A dedicated

Health Plan
for education
professionals in
Mauritius and
Rodrigues.

Distributed by: Insurer:

Eduhealth has been designed by Medibroker Ltd in partnership with SICOM
General Insurance Limited.

MEDIBROKER lTD
Medibroker is the only specialist broker in Mauritius which helps individuals
and companies find the right medical insurance solution for them.

As a member of the Chartered Brokers Group, Medibroker Ltd has been

serving a large number of prestigious organisations and individuals both in
the public and the private sector.

Created in 2001, Medibroker has grown to offer a comprehensive set of

medical solutions spanning from advice to negotiations and even
the day-to-day administration of schemes. As the island’s sole medical
insurance specialist, Medibroker is a point of contact for many HR managers
and individuals across the island.

A more detailed presentation of Chartered Brokers Group and Medibroker

Ltd is available on our website at www.charteredbrokersgroup.com.

SICOM GENERAL INSURANCE LIMITED

The State Insurance Company of Mauritius Ltd (SICOM) stands proudly
today as one of the leading insurance and financial companies in Mauritius.

With an established presence in the economic landscape of Mauritius

since 1975, SICOM Group presently includes the State Insurance Company
of Mauritius Ltd (SICOM), SICOM General Insurance Ltd (SICOM GIN),
SICOM Financial Services Ltd (SFSL), SICOM Global Fund Ltd and SICOM
Management Ltd.

The proactive alignment of its strategies, structures and processes enabled

the Group to become more nimble and responsive to external demands
and was the main contributing factors to its positive financial results.
SICOM Group has been investing heavily on building profitable long term
relationships with its valued customers and fine tuned its insurance solutions
to delight them with revolving products and personalized services.
 Eduhealth benefits
at a glance

Every year, thousands of Mauritians are Preferential rates for the educational
rushed to medical facilities across the island community
for treatment.

Some will have the power to choose whether

they want to be treated in a public hospital
or a private clinic. Most however, will not have
that opportunity.
Exclusive benefits including fertility
When our health, or that of our family’s, is at treatment, maternity cover and more
risk, we would all love to have all options open
to us. In these moments, money should not be
an issue.

Being able to choose your doctors, medical

facilities, or simply having the opportunity to Overseas treatment
recover comfortably in a private room can
drastically improve your chances of a speedy
recovery.

“Luckily, as a member of the education

community, having the power to make your
own decisions for your health and that of Comprehensive insurance that covers
your family’s, has never been more affordable, everything from medication bills to major
thanks to Eduhealth, the first health care surgeries
plan designed specifically for education
professionals.”

Eduhealth is a medical insurance plan

created by Medibroker Ltd and SICOM
General Insurance Limited exclusively for the Family Cover
educational community and their families.

Designed for everyone working in a school, university,

or other educational organisation.
Table of
Benefits
Inpatient - Medical and Surgical Benefit Bronze Silver Gold
1.0
Overall Limit Per Illness Lifetime MUR 50,000 MUR 100,000 MUR 500,000

Inpatient Sub Limit

As per As per As per

1.1 Doctor Fees
Scale of Costs Scale of Costs Scale of Costs

1.2 Clinic room fees Standard Room Standard Room Standard Room

Cancer treatment, incl. cost of surgery and

1.3 50,000 100,000 500,000
chemotherapy.

1.4 Internal Implants and Prosthesis (Incl. cost of surgery) 50,000 100,000 250,000

1.5 External medical appliances 50,000 100,000 250,000

1.6 Psychiatric hospitalisation 10,000 15,000 25,000

1.7 Congenital Benefits – Lifetime Limit 25,000 35,000 50,000

Dental Surgical Operations – extraction of wisdom

1.8 25,000 50,000 75,000
teeth

1.9 Ambulance Cover Included in 1.0 Included in 1.0 Included in 1.0

2.0 Maternity Cover - Annual Limit

2.1 Normal Delivery and Caesarian MUR 35,000 MUR 50,000 MUR 75,000

Maternity Cashback benefit – At home or public

2.2 15,000 25,000 30,000
hospital

2.3 Infertility Treatment - Lifetime limit 25,000 35,000 50,000

3.0 Funeral Benefits 15,000 20,000 25,000

Excess Nil Nil Nil

Outpatient Cover Bronze Silver Gold

4.0
Overall Annual Limit 12,000 18,000 25,000

Sub Limits forming part within the overall outpatient

limits

4.1 Consultations and Prescribed Medicines 5,000 8,000 12,000

4.2 Prescribed Blood Tests, X Rays, ECGs and Procedures 2,500 3,500 6,000

4.3 Pre Natal and Post Natal Routine Appointments 5,000 6,000 8,000

4.4 Over the counter medication 500 600 800

Dental Treatment Including fillings, extractions,

X-Rays, orthodontic treatment, crowns, dental
4.5 3,000 5,000 7,000
implants, surgical operations and gum treatment -
Scaling and Polishing (Non-Cosmetic)
 Optical Benefit -Spectacles including Contact Lenses
4.6 (every 2 years Benefit either frames and lenses or 3,000 5,000 7,000
contact lenses)

4.7 Full Health Screening 2,500 4,000 5,000

4.8 Hormonal Benefit Therapy 2,000 3,000 4,000

4.9 Vaccination,Food Supplement and Vitamins 1,000 2,000 3,000

4.10 Chronic Benefits 1,000 2,000 3,000

Excess 20% 20% 20%

MONTHLY PREMIUM PER PERSON

MUR MUR MUR

Main Member

Below 50 yrs 900 1,350 1,620

Above 50 Years (See note 3 below) 1,035 1,550 1,860

Adult Dependant

Below 50 yrs 855 1,260 1,530

Above 50 Years (See note 3 below) 985 1,450 1,760

Child Dependant 675 1,125 1,350

Catastrophe cover (Optional)

Covers Major Surgeries and Accident
6.0 Monthly Premiums per person

Lifetime Per Illness

6.1 Level 1 - Rs 500,000 450 315 285

6.2 Level 2 - Rs 1,000,000 525 515 460

6.3 Level 3 - Rs 2,000,000 600 585 525

6.4 Level 4 - Rs 3,000,000 675 660 595

6.5 Excess Per Illness aligned to Inpatient Benefit 50,000 100,000 500,000

Notes: 1. Inpatient & Outpatient covers are mandatory.

2. Catastrophe Cover is optional but not available as stand alone.
3. Price applicable up to 60 years only. For applicants above 60 years a 30% loading will apply.
We’ll protect you
while you prepare
the future of
Mauritius
Your job is important for our future, and we’ll Family
offer you the protection you need to work with
complete peace of mind.
health cover
Through Eduhealth, you can guarantee that
SICOM General Insurance Limited guarantees
your family and dependants receive the best
that you have access to the best healthcare
medical attention available on the island.
options on the island, including:

Private clinics Comprehensive

and specialists cover
Eduhealth covers the cost of the majority of
With Eduhealth, get access to the island’s
your medical expenses.
best clinics with zero up-front payments. All
you have to do is to present your National
For example, a doctor’s consultation,
Identity Card for admission.
treatment in a clinic, medication, or a surgical
operation, are all reimbursable under the
Eduhealth plan.
Flexible
Some of the costs covered by the Eduhealth
pricing include:
Eduhealth provides lower rates than standard
• Admissions for illnesses and surgeries
medical insurance policies to suit your needs
• Child Delivery
and that of your dependants so you pay for
• Medical consultations and prescribed
the healthcare you need and not more.
medicines
• Optical and dental treatments
• Pre and post-natal treatments
• Laboratory tests

Exclusive
benefits
In addition to the standard covers offered,
Eduhealth provides you with a number of
exclusive benefits which include the following:

• Infertility Treatment
• Full Health Screening
• Overseas Treatment
• Funeral Grants
• Chronic Illnesses
• Hormonal Benefit Therapy
Step by step
Guide
Also, all questions need to be answered clearly
and accurately. Non-disclosure of relevant
information may cause unnecessary hassle like
repudiation of claims and even suspension of
cover.

Step 5
Step 1
Supporting documents
Visit our website
Once your application is approved, you will be
Visit our website at www.eduhealth.mu. Read required to submit the following documents to
the product brochure to understand the activate your cover:
benefits proposed and the relevant terms and 1. ID (or Passport for foreigners) of Main Member
conditions. The website offers a live chat service
for any assistance you may need. You can also 2. ID (or Passport for foreigners) of Spouse
call at our office for more information. (where applicable)
3. Marriage Certificate (where applicable)
4. Birth Certificate for Child Dependant/s
(where applicable)
Step 2 5. Proof of Residential Address- Utility Bill (Not
Choose your preferred option older than 3 months)
6. Bank Account Details
7. Standing Order Form
EDUHEALTH offers 3 different options to cater
for different needs and budget. Choose the
most appropriate option for you and your family.
Remember, all members of a family should be
on the same option. You may also upgrade your Step 6
inpatient limit with an optional catastrophe Payment of premium
cover.

Payment of your monthly contribution will be

effected by standing order over 11 months.
Step 3 Once your application is approved, you will be
requested to pay for the first month before your
Obtain a quotation cover is activated.

Use our quoting tool provided on the website to

know your monthly contribution. You may also
call at our office for assistance. Step 7
Start of cover

Step 4 Following the submission of the documents listed

in Step 5 above and payment of the first month
Proposal form premium, your cover will be activated. You will
receive your welcome pack so that you may
Should you wish to join Eduhealth, you need to start enjoying the benefits offered by Eduhealth.
complete a Proposal Form which is available
on the website or you may call at our office
to complete the form. It is important that you
provide all information requested.
Terms &
Conditions

1. Scope of Cover
Eduhealth is a health plan that provides cover for Medical and Surgical Expenses reasonably incurred by the
insured members as a direct result of their sustaining accidental bodily injury and/or illness and/or a disease
within the period of insurance.

2. Eligibility
Eduhealth has been designed exclusively for professionals working in the Education Sector in Mauritius and
Rodrigues. Members may also add their spouse/partners and children in the scheme.

3. Age Limit
Age limit to join Eduhealth is 65 years. Once a member, you and your dependants may stay on the scheme
until you reach the age of 85.

Applicants above 50 years will be required to submit a medical report.

Children below 18 years may be added to the scheme at a special discounted rate. This benefit is extended
to children up to 25 years who are following full time courses.

4. Waiting period and Exclusions

4.1 Members not previously insured
i. Accident : Nil
ii. Illnesses and other treatments : 3 months
iii. Childbearing : 24 months
iv. Optical treatment : 12 months
v. Orthodontic Treatment : 12 months
vi. Specific Conditions : 24 months
vii. Full exclusion on any undisclosed medical condition

4.2 Members already insured

For Members who are already insured, continuation of cover will apply provided the gap between the
two policies does not exceed one month.

Member will need to provide certificate of insurance from previous insurer including limit of cover,
remaining balance, terms and conditions of the previous policy and claims history for the past three
years.

SICOM General Insurance Limited reserves the right to accept or reject any application and to impose
waiting periods and exclusions as appropriate.
5. Catastrophe cover
The catastrophe cover, if chosen, will reimburse expenses incurred by a member after limits under the
inpatient cover have been exhausted.

The limit chosen under this section provides for medically necessary and eligible treatment including
hospital bed charges, doctor’s bills, anesthetists’ bills, operating theatre fees, pharmacy, laboratory, and
investigations reasonably incurred by an insured member. Benefits in respect of doctors’ fees will be paid
according to the “scale of costs”.
Treatments not available in Mauritius and its dependencies will be covered but must be authorized by
SICOM General Insurance Limited.

6. Option Selection and Upgrade in Cover

Members may choose any of the three options proposed by Eduhealth including catastrophe benefits.
However, all members of a family should be on the same option.
Members are allowed to change option at renewal only:
i. Upgrade in cover is allowed at renewal only and will be subject to Underwriting.
ii. Application Form is mandatory.

7. KYC Documents
Copies of the following documents need to be submitted, together with the duly completed original
application form:
• ID (or Passport for foreigners) of Main Member.
• ID (or Passport for foreigners) of Spouse (where applicable).
• Marriage Certificate (where applicable).
• Birth Certificate for Child Dependant/s (where applicable).
• Proof of Residential Address - Utility Bill (Not older than 3 months).
• Unmarried children from 18 to the age of 25 years and in full time of education (Proof of full time education
to be submitted).
• Bank Account details.

8. Adding Newborn Babies

A newborn can be added under Inpatient and Outpatient covers as from birth with no waiting period subject
to 3 months prior notification from the expected delivery date.

9. Payment of Premium
The premium is an annual premium covering 12 months insurance period payable monthly in advance.

10. Territorial Limits

The scheme will provide for treatment in Mauritius and Dependencies only, except when the treatment is
not available in Mauritius as certified by a panel of doctors appointed by the insurer. In such cases, the most
cost-effective evidence-based treatment in a hospital of good repute shall be considered.

In which case an economy class ticket for the patient and for an accompanying person shall be provided.
11. Main Exclusions
• Pre-existing medical condition(s)
• Any treatment, detoxification programs, psychological counselling, or psychotherapy/rehabilitation
related to usage/consumption of tobacco, electronic cigarettes (e-cigarette) or vaping of any kind,
alcohol & Illicit drugs or any psychoactive substance use with addictive potential or dependency.
• Any treatment not ordered by a physician.
• Treatment required for medical condition(s) arising as a result of self-harm, self-inflicted injuries including
suicide attempt(s).
• Epidemics and/ or pandemics.
• Loss, breakage, scratching, repairs or replacement of spectacles, frames, and contact lenses.
• Elective abortions/Termination of pregnancy and complications thereof.
• Treatment and medical investigation(s) outside the Territorial Limits of cover unless for emergencies
and/or authorized by us.
• Medical condition(s) arising from an engagement in professional sports.
• Treatment of sleep disorders, including insomnia, obstructive sleep apnea, narcolepsy, snoring and
bruxism.
• Medical Investigation(s) into, and treatment of, loss of hair and any hair replacement.
• Alternative medicine practitioner visits/consultations and treatments, including but not limited to:
Ayurveda, Traditional Chinese Medicine, Homeopathy etc.

*A full list of exclusion is available on the policy document

12. Non-Disclosure
All pre-existing health conditions and other material facts should be fully and accurately disclosed in the
application form. Non-disclosure may lead to rejection of claims and/or cancellation of the cover. SICOM
General Insurance Limited reserves the right to add or waive waiting periods and/or exclusions as necessary.

13. Cancellation
The insured may terminate the scheme by giving one-month notice to the insurer. However, in case of
termination, the full annual premium remains payable if the benefits provided under the policy have been
fully or partly utilized. In case no benefits have been utilized, the premium shall be payable on prorated basis
calculated on the period of cover provided by the Policy.
 Enjoy a
fully digital
service

The Eduhealth Website: Thanks to the Eduhealth website, applying for a healthcare plan has never been easier.
In a few clicks, you can request a quote, submit your application, and chat with an Eduhealth staff member who
will answer any of your questions.

Cashless Service: Forget having to do a bank transfer to clinics or carrying cash on you to visit the optician. All
you have to do is present your National Identity Card, and we’ll handle the payment for you.

Snap and Send: You can submit a claim and receive your refund from the comfort of your house. Take a picture of
your medical bills and send it to us through a digital application. Your claims are processed and refunded directly
in your bank account.

Social Media: Connect with the Eduhealth community and Eduhealth staff via our social media pages.
 Your health. Your choice.

If you would like to learn more about Eduhealth, we offer a free and zero obligation consultation with one of our
health insurance specialists.

Contact us through our website www.eduhealth.mu or call us on 403 5915.