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Eduhealth Essentials AmTrust

Policy Summary
Welcome to the EduHealth Essentials Plan, a private medical insurance plan designed to give you fast access to quality private treatment in the UK. This policy summary does not contain the full terms of your health insurance plan, which can be found in the Members Guide & Policy Document and your policy schedule.

Significant features & benefits
The EduHealth Passport Plan will cover the cost of medically necessary treatment, as shown in the table below, if you live permanently in the UK and you have an acute surgical or medical condition. The plan will cover costs according to the schedule of fees associated with most of your healthcare needs, but may not cover all of them.

Essentials-AmTrust

Excess
If you have chosen the option to apply an excess to your policy, the excess amount is payable once every plan year, if you make an eligible claim. Your excess will be applied to the first eligible treatment that you receive in each plan year. This is regardless of whether the treatment is for the same condition, a related condition, or for an entirely new condition.

Underwriting
Your policy is subject to one of three different types of underwriting, Full Medical Underwriting, Moratorium or Continued Personal Medical Exclusions. For details of what each of these terms means please refer to your Policy Document. Your policy schedule will show which type of underwriting applies to you.

Significant limitations & exclusions
The list below shows the exclusions in summary but you must read the full rules and also refer to page 15 of the Members Guide & Policy Document – Exclusions Explained, to make sure you understand your cover.
Exclusions are not covered under the plan. They are:

1. Ageing, menopause and puberty
2. Allergies and allergic disorders
3. Appliances, physical aids and devices
4. Artificial life maintenance
5. Benefits that are not covered under your plan
6. Birth control, contraception, sexual problems and sex changes
7. Chronic conditions
8. Complementary medicine
9. Complications from excluded/restricted conditions or treatment
10. Congenital conditions
11. Contamination, wars, riots and terrorist acts
12. Convalescence, rehabilitation and general nursing care
13. Cosmetic surgery
14. Deafness
15. Dental or oral treatment (such as fillings, gum disease or jaw shrinkage)
16. Developmental problems, behavioural problems or learning difficulties
17. Dialysis
18. Drugs and dressings for outpatient or takehome use
19. Emergency treatment
20. Terminal care (end of life)
21. Experimental drugs and/or treatment that is not evidence based
22. Eyesight correction
23. General Practitioner consultations or visits
24. Health hydros, nature cure clinics or similar establishments or private beds in a nursing home
25. Intensive care other than routinely required after eligible private inpatient treatment
26. Mental health conditions
27. Neo-natal treatment
28. Obesity
29. Overseas treatment
30. Pandemic
31. Personal comfort and convenience items
32. Pregnancy and childbirth
33. Professional sports injuries
34. Screening and preventative treatment
35. Self-inflicted illness or injury
36. Sexually transmitted diseases
37. Sleep problems and disorders
38. Speech disorders
39. Surrogacy
40. Telephone consultations
41. Temporary relief of symptoms
42. Transplants
43. Travel expenses
44. Treatment caused by injuries or illness resulting from you carrying out an illegal act
45. Treatment for which others may be responsible
46. Treatment that is based on a referral route, place of treatment or type of treatment that is not covered by the plan
47. Unrecognised providers or facilities
48. Vaccinations

How to make a claim
Always call the claims team for pre-authorisation before arranging or receiving any treatment. To register
a claim, please contact us on:
Tel : 0333 577 7274
Email: EduHealth@healix.com
Monday-Friday 08.00 – 18.00
When does cover start and end?

Your cover starts on your start date.

Your cover will end in the following situations:
• if you or any of your dependants have given us misleading information, have kept something from us, or have broken the conditions of this plan
• if you or any of your dependants no longer live full-time in the United Kingdom
• if you pass away
• if you do not pay the premium when due
• if for any reason you ask us to end cover.

Your partner’s cover will end:
• if you get divorced, or your civil partnership is dissolved
• if you no longer live together.

Your dependant child’s cover will end:
• once they turn 24
• if they get married.

Cancelling your policy
You can cancel your plan within the first 14 days of:
• the start date shown in your policy schedule or the date you receive the policy schedule (whichever is later); or
• the date your plan is renewed.
You do not have to give a reason for cancelling the plan and as long as you haven’t made a claim since the start date or annual renewal date, we will give you a full refund of any premiums you have paid in this 14 day period. After this 14 day period, if for any reason you decide to cancel the plan, please notify this by telephone
or in writing to:
EduHealth
Saddler’s House
4-6 South Parade
Bawtry
South Yorkshire DN10 6JH
Tel: 0345 226 9938

How to make a complaint
We aim to provide you with the highest levels of customer service and care at all times. However, if
something has gone wrong we want to do everything we can to put it right as quickly and effectively as
possible. If you wish to make a complaint, please contact either:

For claim related complaints:
Complaints (EduHealth)
Healix House
Esher Green
Esher
Surrey KT10 8AB
Email: eduhealth@healix.com

Any other complaint:
Complaints Officer EduHealth
Saddler’s House
4-6 South Parade
Bawtry
South Yorkshire DN10 6JH
Complaints that cannot be resolved by EduHealth or the insurer (via EduHealth) may be referred to the
Financial Ombudsman Service who will review your case if you remain dissatisfied after we have issued
our final decision. The address you need to write to is: The Financial Ombudsman Service, Exchange
Tower, London E14 9SR. Telephone: 0207 964 1000. Email: complaint.info@financialombudsman.org.uk.
These procedures do not affect your legal rights.

Financial Services Compensation Scheme
EduHealth and AmTrust are both covered by the Financial Services Compensation Scheme (FSCS).
This means that you may be entitled to compensation from this scheme if either cannot meet their
obligations to you. This will provide cover for 90% of the claim without any upper limit. Further information
about compensation is available from the FSCS at www.fscs.org.uk or telephone 0207 741 4100.

Contacting us
We have a team of assessors available to advise and help you, who can be contacted on the helpline
number below:
Tel : 0333 577 7274
Email: EduHealth@healix.com
Monday-Friday 08.00 – 18.00
(excl. Bank Holidays)
Any correspondence, including claims, should be sent to the following address:
EduHealth Claims
Healix Health Services
Healix House, Esher Green
Esher, Surrey.
KT10 8AB

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