Introduction

Welcome to The Embassy of Kuwait Student Healthcare Scheme.

The Embassy of Kuwait have appointed us, Healix Health Services Ltd, to manage this scheme. Our role is to assess and manage medical needs that you might have as well as the care and treatment you receive.

The Embassy of Kuwait Student Healthcare Scheme is designed to cover you for the diagnosis and/or treatment of a short term medical condition, if the treatment is medically necessary.

The scheme is not intended to cover all medical conditions. There are some medical conditions and treatments that are excluded from cover (please see exclusions and limitations for further details on this).

All treatment (including consultations and diagnostic tests) should be authorised in advance. Therefore it is essential that you call us before you receive treatment, to ensure that your proposed treatment is eligible for cover under the scheme.

If you would like your partner or dependants to be covered under the healthcare scheme, regardless of their gender, please contact the Kuwait Cultural Office who will advise you if this is possible.

Table of benefits

Your scheme benefits are set out in the table below.

Benefit limits apply to each individual member or dependant in any one year of cover, unless otherwise stated.

Please note the below benefits are subject to an overall benefit limit of £30,000 per member per scheme year.

Once any of your benefit limits are reached, there will be no further cover for this benefit until the scheme's annual renewal date unless otherwise specified.

The scheme will commence on the 1st July 2024 to 30th June 2025.

Outpatient Investigations and Treatment	Level of cover	Benefit note
Outpatient diagnostic tests, investigations and consultations with a specialist or practitioner following GP or specialist referral (self-referral available for specified cancer symptoms) Outpatient consultations and diagnostic tests for chronic conditions Outpatient drugs and dressings Private GP services Preventative diagnostic tests	Combined overall annual limit of £2,000	1a
Outpatient surgical procedures	Full cover	1b
Outpatient MRI, CT and PET scans on specialist referral	Full cover	1c
Inpatient and Daycase Treatment
Specialist fees and hospital charges for inpatient and daycase treatment	Full cover	2a
Parent accommodation	Full cover	2b
External prosthesis	Up to £5,000 per scheme lifetime	2c
Therapies
Outpatient physiotherapy	Up to 10 sessions per scheme year	3
Mental Health
Outpatient mental health	Up to £1,000 per scheme year	4a
Inpatient and daycase mental health treatment	Up to 28 days per scheme year	4b
Dental Treatment
Consultations, extractions, non-cosmetic fillings, root canal treatment, gum treatment, prescribed medicine and dental x-rays Dental hygiene and polishing (one appointment per scheme year)	Combined limit of £5,000 per scheme year	5
Additional Benefits
Visual examinations	Up to £400 per scheme year	6
Maternity cover	Up to £5,000 per scheme year	7
Private ambulance charges	Full cover	8

Note: The above benefits only apply when the covered person has treatment in the UK unless otherwise specified.

Note 1a: Outpatient Investigations and Treatment

Outpatient investigations

We will pay within your overall outpatient limit for:

outpatient consultations with a specialist following GP referral.
outpatient consultations with a dietician, nurse, orthoptist or speech therapist following GP or specialist referral. The practitioner must be registered with the correct governing body for their field, and meet our definition for a practitioner.
outpatient diagnostics and investigations following GP or specialist referral.

Cover is subject to our reasonable and customary fees.

Outpatient consultations with a specialist on self-referral for specified cancer symptoms

We will pay within your overall outpatient limit for self-referred consultations and investigations for specified cancer symptoms.

Please refer to the self-referred cancer benefits page for further information on the symptoms that are eligible and how to access this benefit.

If a diagnosis of cancer is made, cover for eligible treatment will be subject to any limits as detailed in your cancer treatment benefit.

Outpatient consultations and diagnostic tests for chronic conditions

We will pay within your overall outpatient limit for outpatient consultations with a specialist and diagnostic tests following specialist referral when this relates to a chronic condition.

Outpatient drugs and dressings

We will pay within your overall outpatient limit for the cost of any outpatient drugs or dressing that have been prescribed by a specialist.

Private GP services

We will pay within your overall outpatient limit for the cost of private GP consultations and prescription fees.

Preventative diagnostic tests

Note 1b: Outpatient Treatment and Surgical Procedures

We will pay in full for hospital charges and specialist fees for outpatient surgical procedures, and drugs and dressings used during an outpatient appointment.

Cover is subject to our reasonable and customary fees.

Note 1c: Outpatient MRI, CT and PET Scans

We will pay in full for MRI, CT and PET scans on specialist referral.

Note 2a: Specialist Fees and Hospital Charges for Inpatient and Daycase Treatment

We will pay for specialist fees for inpatient and daycase treatment. Cover is subject to our reasonable and customary fees.

We will pay hospital charges in full for the following:

accommodation and nursing care for inpatient or daycase treatment
operating theatre and recovery room
prescribed medicines and dressings, for use whilst an inpatient or for daycase treatment
eligible surgical appliances - for example, a knee brace following ligament surgery
prosthesis or device which is inserted during eligible surgery
pathology, radiology, diagnostic tests, MRI, CT and PET scans
physiotherapy received during inpatient or daycase treatment
intensive care
short-term dialysis when needed temporarily for sudden kidney failure resulting from an eligible condition or treatment
skin and corneal grafts

Note 2b: Parent Accommodation

We will pay reasonable hospital costs for one parent or legal guardian to stay with a child who is under 16 years old, if a child is admitted to hospital as an inpatient. Cover for this benefit will stop on the child’s 16th birthday. If your child is an inpatient on their 16th birthday, then cover will extend until they are discharged on that occasion. We will only pay the cost if:

it is the parent or legal guardian who stays with the child
the treatment the child receives is covered by the scheme

Note 2c: External Prosthesis

Will we pay up to £5,000 per scheme lifetime for the provision of external prosthesis.

Note 3: Outpatient Physiotherapy

We will pay up to 10 sessions per scheme year for out of network outpatient physiotherapy when this is referred by a GP or specialist. The physiotherapist must still be recognised by us for benefit purposes.

Please refer to the musculoskeletal pathway for further information.

Note 4a: Outpatient Mental Health Treatment

We will pay up to £1,000 per scheme year for outpatient consultations for eligible mental health conditions following GP or specialist referral.

Please refer to the mental health pathway for further information.

Note 4b: Inpatient and Daycase Mental Health Treatment

We will pay up to a maximum of 28 days per scheme year for eligible inpatient and daycase mental health treatment. All treatment must be under the direct control and supervision of a consultant psychiatrist, and must be authorised by us in advance and in writing.

Note 5: Dental Treatment

Dental treatment

We will pay within your overall benefit limit for:

Consultations
Extractions
Non-cosmetic fillings
Root canal treatment
Gum treatment
Prescribed medicine
Dental x-rays

Treatment must be provided by a qualified dentist, or dental hygienist that we recognise for benefit purposes.

Please note: This benefit is only available on a pay and claim basis.

Dental hyenine and polishing

We will pay for one dental hyenine and polishing appointment per scheme year.

Treatment must be provided by a qualified dentist, or dental hygienist that we recognise for benefit purposes.

Please note: This benefit is only available on a pay and claim basis.

Note 6: Visual Examinations

We will reimburse up to £400 per scheme year for routine eye examination with an Optometrist or Opthalmologist.

Please note: This benefit is only available on a pay and claim basis.

Note 7: Maternity Cover

We will pay up to £5,000 per scheme year for the cost of outpatient and inpatient private maternity care (including, but not limited to antenatal, delivery and post natal care) for eligible female members of the healthcare scheme.

Note 8: Private Ambulance Charges

We will pay in full for transport by a private ambulance to and/or from a hospital when ordered for medical reasons.

Second medical opinion

Should you decide that you would like to receive a second medical opinion to ensure you are fully confident with your specialists recommendations please contact us on the claims helpline to discuss pre-authorisation. Our experienced claims team will be able to advise and support you through this process.

Second medical opinions will be arranged with a specialist who is an expert in their field and is recognised for the purposes of providing such second opinions. Without written authorisation for a second opinion, payment cannot be made for any recommended or resulting treatment.

Virtual GP

As part of your scheme you have access to a virtual GP service, called YourHealth247, which is provided by Teladoc.

You can register for this service via their portal, which can be found at:

http://www.yourhealth247.co.uk/

The portal is the fastest and easiest way to register for the virtual GP service and book your consultations. If you do not have access to the portal, you can also call YourHealth247 on 0204 586 5324.

Should YourHealth247 refer you onto a specialist, please contact us on the claims helpline to check if this is eligible under your scheme. Any onward referrals are subject to your scheme underwriting and personal exclusions (if applicable) and general scheme exclusions. Should further information on your past medical history be required, we will need your consent to contact your NHS GP.

Section 9: Glossary

The words and phrases below have the following meanings. They will appear in bold in this guide.

Partners

- a member’s spouse, or the person the member lives with in a relationship similar to that of spouse, regardless of their gender.

Active treatment

- Treatment of an acute medical condition that leads to recovery or restoration of a previous state of health.

Acute condition

- a disease, illness or injury which responds quickly to treatment that aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to you recovering fully.

Annual renewal date

- the anniversary of the start date each year or any other date which we and the Embassy of Kuwait may agree to in writing.

Benefit

- the benefits for which you are entitled as an individual under the scheme subject to the terms and conditions that apply to your membership including all exclusions.

Benefits

-the benefits for which you are entitled as an individual under the scheme subject to the terms and conditions that apply to your membership including all exclusions.

Biological therapies

-drugs or other substances that block the growth and spread of cancer by interfering with specific molecules that are involved in the growth, progression and spread of cancer. Biological therapies are sometimes called "molecularly targeted drugs," "molecularly targeted therapies," "precision medicines," or similar names.

Cancer

- a malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue.

Chronic condition

Please refer to the chronic conditions exclusion.

Daycase

- if you are required to occupy a hospital bed for one day, for medical reasons

Dependant

-a member’s partner (if a member gets divorced their partner will no longer be considered as a dependant for the purposes of this scheme)

-a member’s unmarried dependent children

Dependants

-a member’s partner (if a member gets divorced their partner will no longer be considered as a dependant for the purposes of this scheme)

-a member’s unmarried dependent children

Dialysis

The removal of waste matter from the blood by either:

haemodialysis, (through the use of a kidney machine or dialyser)
peritoneal dialysis (by introducing fluid into the abdomen to act as a filter).

Disorder

– a disturbance of function, structure or behaviour, resulting from genetic or environmental factors such as disease, illness or injury.

Emergency

- a serious medical condition or symptoms resulting from a disease, illness or injury which arises suddenly and requires immediate treatment, generally within hours of onset, and which would otherwise put your health at risk.

End of life care

– treatment for patients with advanced, progressive, and incurable illness that is aimed solely at the management of symptoms and the provision of psychological, social, spiritual and practical support.

Gender Dysphoria

- The distress experienced as a result of the mismatch between the biological gender and the gender identity.

Gender Incongruence

The mismatch between the biological gender and the gender identity. For example, transgender or non binary individuals.

General Practitioner

- a registered medical practitioner in general practice.

GP

- a registered medical practitioner in general practice

High dependency unit

– special department within a hospital designed for patients who require advanced post-operative care and/or support for a single failing organ system.

High risk activities

This includes, but is not limited to, any high-risk activity such as mountaineering, rock climbing, parachuting, hang-gliding, potholing, bungee jumping, racing of any kind, skiing or snowboarding off the designated course (off-piste), scuba diving (unless you have recognised diving qualifications or are accompanied by someone with them).

Home healthcare

- visits from a qualified nurse to your home to give you expert/skilled nursing services under the control of a specialist.

Hospital

NHS hospital - a National Health Service hospital with facilities for medical and surgical treatment, as defined in Section 1.28 of the National Health Service Act 1977 or in any future law.

Private hospital - an independent hospital which can provide acute medical, surgical or psychiatric care. It must be registered under The Registered Homes Act (1984) and approved by the Healthcare Commission or any future law. It may also include a private bed in an NHS hospital.

Inpatient

– if you are required to occupy a hospital bed for one night or more, for medical reasons.

Intensive care unit

– a specialised department within a hospital designed for patients who require support for two or more organ systems and/or advanced respiratory support.

Medical condition

– any physical, mental or psychological disorder, including disease, illness, injury, genetic disorders and behavioural conditions.

Medically necessary

– treatment that is considered to be:

In accordance with professional standards of medical practice in the United Kingdom
Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment
Required for reasons other than the comfort or convenience of the patient or specialist.
Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.
Provided only for an appropriate duration of time.
No more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

Members

- an individual covered under the scheme.

Mental health condition

- a disorder that affects your mind, mental function, emotions or behaviour whether the cause is organic, traumatic or reactive.

Outpatient

- if you do not require a hospital bed for your treatment or consultation.

Palliative care

– treatment that is aimed at slowing the growth of cancer and relieving side effects and symptoms of the treatment/disease.

Partner

- a member’s spouse, or the person the member lives with in a relationship similar to that of spouse, regardless of their gender.

Physiotherapist

- a physiotherapist regulated by and registered as practicing with the Health Professions & Care Council and recognised by us.

Pre-existing condition

- any medical condition for which, in the five years before you joined the scheme:

you have received medication, advice or treatment, or
you have experienced symptoms whether the condition was diagnosed or not.

Private ambulance

- a purpose-built vehicle run by a recognised private ambulance service.

Prosthesis

style="margin: 0cm 0cm 0pt; line-height: normal;">– an artificial body part or device which is inserted during surgery.

Psychological therapist

we recognise the following as psychological therapists.

a psychologist who is:

Registered with the Health and Care Professions Council (HCPC);
Registered with the British Psychological Society (BPS) as a chartered Psychologist

a therapist who is:

An accredited member of the British Association of Counselling and Psychotherapy (BACP); or
An Accredited Member of the British Association for Behavioural and Cognitive Psychotherapies (BABCP); or
An Accredited Member of Scotland’s Professional Body for Counselling and Psychotherapy (COSCA); or
A practitioner who is registered with the United Kingdom Council for Psychotherapy (UKCP)

Registered nurse

- a nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Related condition

- any medical condition which is reasonably considered to be related to another medical condition.

Specialist

- we consider a specialist to be:

a medical practitioner with full current registration with the General Medical Council or
a dentist with full current registration with the General Dental Council

and

a specialist in the treatment you are referred for (this is applicable to all specialities including anaesthetics and psychiatry)
has a certificate of Higher Specialist Training in their specialty that is issued by the Higher Specialist Training Committee of the appropriate Royal College or Faculty
is or has been a National Health Service consultant or dentist
has been recognised for benefit purposes as a specialist by Healix.

Start date

- the date the scheme starts as shown in the scheme schedule.

Surgical appliance

– an artificial device or an artificial body part which is intended as an alternative to surgical treatment or a necessary part of your treatment following surgery

The Scheme

- The ABC Healthcare Scheme

Practitioner

A practitioner recognised by us and registered with the Health and Care Professions Council as:

an occupational therapist
an orthoptist
a speech and language therapist
a dietician
a nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Treatment

- surgical or medical services required following diagnosis of a condition. This includes but is not limited to surgical procedures or non-surgical procedures (such as injections).

Treatments

- surgical or medical services required following diagnosis of a condition. This includes but is not limited to surgical procedures and non-surgical procedures (such as injections).

Trust Deed

- the trust deed (including the rules of the scheme) constituting the healthcare scheme, as amended from time to time.

Trustee, Trustees

- any trustee or trustees for the time being of the healthcare scheme.

United Kingdom

- England, Scotland, Wales and Northern Ireland.

Waiting Period

- a specified period of time that must pass before a benefit becomes eligible. The waiting period is calculated from the joining date of the scheme.

We, Us, Our

- Healix Health Services Ltd, Healix House, Esher Green, Esher, Surrey KT10 8AB.

You, Your

- the eligible member and their dependants, if eligible.

Pandemic

The fast spread of infectious disease to a large number of people in a given population within a short period of time, normally weeks.

Epidemic

more cases of a disease than would be expected for that disease in that area at that time

Neurodevelopmental disorders

A group of disorders that affect the development of the nervous system, leading to altered brain function which may affect emotion, language processing, learning ability and memory. Including but not limited to Autism spectrum disorder, ADHD and dyslexia.

Diagnostic

- outpatient and daycase diagnostic tests included but not limited to scans, blood tests and diagnostic procedures

- outpatient and daycase tests or investigations used to reach a diagnosis of an illness or injury

Member Zone

The Member Zone gives you access to the claims portal and displays all the benefits of your healthcare scheme in an app accessed via your smartphone, tablet or computer.

Member

- a student covered under the scheme.

Scheme lifetime

- the total time you are an active member of the scheme

Scheme

- The Embassy of Kuwait Student Healthcare scheme, of which you are a member

Self-referred cancer benefits

Experiencing symptoms that can be associated with cancer can be concerning. It's important to remember that these symptoms are not definitive of cancer but may indicate a risk. We are here to support you in obtaining timely investigations for any symptoms that could potentially be related to cancer.

If you experience any of the symptoms listed below then you are able to call and speak directly to our claims team to self-refer for a consultation and diagnostic tests.

This means that you no longer need to see your GP before accessing private treatment for these concerns in order to prevent any delays in reaching a diagnosis.

If you are experiencing any of the symptoms below, call the claims helpline and our experienced claims team will be able to help direct you into one of our robust clinical pathways with our in-network providers to help reach a diagnosis.

Type of cancer	Signs and symptoms to watch out for
Breast cancer	Hard, irregular shape lump in the breast or armpit Dimpling of the skin on the breast Newly inverted nipple Discharge from the nipple Any unusual change in size or shape of the breast
Bowel cancer	Bleeding from your back passage/bottom or blood in your stool without piles/haemorrhoids Persistent, unexplained change in bowel habit, including diarrhoea or change in consistency of stool Persistent abdominal discomfort, such as cramps, bloating, wind or pain A feeling that your bowel doesn’t empty completely Unexplained weight loss
Prostate cancer	Raised PSA level as specified below: Age 40-49 >2.5ng/ml Age 50-69 >3ng/ml Age 70-80 >5ng/ml
Testicular cancer	Painless lump or swelling on either testicle Pain, discomfort or numbness in a testicle Any unusual change in size or shape of a testicle
Skin cancer	Any of the following changes to a mole or lesion on the skin: Increase in size Change of colour >7mm in diameter Irregular shape Irregular colour Inflamed or oozing

Please remember that these signs are also features of common health problems that

are not caused by cancer, such as a cyst, piles or infection.

Please contact us via the Member Zone, the My Healix app or by calling the claims helpline to get further advice and to open a new claim. As with all of your healthcare benefits it is important that you obtain pre-authorisation before receiving any treatment to ensure your claim is eligible and to prevent you incurring any unwanted costs.

Musculoskeletal health pathway

Musculoskeletal conditions affect your muscles, bones and joints. They are very common and tend to increase with age.

Pain and discomfort can affect your daily activities but early diagnosis and treatment may help to ease your symptoms and improve the length of time it takes to recover. We have designed the Healix musculoskeletal pathway with this in mind.

How to make a claim

Student only digital triage

As soon as you experience bone or joint pain you can use our digital physiotherapy triage service.

This can be accessed via the Member Zone or the My Healix app where you will be directed straight through to begin your online journey and treatment pathway without the need to contact the claims helpline.

Download the My Healix app

Access the Member Zone

Click here to access the Member Zone using your individual member number

This digital service is designed to provide an assessment of your needs and guide you to the best course of treatment.

Where self-managed care is appropriate, you are able to immediately access a tailored exercise programme with in-app access to a clinician as required. If needed, you will be guided to face-to-face physiotherapy treatment with our network provider.

If face to face physiotherapy sessions are recommended these will not be subject to an excess, scheme underwriting or any scheme limits (if these apply) when treatment is taken with our digital treatment pathway provider. All other healthcare scheme terms and conditions will apply.

Telephone assessment

If you are unable to access the Member Zone, the My Healix app or your claim is for a spouse or dependant the claims helpline to arrange a telephone based clinical assessment. Our experienced team will take your details and arrange for you to have an initial telephone consultation with a physiotherapist at a convenient time for you who will recommend the most appropriate treatment.

The telephone-based clinical assessment will not be subject to any excess, if one applies, however it will be applied to face-to-face treatment should this be required. All other healthcare scheme terms and conditions will apply.

Mental health pathway

The importance of mental health and wellbeing is becoming increasingly recognised in today’s busy world. Acknowledging stress and anxiety then seeking help are the first steps to developing coping strategies and recovery.

If you are experiencing stress, anxiety or depression or any other mental health problem, please refer to the below for further information on how your scheme can support you.

How to make a claim

Student only digital triage

Students are able to access a digital emotional wellness triage and immediate advice via the Member Zone or the My Healix app.

Download the My Healix app

Access the Member Zone

Click here to access the Member Zone using your individual member number

Benefits	What is available?	What can you use this for?
Digital emotional wellness triage	Unlimited access to digital emotional wellness triage Tailored online support programme (where clinically appropriate) Referral through to the healthcare scheme where medically necessary	Any mental health symptoms, including stress, anxiety and low mood.

If face to face mental health treatment is recommended you will be directed into an initial episode of treatment with our network provider.

Where face to face mental health treatment takes place, this will not be subject to an excess, scheme underwriting or any scheme limits (if these apply) when treatment is taken with our digital treatment pathway provider.

Should additional sessions be required beyond the initial episode of treatment, all healthcare scheme terms and conditions, including excess, will then apply.

Telephone assessment

Should you be unable to access the Member Zone, the My Healix app or your claim is for a spouse or dependant, you can contact the claims helpline for support and advice. There is no need to see your GP or obtain a referral letter.

Our experienced claims team will take your details and arrange for you to have an initial telephone consultation with a senior psychological therapist at a convenient time for you. This will give you an opportunity to talk through your concerns and agree on the best treatment pathway.

This could be one of several options including:

Face to face cognitive behavioural therapy (CBT)
Guided online CBT
Counselling
Referral onwards to see a psychiatrist.

Healix will pre-authorise your assessment and treatment (within benefit limits where applicable) and settle all invoices directly.

*Under 18’s will require a referral letter from their own GP.

Digital skin pathway

Changes found to your skin can be concerning. Fortunately, in most instances, these changes are not caused by cancer, however fast detection is key to help identify the cause of these changes and provide reassurance.

Our digital skin pathway provides fast results and recommendations for further treatment depending on your diagnosis following assessment by our dermatology partners. Please note further treatment will be subject to the terms and conditions of the scheme.

This pathway is suitable for many skin complaints, and our experienced claims team will be able to guide you to access the most suitable pathway for your symptoms.

The table below shows which skin complaints are most suitable to be referred into our digital skin pathway:

Skin Conditions Suitable for the Skin Pathway	Skin Conditions Not Suitable for the Skin Pathway
A change to an existing mole (itching/bleeding/increase in size)	Chronic skin conditions such as eczema/psoriasis
A new skin growth that has appeared and is visible	New skin rashes
A sore area of skin that has not healed	Mole mapping services required for screening purposes where there is no identifiable area of immediate concern
-	Members under the age of 18

This pathway is easy to use; just follow the simple steps below and access help today:

Step 1

Open a new claim with one of our member advisors. Please see making a claim for details of how to do this.

Step 2

You will receive an SMS to your mobile phone with a link to register for the service and details of how to submit your digital photographic images.

Step 3

Your digital photographic images will be assessed by our experienced dermatology partners within 2 working days.

Step 4

You will receive an SMS to notify you that your results are back and a link to access the report containing the diagnosis and any recommendation.

Step 5

Should a face-to-face consultation with a dermatologist be recommended, our dermatology partners will call you and assist you to arrange it at a suitable time and location for you.

Please note: face-to-face dermatology consultations taken within our network will not be subject to our reasonable and customary fees, however, these fees will apply should you wish to access a consultation outside of this network.

Section 9: Glossary

The words and phrases below have the following meanings. They will appear in bold in this guide.

Partners

- a member’s spouse, or the person the member lives with in a relationship similar to that of spouse, regardless of their gender.

Active treatment

- Treatment of an acute medical condition that leads to recovery or restoration of a previous state of health.

Acute condition

Annual renewal date

- the anniversary of the start date each year or any other date which we and the Embassy of Kuwait may agree to in writing.

Benefit

- the benefits for which you are entitled as an individual under the scheme subject to the terms and conditions that apply to your membership including all exclusions.

Benefits

-the benefits for which you are entitled as an individual under the scheme subject to the terms and conditions that apply to your membership including all exclusions.

Biological therapies

Cancer

- a malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue.

Chronic condition

Please refer to the chronic conditions exclusion.

Daycase

- if you are required to occupy a hospital bed for one day, for medical reasons

Dependant

-a member’s partner (if a member gets divorced their partner will no longer be considered as a dependant for the purposes of this scheme)

-a member’s unmarried dependent children

Dependants

-a member’s partner (if a member gets divorced their partner will no longer be considered as a dependant for the purposes of this scheme)

-a member’s unmarried dependent children

Dialysis

The removal of waste matter from the blood by either:

haemodialysis, (through the use of a kidney machine or dialyser)
peritoneal dialysis (by introducing fluid into the abdomen to act as a filter).

Disorder

– a disturbance of function, structure or behaviour, resulting from genetic or environmental factors such as disease, illness or injury.

Emergency

End of life care

Gender Dysphoria

- The distress experienced as a result of the mismatch between the biological gender and the gender identity.

Gender Incongruence

The mismatch between the biological gender and the gender identity. For example, transgender or non binary individuals.

General Practitioner

- a registered medical practitioner in general practice.

GP

- a registered medical practitioner in general practice

High dependency unit

– special department within a hospital designed for patients who require advanced post-operative care and/or support for a single failing organ system.

High risk activities

Home healthcare

- visits from a qualified nurse to your home to give you expert/skilled nursing services under the control of a specialist.

Hospital

NHS hospital - a National Health Service hospital with facilities for medical and surgical treatment, as defined in Section 1.28 of the National Health Service Act 1977 or in any future law.

Inpatient

– if you are required to occupy a hospital bed for one night or more, for medical reasons.

Intensive care unit

– a specialised department within a hospital designed for patients who require support for two or more organ systems and/or advanced respiratory support.

Medical condition

– any physical, mental or psychological disorder, including disease, illness, injury, genetic disorders and behavioural conditions.

Medically necessary

– treatment that is considered to be:

In accordance with professional standards of medical practice in the United Kingdom
Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment
Required for reasons other than the comfort or convenience of the patient or specialist.
Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.
Provided only for an appropriate duration of time.
No more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

Members

- an individual covered under the scheme.

Mental health condition

- a disorder that affects your mind, mental function, emotions or behaviour whether the cause is organic, traumatic or reactive.

Outpatient

- if you do not require a hospital bed for your treatment or consultation.

Palliative care

– treatment that is aimed at slowing the growth of cancer and relieving side effects and symptoms of the treatment/disease.

Partner

- a member’s spouse, or the person the member lives with in a relationship similar to that of spouse, regardless of their gender.

Physiotherapist

- a physiotherapist regulated by and registered as practicing with the Health Professions & Care Council and recognised by us.

Pre-existing condition

- any medical condition for which, in the five years before you joined the scheme:

you have received medication, advice or treatment, or
you have experienced symptoms whether the condition was diagnosed or not.

Private ambulance

- a purpose-built vehicle run by a recognised private ambulance service.

Prosthesis

style="margin: 0cm 0cm 0pt; line-height: normal;">– an artificial body part or device which is inserted during surgery.

Psychological therapist

we recognise the following as psychological therapists.

a psychologist who is:

Registered with the Health and Care Professions Council (HCPC);
Registered with the British Psychological Society (BPS) as a chartered Psychologist

a therapist who is:

An accredited member of the British Association of Counselling and Psychotherapy (BACP); or
An Accredited Member of the British Association for Behavioural and Cognitive Psychotherapies (BABCP); or
An Accredited Member of Scotland’s Professional Body for Counselling and Psychotherapy (COSCA); or
A practitioner who is registered with the United Kingdom Council for Psychotherapy (UKCP)

Registered nurse

- a nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Related condition

- any medical condition which is reasonably considered to be related to another medical condition.

Specialist

- we consider a specialist to be:

a medical practitioner with full current registration with the General Medical Council or
a dentist with full current registration with the General Dental Council

and

a specialist in the treatment you are referred for (this is applicable to all specialities including anaesthetics and psychiatry)
has a certificate of Higher Specialist Training in their specialty that is issued by the Higher Specialist Training Committee of the appropriate Royal College or Faculty
is or has been a National Health Service consultant or dentist
has been recognised for benefit purposes as a specialist by Healix.

Start date

- the date the scheme starts as shown in the scheme schedule.

Surgical appliance

– an artificial device or an artificial body part which is intended as an alternative to surgical treatment or a necessary part of your treatment following surgery

The Scheme

- The ABC Healthcare Scheme

Practitioner

A practitioner recognised by us and registered with the Health and Care Professions Council as:

an occupational therapist
an orthoptist
a speech and language therapist
a dietician
a nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Treatment

- surgical or medical services required following diagnosis of a condition. This includes but is not limited to surgical procedures or non-surgical procedures (such as injections).

Treatments

- surgical or medical services required following diagnosis of a condition. This includes but is not limited to surgical procedures and non-surgical procedures (such as injections).

Trust Deed

- the trust deed (including the rules of the scheme) constituting the healthcare scheme, as amended from time to time.

Trustee, Trustees

- any trustee or trustees for the time being of the healthcare scheme.

United Kingdom

- England, Scotland, Wales and Northern Ireland.

Waiting Period

- a specified period of time that must pass before a benefit becomes eligible. The waiting period is calculated from the joining date of the scheme.

We, Us, Our

- Healix Health Services Ltd, Healix House, Esher Green, Esher, Surrey KT10 8AB.

You, Your

- the eligible member and their dependants, if eligible.

Pandemic

The fast spread of infectious disease to a large number of people in a given population within a short period of time, normally weeks.

Epidemic

more cases of a disease than would be expected for that disease in that area at that time

Neurodevelopmental disorders

Diagnostic

- outpatient and daycase diagnostic tests included but not limited to scans, blood tests and diagnostic procedures

- outpatient and daycase tests or investigations used to reach a diagnosis of an illness or injury

Member Zone

The Member Zone gives you access to the claims portal and displays all the benefits of your healthcare scheme in an app accessed via your smartphone, tablet or computer.

Member

- a student covered under the scheme.

Scheme lifetime

- the total time you are an active member of the scheme

Scheme

- The Embassy of Kuwait Student Healthcare scheme, of which you are a member

Making a claim

Healthcare benefits

Register your claim using the Member Zone or the My Healix app. Alternatively, you can call the claims helpline to confirm if cover is available.

In order for us to accurately assess cover under the terms and conditions of your scheme, we may ask to see a copy of your GP referral letter when you open a new claim.

Always contact the claims team before arranging or receiving any treatment.

Download the My Healix app

Access the Member Zone

Click here to access the Member Zone using your individual member number

Call the claims helpline:

0208 049 8340
Monday-Friday 08.00-19.00 (Excl. bank holidays)
Saturday 09.00-13.00

We will confirm:

whether your proposed treatment is eligible for cover under the scheme
whether your proposed treatment costs will be covered under the scheme
any benefit limits or excess that may apply to your claim

To help you make the best possible use of the scheme, we have provided you with a how to claim summary.

How to claim summary

If you believe you require physiotherapy, but you haven't seen your GP

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If your GP refers you onto a specialist or therapist

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If you experience mental health symptoms, but haven't seen your GP

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Log your claim via the Member Zone, the My Healix app or call the claims helpline

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Log your claim via the Member Zone, the My Healix app or call the claims helpline

▼

Log your claim via the Member Zone, the My Healix app or call the claims helpline

▼

We will assess your symptoms and help organise the most effective treatment

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We will advise on cover available, and authorise your eligible treatment

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We will advise on cover available, and authorise your eligible treatment

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If appropriate, we will arrange a physiotherapy referral within 24 hours, through Healix Physiotherapy Network Provider

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If appropriate, we will arrange a referral through Healix Mental Health Network Provider

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If further treatment is required, please visit the Member Zone, the My Healix app or call the helpline again

How to Claim Summary

Your scheme underwriting

Medical History Disregarded (MHD)
We will not apply any personal medical exclusions to your scheme. However your eligibility for cover will be subject to the general terms of the scheme. Please refer to exclusions and limitations for further information.

Reasonable and customary fees

We adhere to a schedule of reasonable and customary (R&C) fees for specialist fees. These are based on a common set of codes and principles set out by the Clinical Classification and Schedule Development (CCSD) group. Our fee levels have been set after review of what the majority of specialist’s charge for medical and surgical services as well as a review by our clinical support team and our panel of specialist advisors.

We have an open referral network which means you can be referred to the specialist of your choice. Should you choose to be referred to a specialist who charges above our fee schedule you can opt to pay the difference or we can assist you in identifying an alternative specialist that charges within our fee schedule. For further information please refer to our fee schedule, or contact the claims team.

Hospital cover

Open network
We have an open network which means you are able to attend the hospital of your choice. Please note reasonable and customary charges will apply to specialists at all hospitals. For help in finding a hospital, please refer to our hospital finder.

What happens in an emergency?

Most private hospitals are not set up to receive emergency admissions. In the event of an emergency you should:

call for an NHS ambulance
visit the accident and emergency department at the local NHS hospital.

If you would like to be transferred to a private facility, please contact us to discuss this. We will then be able to confirm whether your proposed treatment is eligible under the healthcare plan. Please note you must contact us before you transfer to a private facility.

You will not be covered for:

the cost of emergency treatment in a private walk-in centre, accident and emergency department or clinic
the cost of treatment in an intensive care or high dependency unit if you have been transferred specifically to receive this care
the costs of the transfer to a private facility specifically to receive treatment in an intensive care or high dependency unit.

Exclusions and limitations

The following are conditions and treatments which are not covered under your scheme. If you are unsure about anything in this section, please contact us on the claims helpline.

Exclusions and limitations

Ageing, menopause and puberty

We do not pay for treatment to relieve symptoms commonly associated with or caused by ageing, puberty or other natural physiological cause.

Alcohol abuse, substance abuse and addiction

We do not pay for any treatment required for alcohol, solvent or drug abuse, or any treatment arising from such abuse or addiction, this includes mental health treatment.

Appliances, physical aids and devices

We do not pay for the supply or fitting of appliances, physical aids or devices (including but not limited to hearing aids, spectacles, contact lenses, external prostheses and orthotics etc) which do not fall within our definition of a surgical appliance. Any consultations relating to these are also not covered.

Birth control & contraception

We do not pay for:

birth control
sterilisation and/or reversal
termination of pregnancy

Cancer

We do not pay for treatment of cancer or diagnostic tests required to stage cancer (check for cancer spread)

Exception: we will pay for diagnostic tests required to confirm an initial cancer diagnosis.

Chiropody

We do not pay for any treatment related to chiropody or foot care, including treatment under surgical podiatrists. This includes gait analysis and orthotics.

Complications from excluded/restricted conditions or treatment

We do not pay for treatment which arises from, or is related to any exclusion listed in this booklet or treatment which arises from or is related to a surgical procedure we do not cover.

Contamination, wars, riots and terrorist acts

We do not pay for treatment of any medical condition which is caused or contributed to by; nuclear, radioactive, biological or chemical contamination, war (whether declared or not), act of foreign enemy, riot, revolution, invasion, civil war, rebellion, insurrection, overthrow of a legally constituted government, explosions of war weapons, terrorist act or military activity. We will not pay for treatment of any medical condition which is received while you or your dependants are carrying out army, naval or air services duties.

Convalescence and general nursing care

We do not pay for treatment if it is primarily used for domestic and/or social reasons.

Cosmetic treatment

We do not pay for any treatment to change your appearance even when required for psychological reasons.

We do not pay for any treatment, including surgery:

where the intention of treatment, whether directly or indirectly, is the reduction or removal of healthy, surplus or fat tissue (for example, weight reduction surgery / treatment)
where the aim is to aesthetically enhance the appearance of the face or body where no functional condition is present (for example, botox, fillers or asymptomatic rhinoplasty)

Exception: we will pay for medically necessary treatment to restore your appearance in the following circumstances:

where it results from an eligible underlying disease process
following eligible treatment (including cancer treatment)
where the condition is causing a functional problem

Please note: we use clinical guidance as a benchmark for deciding whether the exceptions above are eligible for cover. All requests for cover must be submitted in writing with supporting medical information.

Dangerous or high risk activities

We do not pay for any treatment which is directly or indirectly related to the participation of hazardous or high risk activities.

Dental or oral treatment

We do not pay for any dental or oral treatment other than listed in your table of benefits.

Dialysis

We do not pay for treatment for or associated with dialysis.

Drugs and dressings for outpatient or take-home use

We do not pay for drugs and dressings provided or prescribed for use as an outpatient or for you to take home, other than those outlined in your table of benefits.

Emergency treatment in the UK

We do not pay for:

the cost of emergency treatment in a private walk-in centre, accident and emergency department or clinic
the cost of an emergency admission into a private hospital
the cost of treatment in an intensive care or high dependency unit if you have been transferred specifically to receive this care
the costs of the transfer to a private facility specifically to receive treatment in an intensive care or high dependency unit.

Experimental drugs and treatment

We do not pay for treatments (including medication) which in our reasonable opinion are experimental or not yet approved by the National Institute for Health and Care Excellence (NICE), are being researched or lack sufficient evidence to conclude that:

the harmful effects are outweighed by the beneficial effects
they are likely to lead to the same or better outcomes than available alternatives
they are based on established medical practice in the United Kingdom.

Examples of the criteria we use for considering a treatment as experimental include:

the treatment is still undergoing clinical trials and/or yet to undergo a phase III clinical trial for the indication in question
the treatment does not have approval from the relevant government body
the treatment does not conform to usual clinical practice in the view of the majority of medical practitioners in the relevant field
the treatment is being used in a way other than that previously studied or that for which it has been granted approval by the relevant government body
the treatment is rarely used, novel, or unknown and there is a lack of authoritative evidence of safety and efficacy.

We do not pay for any treatment required for complications arising or resulting from experimental treatment that you receive or for any subsequent treatment you may need as a result of you undergoing any experimental treatment.

Eyesight correction

We do not pay for treatment to correct your sight other than specified in your table of benefits.

Fertility treatment

We do not pay for:

any type of fertility investigations
fertility treatment
assisted reproduction, surrogacy, harvesting of donor eggs or donor insemination
sperm collection and storage
complications following any of the above

Gender dysphoria

We do not pay for any treatment of gender dysphoria, or any treatment arising from or relating to gender dysphoria.

General practitioner consultations

We do not pay for any GP consultations or visits other than those specified in your table of benefits. We do not pay for any charges for the completion of claim forms or referral letters, unless we have requested these specifically to assess your claim.

Holistic and alternative medicine

We do not pay for holistic or alternative medicine or therapies, unless these are specifically listed in your table of benefits. For example yoga, massage, spas and health resorts.

Illegal activity

We do not pay for:

any treatment caused by or resulting from you carrying out an illegal act
any treatment resulting from a road accident where you were not wearing a seat belt (as required by law).

Mechanical heart pumps

We do not pay for the treatment associated with mechanical heart pumps (Ventricular Assist Devices and artificial hearts), this includes monitoring, consultations, check ups, scans and examinations related to the implantation or device.

Neurodevelopmental disorders

We do not pay for any treatment (including assessment) of adult or childhood neurodevelopmental disorders including but not limited to dyslexia, dyspraxia, autism, ADHD or neurodevelopmental delay without diagnosis.

Obesity

We do not pay for any weight loss treatment including treatment required as a result of obesity.

Overseas treatment

We do not pay for treatment outside the United Kingdom including evacuation or repatriation.

Pandemic and/or epidemic disease

We do not pay for treatment for or arising from pandemic and / or epidemic disease.

Personal comfort and convenience items

We do not pay for personal comfort and convenience items or services including but not limited to travel expenses, television, WIFI, telephone costs, newspapers, and guest meals.

Pregnancy and childbirth

We do not pay for any treatment related to pregnancy or childbirth, other than as listed in the exception below:

Exception: We will pay for the following eligible specified obstetric procedures / treatment:

pelvic girdle pain in pregnancy
miscarriage or when the foetus has died and remains with the placenta in the womb
still birth
hydatidiform mole (abnormal cell growth in the womb)
ectopic pregnancy (foetus growing outside the womb)
diastasis recti or Rectus Abdominis (splitting of the abdominal muscles during pregnancy)
post-partum haemorrhage (heavy bleeding in the hours and days immediately after childbirth)
retained placental membrane (afterbirth left in the womb after the delivery of the baby)
eligible mental health treatment for post-natal depression subject to the conditions and limitations set out in the mental health benefit.
medically essential caesarean section where this is an inevitable consequence of a complication to the current pregnancy.
complications following any of the above conditions.
flare up of a non-pregnancy related medical condition that has been made worse by pregnancy.

We will require full clinical details from your specialist before we can give our decision on cover.

In the event that the newborn requires immediate treatment as a result of an eligible caesarean section, this should be administered by the NHS free of charge. If the newborn is not entitled to NHS care and is not accepted as a dependant on the scheme we will pay for treatment for up to 7 days following the birth, to allow you time to make alternative arrangements. In cases where they are accepted as a member of the scheme they will only be entitled to benefits outlined in the benefits table and will be subject to the exclusions listed within the scheme.

Screening and preventative treatment

We do not pay for any form of genetic testing or screening, health screening, health checks or preventative treatment, procedures or medical services where no disease is present.

We do not pay for treatment;

recommended because of a genetic predisposition towards developing a medical condition
recommended because of a family history of a medical condition.

Self-inflicted injury or suicide

We do not pay for treatment you need as a direct result of a suicide attempt or self-inflicted injury.

Sexual dysfunction

We do not pay for any treatment required due to sexual dysfunction, sexually transmitted infections or sexual problems, whatever the cause.

Sleep disorders

We do not pay for treatment for or arising from sleep disorders. This includes but is not limited to: sleep apnoea, snoring, insomnia, sleep walking, narcolepsy, and night terrors.

Sports related injury

We do not pay for treatment you need as a result of participating in any sport for which you are financially remunerated, receive a grant or sponsorship, or are competing for prize money.

Transplants and adoptive cell transfer therapies

We do not pay for any transplants, adoptive cell transfer, gene therapies and/or any complications related to, or resulting from these treatments. This includes, but is not limited to CAR T cell therapy, Tumour Infiltrating Lymphocyte therapy and stem cell/bone marrow treatments. We also do not pay for:

donor costs
harvesting
storage
administration
and/or any complications/treatment arising from any of the above

Exception: we will pay for recipient costs for skin or corneal grafts when eligible for benefit

Unrecognised providers

We do not pay for treatment carried out by a provider who we do not recognise as being qualified and/or registered to provide the type of treatment you need or for treating the medical condition you have.

We do not pay for treatment with sports therapists, massage therapists, or anyone who does not meet our definition of a specialist.

We do not pay for any treatment carried out by you, your spouse, parents or children.

Warts

We do not pay for the treatment of skin warts.

Section 9: Glossary

The words and phrases below have the following meanings. They will appear in bold in this guide.

Partners

- a member’s spouse, or the person the member lives with in a relationship similar to that of spouse, regardless of their gender.

Active treatment

- Treatment of an acute medical condition that leads to recovery or restoration of a previous state of health.

Acute condition

Annual renewal date

- the anniversary of the start date each year or any other date which we and the Embassy of Kuwait may agree to in writing.

Benefit

- the benefits for which you are entitled as an individual under the scheme subject to the terms and conditions that apply to your membership including all exclusions.

Benefits

-the benefits for which you are entitled as an individual under the scheme subject to the terms and conditions that apply to your membership including all exclusions.

Biological therapies

Cancer

- a malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue.

Chronic condition

Please refer to the chronic conditions exclusion.

Daycase

- if you are required to occupy a hospital bed for one day, for medical reasons

Dependant

-a member’s partner (if a member gets divorced their partner will no longer be considered as a dependant for the purposes of this scheme)

-a member’s unmarried dependent children

Dependants

-a member’s partner (if a member gets divorced their partner will no longer be considered as a dependant for the purposes of this scheme)

-a member’s unmarried dependent children

Dialysis

The removal of waste matter from the blood by either:

haemodialysis, (through the use of a kidney machine or dialyser)
peritoneal dialysis (by introducing fluid into the abdomen to act as a filter).

Disorder

– a disturbance of function, structure or behaviour, resulting from genetic or environmental factors such as disease, illness or injury.

Emergency

End of life care

Gender Dysphoria

- The distress experienced as a result of the mismatch between the biological gender and the gender identity.

Gender Incongruence

The mismatch between the biological gender and the gender identity. For example, transgender or non binary individuals.

General Practitioner

- a registered medical practitioner in general practice.

GP

- a registered medical practitioner in general practice

High dependency unit

– special department within a hospital designed for patients who require advanced post-operative care and/or support for a single failing organ system.

High risk activities

Home healthcare

- visits from a qualified nurse to your home to give you expert/skilled nursing services under the control of a specialist.

Hospital

NHS hospital - a National Health Service hospital with facilities for medical and surgical treatment, as defined in Section 1.28 of the National Health Service Act 1977 or in any future law.

Inpatient

– if you are required to occupy a hospital bed for one night or more, for medical reasons.

Intensive care unit

– a specialised department within a hospital designed for patients who require support for two or more organ systems and/or advanced respiratory support.

Medical condition

– any physical, mental or psychological disorder, including disease, illness, injury, genetic disorders and behavioural conditions.

Medically necessary

– treatment that is considered to be:

In accordance with professional standards of medical practice in the United Kingdom
Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment
Required for reasons other than the comfort or convenience of the patient or specialist.
Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.
Provided only for an appropriate duration of time.
No more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

Members

- an individual covered under the scheme.

Mental health condition

- a disorder that affects your mind, mental function, emotions or behaviour whether the cause is organic, traumatic or reactive.

Outpatient

- if you do not require a hospital bed for your treatment or consultation.

Palliative care

– treatment that is aimed at slowing the growth of cancer and relieving side effects and symptoms of the treatment/disease.

Partner

- a member’s spouse, or the person the member lives with in a relationship similar to that of spouse, regardless of their gender.

Physiotherapist

- a physiotherapist regulated by and registered as practicing with the Health Professions & Care Council and recognised by us.

Pre-existing condition

- any medical condition for which, in the five years before you joined the scheme:

you have received medication, advice or treatment, or
you have experienced symptoms whether the condition was diagnosed or not.

Private ambulance

- a purpose-built vehicle run by a recognised private ambulance service.

Prosthesis

style="margin: 0cm 0cm 0pt; line-height: normal;">– an artificial body part or device which is inserted during surgery.

Psychological therapist

we recognise the following as psychological therapists.

a psychologist who is:

Registered with the Health and Care Professions Council (HCPC);
Registered with the British Psychological Society (BPS) as a chartered Psychologist

a therapist who is:

An accredited member of the British Association of Counselling and Psychotherapy (BACP); or
An Accredited Member of the British Association for Behavioural and Cognitive Psychotherapies (BABCP); or
An Accredited Member of Scotland’s Professional Body for Counselling and Psychotherapy (COSCA); or
A practitioner who is registered with the United Kingdom Council for Psychotherapy (UKCP)

Registered nurse

- a nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Related condition

- any medical condition which is reasonably considered to be related to another medical condition.

Specialist

- we consider a specialist to be:

a medical practitioner with full current registration with the General Medical Council or
a dentist with full current registration with the General Dental Council

and

a specialist in the treatment you are referred for (this is applicable to all specialities including anaesthetics and psychiatry)
has a certificate of Higher Specialist Training in their specialty that is issued by the Higher Specialist Training Committee of the appropriate Royal College or Faculty
is or has been a National Health Service consultant or dentist
has been recognised for benefit purposes as a specialist by Healix.

Start date

- the date the scheme starts as shown in the scheme schedule.

Surgical appliance

– an artificial device or an artificial body part which is intended as an alternative to surgical treatment or a necessary part of your treatment following surgery

The Scheme

- The ABC Healthcare Scheme

Practitioner

A practitioner recognised by us and registered with the Health and Care Professions Council as:

an occupational therapist
an orthoptist
a speech and language therapist
a dietician
a nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Treatment

- surgical or medical services required following diagnosis of a condition. This includes but is not limited to surgical procedures or non-surgical procedures (such as injections).

Treatments

- surgical or medical services required following diagnosis of a condition. This includes but is not limited to surgical procedures and non-surgical procedures (such as injections).

Trust Deed

- the trust deed (including the rules of the scheme) constituting the healthcare scheme, as amended from time to time.

Trustee, Trustees

- any trustee or trustees for the time being of the healthcare scheme.

United Kingdom

- England, Scotland, Wales and Northern Ireland.

Waiting Period

- a specified period of time that must pass before a benefit becomes eligible. The waiting period is calculated from the joining date of the scheme.

We, Us, Our

- Healix Health Services Ltd, Healix House, Esher Green, Esher, Surrey KT10 8AB.

You, Your

- the eligible member and their dependants, if eligible.

Pandemic

The fast spread of infectious disease to a large number of people in a given population within a short period of time, normally weeks.

Epidemic

more cases of a disease than would be expected for that disease in that area at that time

Neurodevelopmental disorders

Diagnostic

- outpatient and daycase diagnostic tests included but not limited to scans, blood tests and diagnostic procedures

- outpatient and daycase tests or investigations used to reach a diagnosis of an illness or injury

Member Zone

The Member Zone gives you access to the claims portal and displays all the benefits of your healthcare scheme in an app accessed via your smartphone, tablet or computer.

Member

- a student covered under the scheme.

Scheme lifetime

- the total time you are an active member of the scheme

Scheme

- The Embassy of Kuwait Student Healthcare scheme, of which you are a member

End of cover

Cover for you (the member) will end in the following situations:

if for any reason you or Kuwait Cultural Office ask us to end cover
if you or any of your dependants have given us misleading information, have kept something from us, or have broken the conditions of this scheme
if you pass away

If your cover ends, your dependants cover will also end on the same day as your cover.

Cover for dependants will end in the following situations:

Your partner's cover will end:

if you get divorced, or your civil partnership is dissolved. Cover for your partner will end as soon as the final decree/final dissolution order has been granted.
if you no longer live together, then your partner will no longer be considered a dependant for the purposes of this scheme.

Your dependant child’s cover will end:

after they have turned 24. They will be removed from cover on the next annual renewal date following their 24^th birthday.
if they get married, then they will no longer be considered a dependant for the purposes of this scheme.
if they no longer live full time in the United Kingdom

Members must inform the Kuwait Cultural Office as soon as possible of any changes of this matter.

If treatment has been authorised, but has not yet taken place, you will be responsible for any treatment costs if the scheme then terminates or you leave the scheme.

How to make a complaint

It is always our intention to provide a first class standard of service: however, we recognise that on occasions, your requirements may not have been met.

Should you have any cause for complaint, you should contact us.

How your complaint will be handled

Stage 1

You will receive a written acknowledgement of your complaint within five business days of receipt. This will include the name and job title of the individual handling the complaint.

Stage 2

Within four weeks of receiving your complaint, you will receive either:

A final response or
A holding response, explaining why we are not yet in a position to resolve the complaint and indicating when we will be making further contact (this will be within eight weeks from receiving the complaint).

Stage 3

If you have not received a final response within four weeks, by the end of eight weeks after receipt of the complaint, you will receive either:

A final response.
A response explaining why we are still not in a position to provide a final response and explaining when we believe we will be able to do so.
If we are unable to provide a final response, due to the delay which has now occurred, you may refer your complaint to the Trustees.

If, during stage 2 or 3, we issue our final response but you remain dissatisfied, you may refer your complaint to the Trustees. To do this, please set out your reasons fully in writing to the Operations Director, asking for referral to the trustees for further consideration.

How to claim reimbursement

How to claim reimbursement of medical expenses

If you have paid a provider directly for eligible medical services you can claim a reimbursement of these costs as long as the treatment received is eligible for cover as detailed in your table of benefits.

In order to claim these benefits you can register your claim via the Member Zone or the My Healix app

You will need to provide the following information for a claim to be processed:

An itemised receipt confirming the following information:
- Date treatment was received
- Details of the treatment received
- Amount paid for the treatment
Bank details for the reimbursement to be made to
- Account holder’s name
- Sort code
- Account number

Please note:

Once the claim has been confirmed as eligible by the claims team, reimbursement will be arranged via direct bank transfer.

All reimbursement claims (including cash benefit claims) must be submitted within six months of your treatment date / birth or adoption date or within 6 months of the end of the scheme year you wish to claim against - whichever comes soonest.

Additional information can be found in the payment of invoices page.

Payment of invoices

All treatment should be authorised in advance, so that we can place a guarantee of payment with your healthcare provider, subject to your benefit limits and our reasonable and customary guidelines. If you have pre-authorised your treatment, we will settle the bill (up to applicable limits) directly with your specialist, therapist or hospital. You are responsible for making sure we have all the information we need to pay your claims.

In some circumstances it may be necessary for you to pay for pre-authorised treatment yourself, and request a reimbursement from us for the cost of the treatment. In these cases please send us a copy of your receipt via email, along with your bank account details, and we will arrange reimbursement via bank transfer. All reimbursement claims must be submitted within six months of your treatment date or within six months of the end of the scheme year you wish to claim against -whichever comes soonest. Any claims submitted after this, will be assessed on a case by case basis, and paid at our discretion.

We will not pay for claims:

if the invoice or reimbursement claim is not submitted within six months of your treatment date / birth or adoption date or within 6 months of the end of the scheme year you wish to claim against - whichever comes soonest
if the treatment takes place after you have left the scheme
if you break any terms and conditions of your membership
if you incur a fee for non-attendance or late cancellations.

Requests for additional information

We may ask you to provide information to help us assess your claim. For example we may ask you for one or more of the following:

Medical reports and other information about the treatment for which you are claiming. If we request a medical report from your specialist and they charge for providing this we will pay the cost.
Original accounts and invoices in connection with your claim.
Obtain results of an independent medical examination or second opinion for which we may ask you to make an appointment with a with a specialist. We will pay for the cost of any independent medical examination or second opinion we require and we will authorise this in writing, in advance.
Provide results of any second opinion you have independently sought under the care of another specialist. On such occasions we may additionally request our own, independent, second opinion from an expert in that field to assess eligibility of cover. We will pay the costs of any second opinion we organise on your behalf, this includes the cost of the consultation and any tests undertaken as a result of that consultation.

We will liaise with you and your medical specialists throughout your treatment and will request medical information, when we deem this to be necessary for the assessment of your claim. You will be asked for your consent before we do this.

Throughout your claim we will make you aware of the options that are available to you. If your medical specialist recommends treatment, you should contact the claims helpline as soon as possible to be sure that continued treatment is covered.

Our team of case managers will assess the level of cover available to you for planned treatment within the terms and conditions of the scheme. In some instances it may be necessary to refer your claim to our specialist nurses, along with our panel of independent specialist advisors, who will advise on the level of cover available for the recommended treatment.

Duplicate cover

You must tell us if you are able to make a claim for the cost of any of your treatment from anyone else either under another healthcare scheme or under an insurance policy. For example, if you received an injury that was caused by someone else such as a road traffic accident in which you are not at fault, the scheme will only pay a share of the total costs as appropriate.

If benefits are claimed for treatment to you when the injury or medical condition was caused by a third party, the scheme shall, at its own expense, have the right to pursue such claims in any way considered appropriate in your name. You must co-operate with all reasonable requests in this respect and advise us of any amount you recover directly from the third party.

Healix privacy notice

If you would like to know more about how Healix store and process your personal data, please find our Privacy Notice by clicking here.

Section 9: Glossary

The words and phrases below have the following meanings. They will appear in bold in this guide.

Partners

- a member’s spouse, or the person the member lives with in a relationship similar to that of spouse, regardless of their gender.

Active treatment

- Treatment of an acute medical condition that leads to recovery or restoration of a previous state of health.

Acute condition

Annual renewal date

- the anniversary of the start date each year or any other date which we and the Embassy of Kuwait may agree to in writing.

Benefit

- the benefits for which you are entitled as an individual under the scheme subject to the terms and conditions that apply to your membership including all exclusions.

Benefits

-the benefits for which you are entitled as an individual under the scheme subject to the terms and conditions that apply to your membership including all exclusions.

Biological therapies

Cancer

- a malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue.

Chronic condition

Please refer to the chronic conditions exclusion.

Daycase

- if you are required to occupy a hospital bed for one day, for medical reasons

Dependant

-a member’s partner (if a member gets divorced their partner will no longer be considered as a dependant for the purposes of this scheme)

-a member’s unmarried dependent children

Dependants

-a member’s partner (if a member gets divorced their partner will no longer be considered as a dependant for the purposes of this scheme)

-a member’s unmarried dependent children

Dialysis

The removal of waste matter from the blood by either:

haemodialysis, (through the use of a kidney machine or dialyser)
peritoneal dialysis (by introducing fluid into the abdomen to act as a filter).

Disorder

– a disturbance of function, structure or behaviour, resulting from genetic or environmental factors such as disease, illness or injury.

Emergency

End of life care

Gender Dysphoria

- The distress experienced as a result of the mismatch between the biological gender and the gender identity.

Gender Incongruence

The mismatch between the biological gender and the gender identity. For example, transgender or non binary individuals.

General Practitioner

- a registered medical practitioner in general practice.

GP

- a registered medical practitioner in general practice

High dependency unit

– special department within a hospital designed for patients who require advanced post-operative care and/or support for a single failing organ system.

High risk activities

Home healthcare

- visits from a qualified nurse to your home to give you expert/skilled nursing services under the control of a specialist.

Hospital

NHS hospital - a National Health Service hospital with facilities for medical and surgical treatment, as defined in Section 1.28 of the National Health Service Act 1977 or in any future law.

Inpatient

– if you are required to occupy a hospital bed for one night or more, for medical reasons.

Intensive care unit

– a specialised department within a hospital designed for patients who require support for two or more organ systems and/or advanced respiratory support.

Medical condition

– any physical, mental or psychological disorder, including disease, illness, injury, genetic disorders and behavioural conditions.

Medically necessary

– treatment that is considered to be:

In accordance with professional standards of medical practice in the United Kingdom
Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment
Required for reasons other than the comfort or convenience of the patient or specialist.
Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.
Provided only for an appropriate duration of time.
No more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

Members

- an individual covered under the scheme.

Mental health condition

- a disorder that affects your mind, mental function, emotions or behaviour whether the cause is organic, traumatic or reactive.

Outpatient

- if you do not require a hospital bed for your treatment or consultation.

Palliative care

– treatment that is aimed at slowing the growth of cancer and relieving side effects and symptoms of the treatment/disease.

Partner

- a member’s spouse, or the person the member lives with in a relationship similar to that of spouse, regardless of their gender.

Physiotherapist

- a physiotherapist regulated by and registered as practicing with the Health Professions & Care Council and recognised by us.

Pre-existing condition

- any medical condition for which, in the five years before you joined the scheme:

you have received medication, advice or treatment, or
you have experienced symptoms whether the condition was diagnosed or not.

Private ambulance

- a purpose-built vehicle run by a recognised private ambulance service.

Prosthesis

style="margin: 0cm 0cm 0pt; line-height: normal;">– an artificial body part or device which is inserted during surgery.

Psychological therapist

we recognise the following as psychological therapists.

a psychologist who is:

Registered with the Health and Care Professions Council (HCPC);
Registered with the British Psychological Society (BPS) as a chartered Psychologist

a therapist who is:

An accredited member of the British Association of Counselling and Psychotherapy (BACP); or
An Accredited Member of the British Association for Behavioural and Cognitive Psychotherapies (BABCP); or
An Accredited Member of Scotland’s Professional Body for Counselling and Psychotherapy (COSCA); or
A practitioner who is registered with the United Kingdom Council for Psychotherapy (UKCP)

Registered nurse

- a nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Related condition

- any medical condition which is reasonably considered to be related to another medical condition.

Specialist

- we consider a specialist to be:

a medical practitioner with full current registration with the General Medical Council or
a dentist with full current registration with the General Dental Council

and

a specialist in the treatment you are referred for (this is applicable to all specialities including anaesthetics and psychiatry)
has a certificate of Higher Specialist Training in their specialty that is issued by the Higher Specialist Training Committee of the appropriate Royal College or Faculty
is or has been a National Health Service consultant or dentist
has been recognised for benefit purposes as a specialist by Healix.

Start date

- the date the scheme starts as shown in the scheme schedule.

Surgical appliance

– an artificial device or an artificial body part which is intended as an alternative to surgical treatment or a necessary part of your treatment following surgery

The Scheme

- The ABC Healthcare Scheme

Practitioner

A practitioner recognised by us and registered with the Health and Care Professions Council as:

an occupational therapist
an orthoptist
a speech and language therapist
a dietician
a nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Treatment

- surgical or medical services required following diagnosis of a condition. This includes but is not limited to surgical procedures or non-surgical procedures (such as injections).

Treatments

- surgical or medical services required following diagnosis of a condition. This includes but is not limited to surgical procedures and non-surgical procedures (such as injections).

Trust Deed

- the trust deed (including the rules of the scheme) constituting the healthcare scheme, as amended from time to time.

Trustee, Trustees

- any trustee or trustees for the time being of the healthcare scheme.

United Kingdom

- England, Scotland, Wales and Northern Ireland.

Waiting Period

- a specified period of time that must pass before a benefit becomes eligible. The waiting period is calculated from the joining date of the scheme.

We, Us, Our

- Healix Health Services Ltd, Healix House, Esher Green, Esher, Surrey KT10 8AB.

You, Your

- the eligible member and their dependants, if eligible.

Pandemic

The fast spread of infectious disease to a large number of people in a given population within a short period of time, normally weeks.

Epidemic

more cases of a disease than would be expected for that disease in that area at that time

Neurodevelopmental disorders

Diagnostic

- outpatient and daycase diagnostic tests included but not limited to scans, blood tests and diagnostic procedures

- outpatient and daycase tests or investigations used to reach a diagnosis of an illness or injury

Member Zone

The Member Zone gives you access to the claims portal and displays all the benefits of your healthcare scheme in an app accessed via your smartphone, tablet or computer.

Member

- a student covered under the scheme.

Scheme lifetime

- the total time you are an active member of the scheme

Scheme

- The Embassy of Kuwait Student Healthcare scheme, of which you are a member

Contact Us

The Healix Team

We have a team of experienced case managers and nurses available to advise and help you, who can be contacted on the helpline number below:

Tel: 0208 049 8340
Email: kcouk@healix.com
Monday-Friday 08.00-19.00 (Excl. bank holidays)
Saturday 09.00-13.00

Telephone calls to and from our organisation are recorded for the purposes of quality and training.

Any correspondence should be sent to the following address:

Kuwait Cultural Office Student Healthcare Scheme
Claims Administration Department
Healix Health Services
Healix House, Esher Green
Esher, Surrey
KT10 8AB

Section 9: Glossary

The words and phrases below have the following meanings. They will appear in bold in this guide.

Partners

- a member’s spouse, or the person the member lives with in a relationship similar to that of spouse, regardless of their gender.

Active treatment

- Treatment of an acute medical condition that leads to recovery or restoration of a previous state of health.

Acute condition

Annual renewal date

- the anniversary of the start date each year or any other date which we and the Embassy of Kuwait may agree to in writing.

Benefit

- the benefits for which you are entitled as an individual under the scheme subject to the terms and conditions that apply to your membership including all exclusions.

Benefits

-the benefits for which you are entitled as an individual under the scheme subject to the terms and conditions that apply to your membership including all exclusions.

Biological therapies

Cancer

- a malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue.

Chronic condition

Please refer to the chronic conditions exclusion.

Daycase

- if you are required to occupy a hospital bed for one day, for medical reasons

Dependant

-a member’s partner (if a member gets divorced their partner will no longer be considered as a dependant for the purposes of this scheme)

-a member’s unmarried dependent children

Dependants

-a member’s partner (if a member gets divorced their partner will no longer be considered as a dependant for the purposes of this scheme)

-a member’s unmarried dependent children

Dialysis

The removal of waste matter from the blood by either:

haemodialysis, (through the use of a kidney machine or dialyser)
peritoneal dialysis (by introducing fluid into the abdomen to act as a filter).

Disorder

– a disturbance of function, structure or behaviour, resulting from genetic or environmental factors such as disease, illness or injury.

Emergency

End of life care

Gender Dysphoria

- The distress experienced as a result of the mismatch between the biological gender and the gender identity.

Gender Incongruence

The mismatch between the biological gender and the gender identity. For example, transgender or non binary individuals.

General Practitioner

- a registered medical practitioner in general practice.

GP

- a registered medical practitioner in general practice

High dependency unit

– special department within a hospital designed for patients who require advanced post-operative care and/or support for a single failing organ system.

High risk activities

Home healthcare

- visits from a qualified nurse to your home to give you expert/skilled nursing services under the control of a specialist.

Hospital

NHS hospital - a National Health Service hospital with facilities for medical and surgical treatment, as defined in Section 1.28 of the National Health Service Act 1977 or in any future law.

Inpatient

– if you are required to occupy a hospital bed for one night or more, for medical reasons.

Intensive care unit

– a specialised department within a hospital designed for patients who require support for two or more organ systems and/or advanced respiratory support.

Medical condition

– any physical, mental or psychological disorder, including disease, illness, injury, genetic disorders and behavioural conditions.

Medically necessary

– treatment that is considered to be:

In accordance with professional standards of medical practice in the United Kingdom
Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment
Required for reasons other than the comfort or convenience of the patient or specialist.
Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.
Provided only for an appropriate duration of time.
No more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

Members

- an individual covered under the scheme.

Mental health condition

- a disorder that affects your mind, mental function, emotions or behaviour whether the cause is organic, traumatic or reactive.

Outpatient

- if you do not require a hospital bed for your treatment or consultation.

Palliative care

– treatment that is aimed at slowing the growth of cancer and relieving side effects and symptoms of the treatment/disease.

Partner

- a member’s spouse, or the person the member lives with in a relationship similar to that of spouse, regardless of their gender.

Physiotherapist

- a physiotherapist regulated by and registered as practicing with the Health Professions & Care Council and recognised by us.

Pre-existing condition

- any medical condition for which, in the five years before you joined the scheme:

you have received medication, advice or treatment, or
you have experienced symptoms whether the condition was diagnosed or not.

Private ambulance

- a purpose-built vehicle run by a recognised private ambulance service.

Prosthesis

style="margin: 0cm 0cm 0pt; line-height: normal;">– an artificial body part or device which is inserted during surgery.

Psychological therapist

we recognise the following as psychological therapists.

a psychologist who is:

Registered with the Health and Care Professions Council (HCPC);
Registered with the British Psychological Society (BPS) as a chartered Psychologist

a therapist who is:

An accredited member of the British Association of Counselling and Psychotherapy (BACP); or
An Accredited Member of the British Association for Behavioural and Cognitive Psychotherapies (BABCP); or
An Accredited Member of Scotland’s Professional Body for Counselling and Psychotherapy (COSCA); or
A practitioner who is registered with the United Kingdom Council for Psychotherapy (UKCP)

Registered nurse

- a nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Related condition

- any medical condition which is reasonably considered to be related to another medical condition.

Specialist

- we consider a specialist to be:

a medical practitioner with full current registration with the General Medical Council or
a dentist with full current registration with the General Dental Council

and

a specialist in the treatment you are referred for (this is applicable to all specialities including anaesthetics and psychiatry)
has a certificate of Higher Specialist Training in their specialty that is issued by the Higher Specialist Training Committee of the appropriate Royal College or Faculty
is or has been a National Health Service consultant or dentist
has been recognised for benefit purposes as a specialist by Healix.

Start date

- the date the scheme starts as shown in the scheme schedule.

Surgical appliance

– an artificial device or an artificial body part which is intended as an alternative to surgical treatment or a necessary part of your treatment following surgery

The Scheme

- The ABC Healthcare Scheme

Practitioner

A practitioner recognised by us and registered with the Health and Care Professions Council as:

an occupational therapist
an orthoptist
a speech and language therapist
a dietician
a nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Treatment

- surgical or medical services required following diagnosis of a condition. This includes but is not limited to surgical procedures or non-surgical procedures (such as injections).

Treatments

- surgical or medical services required following diagnosis of a condition. This includes but is not limited to surgical procedures and non-surgical procedures (such as injections).

Trust Deed

- the trust deed (including the rules of the scheme) constituting the healthcare scheme, as amended from time to time.

Trustee, Trustees

- any trustee or trustees for the time being of the healthcare scheme.

United Kingdom

- England, Scotland, Wales and Northern Ireland.

Waiting Period

- a specified period of time that must pass before a benefit becomes eligible. The waiting period is calculated from the joining date of the scheme.

We, Us, Our

- Healix Health Services Ltd, Healix House, Esher Green, Esher, Surrey KT10 8AB.

You, Your

- the eligible member and their dependants, if eligible.

Pandemic

The fast spread of infectious disease to a large number of people in a given population within a short period of time, normally weeks.

Epidemic

more cases of a disease than would be expected for that disease in that area at that time

Neurodevelopmental disorders

Diagnostic

- outpatient and daycase diagnostic tests included but not limited to scans, blood tests and diagnostic procedures

- outpatient and daycase tests or investigations used to reach a diagnosis of an illness or injury

Member Zone

The Member Zone gives you access to the claims portal and displays all the benefits of your healthcare scheme in an app accessed via your smartphone, tablet or computer.

Member

- a student covered under the scheme.

Scheme lifetime

- the total time you are an active member of the scheme

Scheme

- The Embassy of Kuwait Student Healthcare scheme, of which you are a member