QQP Accident Cover

About You

Cover

Payment

About You

Are you a UK resident?

Yes No

How old are you?

Date of Birth *

What is your name?

Title *

First Name *

Last Name *

Where do you live?

Postcode *

Address line 1 *

Address line 2

City *

County

How can we contact you?

Telephone *

Email *

Tell us more about you?

Sex at birth *

Marital Status *

What do you do for work?

Employment status *

Main occupation *

Do you have a second occupation?

Yes No

Cover

Core Cover

MetLife EverydayProtect is an affordable protection plan that can be tailored to suit your needs.

There are five levels of cover, choose between one and five units -the more units you buy the higher your benefits will be.

Select Cover Units*

Core Cover	£ /month	£ 0 /month	£ 10 /month
Broken bones	up to £	up to £0	up to £1000
Major	up to £	up to £0	up to £1000
Minor (ear bones, facial bones other than the mandible, excluding the nose, any other bone not listed as major)	up to £	up to £0	up to £250
Hospitalisation in the UK (per 24 hour period)	up to £	up to £0	up to £50
Hospital admission due to sickness is covered once you've held the policy for at least 12 months	up to £	up to £0	up to £50
Accidental permanent injury	up to £	up to £0	up to £25000
Paralysis of limbs total and irreversible	up to £	up to £0	up to £25000
Blindness in both eyes permanent and irreversible	up to £	up to £0	up to £20000
Loss of both hands or both feet permanent physical severance	up to £	up to £0	up to £20000
Deafness in both ears permanent and irreversible	up to £	up to £0	up to £7500
Loss of use of elbow, hip, shoulder, knee, ankle or wrist	up to £	up to £0	up to £7500
Loss of one hand or foot permanent physical severance	up to £	up to £0	up to £7500
Loss of thumb	up to £	up to £0	up to £7500
Third-degree burns covering 20% of the body's surface	up to £	up to £0	up to £7500
Loss of major organ (kidney, spleen, lung, pancreas, urinary bladder or stomach)	up to £	up to £0	up to £7500
Blindness in one eye permanent and irreversible	up to £	up to £0	up to £7500
Blindness in one eye permanent and irreversible	up to £	up to £0	up to £7500
Deafness in one ear permanent and irreversible	up to £	up to £0	up to £2500
Loss of finger (not thumb) or toe	up to £	up to £0	up to £2500
Loss of use of elbow, hip, shoulder, knee, ankle or wrist	up to £	up to £0.00	up to £2000.00
Loss of finger (not thumb) or toe	up to £	up to £0.00	up to £250.00
Total permanent disablement	up to £	up to £0	up to £50
Accidental death	up to £	up to £0	up to £40
Loss of speech total permanent and irreversible	up to £	up to £0	up to £7500
Non-accidental death	up to £	up to £0	up to £2000
Within 1 year	up to £	up to £Premiums refunded	up to £Premiums refunded
Year 2	up to £	up to £0	up to £1000
Years 3-4	up to £	up to £0	up to £1500
Year 5+	up to £	up to £0	up to £2000

*The benefit amount payable for Total Permanent Disablement will be reduced by the amount already paid in connection with the same accident that caused your total disablement.

The maximum amount payable under Core Cover for any ONE of the following insured events is £50,000 per unit of cover:

a single accident, resulting in any combination of Core Cover benefits being paid
a single, uninterrupted hospital stay

Once the maximum benefit has been paid for a single insured event as above, your policy will end.

The benefit amounts payable for Core Cover are reduced by 50% from the policyholder's 70th birthday.

Child Cover

Child Cover offers a wide range of benefits to help support you through difficult times, including if your child is diagnosed with cancer - (excluding less advanced cases), and protects all of your children

(and any step children) aged 6 months to 18 years, or up to 23 years if in full-time education. Children do not need to live with the policyholder and you do not need to pay per child, or provide any details of your child(ren), they will automatically be covered when the below is selected.

The number of units selected for Core Cover must match the number of units for Child Cover.

Add Child Cover?

Child Cover	£ /month	£ 0 /month	£ 2 /month
Broken bones	up to £	up to £ 0	up to £ 250
Major (arm, ankle, back, hip, mandible, leg, neck, pelvis, shoulder, wrist, skull - not including facial bones or ear bones)	up to £	up to £ 0	up to £ 250
Minor (ear bones, facial bones other than the mandible, excluding the nose, any other bone not listed as major)	up to £	up to £ 0	up to £ 50
Hospitalisation in the UK (per 24 hour period) as a result of accident, or self-inflicted injury	up to £	up to £ 0	up to £ 20
Hospital admission due to sickness or treatment of self-inflicted injury, is covered once the Child Cover has been held for at least 12 months	up to £	up to £ 0	up to £ 20
Accidental permanent injury	up to £	up to £ 0	up to £ 5000
Paralysis of limbs total and irreversible	up to £	up to £ 0	up to £ 5000
Blindness in both eyes permanent and irreversible	up to £	up to £ 0	up to £ 4000
Loss of both hands or both feet permanent physical severance	up to £	up to £ 0	up to £ 4000
Deafness in both ears permanent and irreversible	up to £	up to £ 0	up to £ 2000
Loss of one hand or foot permanent physical severance	up to £	up to £ 0	up to £ 2000
Loss of use of elbow, hip, shoulder, knee, ankle or wrist	up to £	up to £ 0.00	up to £ 2000.00
Loss of use of elbow, hip, shoulder, knee, ankle or wrist	up to £	up to £ 0.00	up to £ 2000.00
Loss of thumb	up to £	up to £ 0.00	up to £ 1000.00
Deafness in one ear permanent and irreversible	up to £	up to £ 0.00	up to £ 1000.00
Loss of major organ (kidney, spleen, lung, pancreas, urinary bladder or stomach)	up to £	up to £ 0.00	up to £ 1000.00
Blindness in one eye permanent and irreversible	up to £	up to £ 0.00	up to £ 1000.00
Loss of speech total permanent and irreversible	up to £	up to £ 0.00	up to £ 1000.00
Burn referred to a specialist burns unit due to its severity, covering 5% of the body's surface	up to £	up to £ 0.00	up to £ 1000.00
Total permanent disablement unable to look after yourself ever again (due to accidental injury only)	up to £	up to £ 0	up to £ 5000
Cancer as defined in the pollicy Terrms & Condition	up to £	up to £ 0	up to £ 5000
Accidental death	up to £	up to £ 0	up to £ 4000

^The Child Cover benefit amount for Paralysis of Limbs will be reduced by the amount already paid in connection with the same accident that caused the child's paralysis.^^The Child Cover benefit amount payable for Total Permanent Disablement will be reduced by the amount already paid in connection with the same accident that caused the child's total disablement.

The maximum amount payable under Child Cover for any ONE of the following insured events is £5,000 per unit of cover:

a single accident, resulting in any combination of Child Cover benefits being paid.
a single, uninterrupted hospital stay.
diagnosis of cancer.

Payment of the benefit for diagnosis of cancer is a separate insured event from any hospital stays.

Non-accidental death benefit is not included under Child Cover. Please see the Policy Terms and Conditions for full details.

Active Lifestyle Cover

Active Lifestyle Cover provides additional cover in the event of you sustaining bodily injury caused by an accident, which results in a dislocation and/or either a tendon rupture or ligament tear. We'll help you get back on track, so that you can keep enjoying the activities you love.

The number of units selected for Core Cover must match the number of units for Active Lifestyle Cover.

Add Active Lifestyle Cover

Add Active Lifestyle Cover?

Active Lifestyle Cover	£ /month	£ 0 /month	£ 1 /month
Active Lifestyle Cover	up to £	up to £ 0	up to £ 1000
Dislocation (excluding fingers, thumbs and toes)	up to £	up to £ 0.00	up to £ 1000.00
Ligament tear - complete tear (grade 3) of knee or ankle joint ligament	up to £	up to £ 0.00	up to £ 1000.00
Ligament tear - partial tear (grade 2) of knee or ankle joint ligament	up to £	up to £ 0.00	up to £ 500.00
Tendon rupture (to Achilles, hamstring, bicep brachii (upper arm), quadriceps, or rotator cuff)	up to £	up to £ 0.00	up to £ 1000.00

Limitations to benefits

In each policy year, Active Lifestyle Cover can pay a benefit for:

one dislocation; and
one tendon rupture or grade 3 / grade 2 ligament tear

Dislocations: only dislocations resulting in a radiological scan and surgical intervention or manipulation under anaesthetic are covered.Ligament tears: If benefit has previously been paid for a partial (grade 2) ligament tear, the benefit for a subsequent complete (grade 3) ligament tear happening in the same policy year will be the same as that paid for a partial (grade 2) ligament tear.Benefit payable is reduced by 50% from the policyholder's 70th birthday.

Your Quote

MetLife EverydayProtect

About You
Full name
Date of birth
UK resident	Yes
Address
Telephone
Email
Sex at birth
Marital status
Employment status
Main occupation
Has occupation
Your Cover
Cover units
Child cover
Active Lifestyle cover

Core Cover
Child Cover
Active Lifestyle cover
Monthly Total

I would like to receive my EverydayProtect policy documentation by

Post

Payment Summary

MetLife EverydayProtect
Monthly payment	£50

Terms & Conditions

MetLife EverydayProtect

Policy coverage

What is insured?

Under EverdayProtect Core Cover you are insured for:

Broken bones - unable to look after yourself again
Accidental permanent injuries
Accidental total permanent disablement - unable to look after yourself again
Accidental death
UK hospital stays from accidents - Hospital admission due to sickness is covered once you've held the policy for at least 12 months
Non-accidental death

The policy offers some optional cover:

Child Cover

Not Selected

With EverdayProtect Child Cover your children have the same cover as Core Cover (excluding non-accident death) but with lower benefits, plus:

Diagnosis of cancer - excluding less advanced cases

Active Lifestyle Cover

Not Selected

With EverdayProtect Active Lifestyle Cover you're covered for:

Dislocations (excluding fingers, thumbs and toes)
Ligament tears - complete (grade 3) tear of knee or ankle joint ligament
Ligament tears - partial (grade 2) of knee or ankle joint ligament
Tendon ruptures (to Achilles, hamstring, bicep brachii (upper arm), quadriceps, or rotator cuff)

What is not covered?

The following are some of the exclusions on the policy, please refer to the policy terms and conditions for all exclusions:

Actual or attempted suicide or self-inflicted injury
Active participation in actual or attempted illegal act
Participation in some sporting activities including playing professional sport
Participation in a contest of speed such as motorsport
War or act of foreign enemy
Aerial flight (other than as fare-paying passenger)
Where alcohol was a significant factor
Certain tasks undertaken during employment or self-employment
Any form of military service
Hospital stays in non-UK hospitals
Hospital stays for optional surgery
Hospital stays for pregnancy and childbirth
*Benefit for hospitalisation due to pregnancy-related complications is payable if admitted to hospital as an inpatient for at least 4 complete and unninterrupted dates
Broken bones are not covered if caused by osteoporosis, brittle bone disease or other degenerative bone disorder
Psychiatric illness, depression, mental or nervous disorders or stress-related conditions
Mountaineering
Outdoor climbding or rock climbing
Potholing

Restrictions on cover:

The maximum payable for UK hospital stays is 90 days per condition
Active Lifestyle Cover can only be added at the start of the policy
Active Lifestyle Cover covers one dislocation and one tendon rupture or ligament tear in a policy year
Dislocations under Active Lifestyle Cover are only covered where surgical intervention takes place

Data protection

MetLife is a data controller in respect of any customer personal data provided to us. The ways in which MetLife may collect, share or process personal data are explained in MetLife's Privacy Notice, which forms part of the EverydayProtect policy. MetLife's Privacy Notice also explains the customer's rights regarding their personal data. A copy of the Privacy Notice is available at www.metlife.co.uk, this can be accessed using this link: Privacy NoticeShould you have any questions or concerns, please contact the Metlife Data Protection Officer at DataProtectionUK@MetLife.com

Your demands and needs

We have not provided you with a personal recommendation as to whether this policy is suitable for your specific needs. You currently do not have enough insurance to cover you should you have an accident that results in a temporary or permanent injury, hospitalisation, total permanent disablement - unable to look after yourself ever again, or death.Please let us know as soon as possible if your needs are not reflected here correctly as this may mean the policy is not suitable for you.

About your policy

The MetLife EverydayProtect policy will help meet your accident protection needs by providing a cash lump sum in the event of you suffering a range of specified accidental injuries - from less serious like breaking an arm, to being blinded or accidental death. It also covers you if you must spend time in hospital due to an accident and once you have held the policy for at least 12 months it will also cover you if you must stay in hospital due to sickness. It also provides a benefit if you should die from non-accidental causes so there will be some money to help your family with funeral costs and other costs associated with the death. Metlife does not require you to answer any medical questions when you take the policy out, but you should understand that your policy primarily covers you if you suffer bodily injury solely as a result of an accident. The cost is known up front and you can select between 1 and 5 different benefit levels (referred to as 'units' of cover). The more units you opt for, the more benefit you could receive from EverydayProtect. You have selected 5 units based on the balance of cost and benefits that are suitable for you. We have informed you of the total cost of the policy and you confirm that you can afford the monthly premium of £50.

Your declarations

You are under a duty to take reasonable care to not make any false statements and all information you give to MetLife must be true, accurate and complete. If information is untrue, inaccurate or incomplete, the policy cover may be void and any policy benefit payable in respect of a claim may be reduced or declined. You have read and understood the MetLife EverydayProtect Policy Terms and Conditions, Policy Summary and Important Information Document. You understand that the policy provides a lump sum payment, at the level of cover you select, if you suffer an accidental injury specified in the policy and you understand your cancellation rights.

I have read the MetLife EverydayProtect statements above and agree to the terms. I confirm that I understand the duty and have given true, accurate and complete information.

Yes, I confirm

Want to hear from us?

MetLife may, from time to time, contact you about other products or services offered by MetLife or carefully selected third parties which may be of benefit to you

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From time to time MetLife may contact you by e-mail to tell you about other products or services

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We'd love to keep in touch with exclusive offers and cycling tips and hints from VeloLife. We promise that we will never share your data with any third party (other than the necessary information in order to process your insurance policy(s), if you're happy with this opt-in to any of the contact methods below (you can opt-out at any time):

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Quote Summary

£ 0 p/m

Annually you will pay £0

Discount Vouchers

No vouchers available

Important Information

Policy Summary

Terms & Conditions

Brochure

Policy Information Document

Products and services are offered by MetLife Europe d.a.c which is an affiliate of MetLife, Inc. and operates under the "MetLife" brand.MetLife Europe d.a.c. is a private company limited by shares, registered in Ireland under company number 415123. Registered office at 20 on Hatch, Lower Hatch Street, Dublin 2, Ireland. UK branch office at Invicta House, Trafalgar Place, Brighton BN1 4FR. Branch establishment number: BR008866. MetLife Europe d.a.c. (trading as MetLife) is authorised and regulated by Central Bank of Ireland. Authorised by the Prudential Regulation Authority. Subject to regulation by the Financial Conduct Authority and limited regulation by the Prudential Regulation Authority. Details about the extent of our regulation by the Prudential Regulation Authority are available from us on request.

EverydayProtect

Setup a direct debit with MetLife. Your monthly payment will be £10.00

You're setting up a Direct Debit for monthly payments of £10. When payments are collected from your account, the name MetLife will appear on your bank account statement.

Before continuing, please make sure you read the Direct Debit Guarantee.

It will take a minimum of 8 working days to process the first payment. The first Direct Debit may be collected very close to the second payment. Your policy welcome pack will show the exact dates that your premiums will be taken, please ensure that you check the dates and keep your welcome pack in a safe place.

Who will be paying?

Applicant

Third Party

Bank details

Account holder name *

Account number *

Sort code *

Which day of the month should the Direct Debit be collected?

Preferred payment date *

We will store your bank details in our database in order to process your EverydayProtect policy with MetLife. We will only use your bank details for this reason and you have the right to ask us to delete your details at anytime which can be done by emailing info@velolife.co. Please confim you are happy for us to do this:

Yes, I confirm

Need help?

Need help?

EverydayProtect

Stage: application

About You

Cover

Core Cover

Child Cover

Active Lifestyle Cover

Your Quote

MetLife EverydayProtect

Payment Summary

Terms & Conditions

MetLife EverydayProtect

Policy coverage

What is insured?

The policy offers some optional cover:

Child Cover

Active Lifestyle Cover

What is not covered?

Restrictions on cover:

Data protection

Your demands and needs

About your policy

Your declarations

Want to hear from us?

Quote Summary

Discount Vouchers

Important Information

EverydayProtect

Payments Pending