife may not cover it, and the general regime of annulablity shall be used. c) MetLife has the right to the premium due at the end of the period mentioned in a), except in the case of the Insurer committing fraud or gross negligence. d) Should the Insured Person commit fraud, with the intention of obtaining an advantage, MetLife has the right to the part of the premium regarding the admission of the Insured Person. The Insured Person is required to repair any losses and damage caused to MetLife arising from providing inaccurate statements or omissions.
With regard to D cover, the membership of each Insured Person is incontestable, once two years have passed after the respective date of entering into force, and MetLife cannot avail itself of omissions or negligent inaccuracies in the initial statement of the risk.
Procedures in Case of a Claim
The Insured Person, or their legal representative, or whoever has a legitimate interest in actioning the insurance, must communicate the claim to MetLife's Claims Department, by email to firstname.lastname@example.org, using the telephone number 808 500 005 (cost of a local call) or in writing sent to MetLife's address. MetLife will immediately deliver or send the Claim Report form.
The Claim Report must be duly completed and delivered or sent to the Insurer within a maximum period of 30 (thirty) days counting from the occurrence of any claim that might come within the framework of the contracted cover, under penalty of the Insured Person responsible for the delay answering to any losses or damages.
The Claim Report must have the following items attached:
a) In the case of D and AD:
b) In the case of APD:
Explanation of the acknowledgement of Disablement by the Social Security or other equivalent social security systems (original or authenticated copy).
c) In the case of TTD:
d) In the case of U:
f) In the case of Hosp:
For all coverage, MetLife reserves the right to request information and complementary items required to analyse the claim.
The expenses incurred in obtaining the necessary documentary proof for settling the claim are borne by Insured Person or their legal representative.
The Insured Person shall undertake to authorise their physician to provide the necessary information for analysing the claim, to undergo the requested medical exams, and to comply with the medical prescriptions in order to avoid increasing the claim.
The Insured Person shall undertake to carry out the exams that the doctor representing the Insurer deems necessary to prove the TTD, also undertaking to authorise their physician to provide the Insurer, in the person of the doctor representing the Insurer, all the information required for that same purpose, and the Insurer's authorised doctor may also visit the Insured Person in any case or time in order to assess their state of health.
If no agreement is made between the Insured Person, or whoever represents them, on the cause, the nature or the degree of TTD, each of the parties will designate a medical expert in order to jointly decide upon the matter. In the case of a disagreement, the two doctors will nominate a third doctor for the casting decision. If it is not possible to come to an agreement regarding the designation of that last doctor, the choice will be requested from the President of the Portuguese Medical Society. Each of the parties will bear the expenses and fees of their doctor, whilst those of the third doctor will be divided equally between the parties.
The claim will be paid to Iberdrola within a maximum period of 30 days following receipt of all the documents and information requested by MetLife.
Should the Insured Person or the Policyholder use fraud, simulation, falsehood or any other deceitful means, as well as false documents to justify a complaint about the existence of a claim, the right to any payment shall cease, MetLife also being conferred the right to terminate the membership of the scheme, notwithstanding the right to compensation for losses and damages.
Irrevocable Beneficiary of the Insurance
All payments foreseen in the Insurance Contract will be exclusively paid to IBERDROLA with whom the Insured Person has entered into a Supply Contract, in the quality of the irrevocable beneficiary of the Contract.
The Insured Person shall benefit from the coverage of the present Contract, within the following terms:
Determination of the premium:
a) the monthly premium is calculated monthly by applying a single overall rate depending on the Insured Capital.
b) Breakdown of the monthly premium by coverage:
Legally due fees and taxes at the date of collection will be added to the amounts mentioned.
The above-mentioned amounts may be subject to being annually updated in accordance with the Consumer Price Index (CPI), published by the Instituto Nacional de Estatística (Portuguese Institute of Statistics), which will use as a reference the period from November to November before the application of the update, and the update will be reflected on the 1st January of the following year in which the present insurance contract is in force.
Failure to pay the premium:
Failure to pay part of the monthly fraction of the Premium corresponding to each membership leads to termination of all cover with effect on the date of joining the Contract or on the date the monthly premium becomes due, when it is a premium subsequent to joining the Policy.
Change in the value of the premium:
The value of the premium for each cover may be changed by the Insurer whenever it is found not to be adequate for the risk to be insured, in which case the Policyholder will inform the Insured Persons about the new premium at least 60 (sixty) days in advance.
Freedom of Rescission and Termination
The Insured Person can terminate their membership, without invoking just cause, during the 30 days following reception of this document, communicating it to Iberdrola by registered letter sent to Iberdrola, Apartado 12011, EC Picoas, 1061-001 Lisbon or by sending an email to the electronic address email@example.com, attaching, in either case, a copy of their personal identification document.
The Insured Person may terminate their membership of the insurance scheme, on their own initiative, whether as a result of the change in the value of the premium of for any other reason, through a written communication, at least 30 days prior to it taking effect, which must be sent by registered letter to Iberdrola at Apartado 12011, EC Picoas, 1061-001 Lisboa or by email to the electronic address firstname.lastname@example.org, attaching, in either case, a copy of their personal identification document.
Redemption, Reduction and Profit-Sharing Values
This type of Insurance does not confer the right to any reduction, redemption, addendum or any profit-sharing.
Payments in Case of a Claim
The amount paid in the case of a claim will be allocated to a credit in the account of the Supply Contract to which the Insured Person is a party. For Death and Accidental Death cover, and should there not be any legal heirs residing in the same home as the Insured Person at the time the claim occurs, the above-mentioned amount may be credited in the account of another Supply Contract with IBERDROLA, to which the one of the legal heirs of the Insured Person is a party. If the legal heirs of the Insured Person do not have a Supply Contract, the Insured Capital will be transferred by Iberdrola to the BIN indicated by them for this purpose. Payment of claims arising from D, APD and Hosp coverage will be made in full, all at one time. The Insured Person does not have the right to action U cover if payment is simultaneously being made as a result of activating TTD cover. U cover may only be actioned by the Insured Persons who, on the date of the claim, meet the eligibility criteria.
Personal Data Processing
The personal data collected for the membership and management of membership of the insurance contract will be processed and stored on a computer. MetLife guarantees to maintain the personal data private and to take appropriate measures to keep them confidential, reserving access to them to that strictly necessary for its normal activity. The owner of the data is guaranteed the right to assess any datum concerning them, and may request for it to be corrected, added or eliminated, in writing to email@example.com, attaching a copy of their personal identification document.
The Insured Person shall authorise that personal data collected for the purpose of joining the insurance scheme or subsequently, namely when filing a claim, be processed and stored on a computer in order for the insurance Policy to be managed, including making data available to the judicial or administrative authorities in compliance with MetLife's legal obligation, as well as to reinsurers and companies in the MetLife Group, which may involve the transfer of information to other countries, even outside the European Union. Without the holder of the personal data having this authorisation, MetLife cannot accept admission to the insurance contract.
The Contract shall be subject to Portuguese Law and to the Portuguese tax regime in force at any given moment.
Identification of the Policy's Insurance Mediator
The following Insurance Broker shall deal with this insurance policy: IBERDROLA CLIENTES PORTUGAL, UNIPESSOAL, LDA., with its head office in Av. da Liberdade, 180 A, 6th floor, Edifício Tivoli Fórum, 1250-146 Lisbon, registered at the Lisbon Commercial Registry, with the single registration and corporate identity number 502124083, Tied Insurance Mediator, registered under number 215423617, for the Life and Non-Life business.
The registration of the mediator can be confirmed on the website of the Portuguese Insurance and Pension Funds Supervisory Authority: www.asf.com.pt.
Iberdrola does not have shareholdings in any insurers. No insurer directly or indirectly has any shareholding in Iberdrola.
The Insured Person may request information from the Mediator on the remuneration for providing the mediation service and the Mediator must provide such information.
Information and Complaints
Any request for information may be addressed to MetLife, Avenida da Liberdade, 36 - 2nd floor, 1269-047 Lisbon, or by telephone using the Customer Service number 808 500 005 (from Monday to Friday, from 8.45 a.m. to 12.45 p.m. and from 1.45 p.m. to 4.45 p.m. at the cost of a local call), as well as by email sent to the electronic address firstname.lastname@example.org or IBERDROLA CLIENTES PORTUGAL, UNIPESSOAL, LDA., Apartado 12011, EC Picoas, 1061-001 Lisbon; or by telephone using the Customer Service Number 808 502 050 (working days, from 9 a.m. to 8 p.m. at the cost of a local call), as well as by e-mail sent to the electronic address email@example.com, in its capacity of Insurance Mediator.
Iberdrola and MetLife have a complaints book.
Any complaint may also be addressed in writing to the addresses indicated, which can be found on the websites www.iberdrola.pt or www.metlife.pt, or addressed to Autoridade de Supervisão de Seguros e Fundos de Pensões (www.asf.com.pt), the Portuguese insurance company supervisory entity.
Complaints and Disputes
Within the scope of its competences, it is the responsibility of Autoridade de Supervisão de Seguros e Fundos de Pensões (previously called Instituto de Seguros de Portugal) to analyse and give its opinion on requests for information and complaints presented by consumers and the respective associations against insurers and insurance mediators, notwithstanding the possibility of turning to the courts of law, in the case of a dispute arising from the mediation, or of turning to organisations that may come to be created for extrajudicial resolution.