Statement of Fact / Confirmation of cover / Policy Summary
MediCover Student Travel/Personal Medical Expenses Insurance
For students from non-EEA countries attending an educational course in Ireland.
Certificate number: IN-IE-30112023439510IAS84420 Policy number: IAS84420
Education institution: Griffith College Direct Education Agency:
This policy provides cover for medical and other travel expenses, Injury and Personal Liability.
Personal details
First Name(s) Rafi Family Name: Shaik
Address: 2-181,Munnaluru Date of Birth: 21/09/2000
NTR district Issue Date: 30/11/2023
Andhra Pradesh Cover Start Date: 20/01/2024
Country of Origin: India Cover Finish Date 19/01/2025
* Cover will end on cover finish date or following emergency repatriation only, from the date of arrival, or admission to hospital, in your
Country of Origin. The policy will provide cover if you are travelling abroad to any country within Europe for a maximum duration of 14 days
any one trip and in aggregate during the Period of cover (if 12 months cover has been purchased) or not exceeding 7 days (if less than 12
months cover has been chosen). All trips start and end in Ireland.
Please note the policy does not cover any trips which involve hazardous activities, which includes winter sports.
Total Premium: € 150.00 - Insurer Premium € 97.00 including 5% government levy and an admin fee of € 53.00
Pre-requirements for cover to apply
1. I am not:
a. in Ireland to attend a course of study of more than one academic year’s duration;
b. currently under treatment, taking medication, or receiving follow-up consultation for any of the following conditions:
i) cancer;
ii) any heart/circulatory-related condition (including hypertension, angina, stroke etc); or
iii) any chronic lung/breathing-related condition (excluding asthma suffered in isolation and controlled by the use of one or two
inhalers); or
iv) a clinically diagnosed psychiatric disorder, anxiety or depression;
c. receiving or waiting for medical treatment at a hospital or nursing home;
d. waiting for investigation or referral, or the results of any investigation, medical treatment or surgical procedure, for any condition,
whether diagnosed or undiagnosed.
e. choosing not to take prescribed medication, or the correct dose of prescribed medicine.
f. travelling against the advice of a medically qualified doctor;
g. travelling to obtain medical, dental or cosmetic treatment;
h. travelling with a terminal condition;
2. I wish to be insured under this scheme, subject to my obtaining a satisfactory visa / period of extension. I have read and understood the
terms, conditions and exclusions which apply to this insurance.
Please note that should the above points 1 and 2 not be correct you should immediately advise StudyandProtect in writing. In the
absence of such a reply you will be deemed to have accepted the cover on the terms and conditions quoted.
James Duncan
Authorised Official
Chubb European Group SE
How to Claim:
Should you need emergency medical assistance contact Chubb Assistance Hotline:
If you need to make any other claim you should contact:
Phone: 01-6395800; studyandprotect@[Link] Chubb Assistance (24/7, 365 days)
Arachas Study & Protect Team, The Courtyard,Carmanhall Rd,
Sandyford Business Estate, Sandyford, Dublin 18, D18 X377
+353 (0) 1 440 1762
To avoid delays in settling your claim:
• Indicate the type of claim (e.g. injury, illness, medical expenses, personal liability, etc.)
• Quote the name of the university/college being attended and the Certificate Number.
• Substantiate your claim by attaching the applicable statement, receipts or accounts.
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Summary of cover
MediCover Student Travel/Personal Medical Expenses Insurance
This is a summary of cover and does not ‘In-patient’ means an Insured Person, Policyholder provides a medical
contain all the terms and conditions these whose Hospital confinement is as a resident certificate - which must be dated
can be found in Policy document number bed patient, for whom a clinical case record no earlier than 5 days before the
IAS84420 which has been provided to has been opened and whose confinement outbound travel date - issued by a
you. Please take time to make sure you is necessary for the medical care, diagnosis doctor or midwife confirming the
understand the cover it provides. Cover is and treatment of an Illness or Bodily Injury number of weeks of pregnancy and
underwritten by Chubb European Group SE. covered by this Policy and not merely that they are fit to travel).
for any form of nursing, convalescence,
What is MediCover travel/student rehabilitation, rest or extended-care. 2. Dental expenses must be incurred
Private Medical Expenses Insurance? within 24 hours of the injury (Max limit
Pre-requirements for cover to apply €500).
The MediCover travel/student Private
Medical Expenses Insurance covers Insured As with all insurance policies, other than All expenses must be pre-approved and
Persons whose Country of Origin is outside life assurance, the policy covers only arranged by Chubb Assistance which
the EEA and who, whilst in Ireland for the unexpected and unforeseen events. If you operates 24 hours a day, 365 days a year
purpose of attending an academic course cannot confirm the above statements under
with the Insured, during the period of the heading Pre-requirements for cover T +353 1 440 1762.
insurance, suffer an injury resulting in death to apply you will not be covered by this
or disablement; incur medical expenses insurance. Significant or Unusual Exclusions or
following illness requiring hospitalisation Limits applicable to Section A
or following an accident; or require to be Chubb Assistance
indemnified should they become liable for This section does not cover:
some unintentional injury, illness or damage Emergency medical assistance • Any claim of any kind directly or
to the property T +353 1 440 1762 indirectly arising from, relating to or in
of another. operates 24 hours a day, 365 days a year. any way connected with COVID-19 or its
outbreak
Who can be covered? Significant Features and benefits • The first €100 of any claim under A.
Medical Expenses
A. Students whose Country of Origin is A) This policy provides cover for • Expenses incurred without the
outside the EEA, whilst in Ireland for the €2,500,000 for medical expenses authorisation in advance of Chubb
purpose of attending a course of one (including dental expenses necessitated Assistance
academic year or less. by bodily injury), nursing home and • Amounts recoverable from any free
B. Any Partner of a person described in ambulance charges and unlimited national health scheme
Category A when StudyandProtect and expenses for emergency repatriation. • Injury/illness where a Doctor has not
Chubb agree to include such person in Funeral expenses are limited to €7,000 confirmed the treatment to be medically
this insurance. and physiotherapy, homeopathy, necessary
C. Any Child of a person described in osteopathy or chiropractic treatment is • Treatment provided by a member of the
Categories A or B when the limited to €1,000. An excess of €100 per Insured Person’s family
Intermediary and Chubb agree to claim applies. • Physiotherapy, homeopathy, osteopathy
include such person in this insurance. or chiropractic treatment unless
B) In case of injury, the benefit payable in necessitated by bodily injury
Definitions respect of death, loss of two or more • Cosmetic treatment unless agreed by us
limbs, or loss of sight in both eyes, is and necessary as a result of accidental
‘Accident’ and ‘accidental’ means a €10,000. In the case of loss of one limb bodily injury
sudden identifiable violent external event or loss of sight in one eye the benefit • Expenses incurred in the Insured
which happens by chance and which could payable is €5,000. Person’s Country of Origin except as
not be expected; or unavoidable exposure to specifically covered
severe weather. C) Personal liability cover included with a • When the purpose of the trip is to
limit of indemnity of €5,000,000. receive medical treatment, cosmetic
‘Bodily injury’ means injury which is treatment, or medical advice
caused solely by Accidental means and Section A. Medical Expenses – up to • Dental or optical expenses other
which independently of Illness or any other €2,500,000 than those incurred in providing the
cause, occurs within 12 months from the minimum level necessary to relieve pain
date of the Accident. 1. ‘Medical Expenses’ means all and discomfort for the duration of the
reasonable costs necessarily incurred journey following the injury
‘Illness’ means any illness, disease, medical whilst an Insured Person is in Ireland • Medication costs known or required
complaint or medical condition which is including: prior to travelling
not Accidental Bodily Injury and which is a) surgical or other diagnostic or • When treatment could have waited until
contracted by an Insured Person. remedial treatment given or return to Country of Origin.
prescribed by a Qualified Medical • When travelling against the advice of a
‘Insured’ means the person, firm, company Practitioner; medical practitioner
or organisation named above in the b) nursing home and ambulance • Expenses incurred for which no receipts
confirmation of cover. charges; and are provided.
c) costs incurred for complications
‘Insured Person’ means the student of pregnancy (as diagnosed by a For further details please refer to the
mentioned above, whose Country of Origin Qualified Medical Practitioner who policy document
is outside the European Economic Area who specialises in obstetrics provided Cover – Pages 16 - 20
has chosen to participate in the Insured’s that if travelling within 12 weeks of Exclusions – Pages 21 - 25
MediCover Student Travel Insurance. the expected date of delivery the
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Section B. Personal Accident – up to unless licensed in Ireland; flying other than 1) Indicate the type of claim (e.g. injury,
€10,000 as a passenger; illegal acts; self-injury or illness, medical expenses, Personal
suicide; drug abuse; HIV/AIDS; treatment for Liability, etc.)
Accidental bodily injury which causes: symptoms which should reasonably have 2) Quote the name of the Language School/
• Death/Loss of more than one limb/Loss been treated before travelling. College being attended and the Policy/
of sight in more than one eye: €10,000 Certificate number.
• Loss of one limb or loss of sight in one Duration of policy 3) Substantiate your claim by attaching
eye: €5,000. the applicable statement, receipts or
This policy will start and finish on the dates accounts.
Significant or Unusual Exclusions or shown above in the confirmation of cover.
Limits applicable to Section B Complaints procedure
Right of cancellation
This section does not cover: Both Chubb and Arachas are dedicated to
• suicide or deliberate self harm The Insured or the Insured Person may providing a high quality service and want
• post traumatic stress disorder, cancel this policy at any time. If the Insured to maintain this at all times. If you are not
psychological or psychiatric condition or Insured Person cancels within 14 working satisfied with our service please contact:
• Repetitive stress (strain) injury or 1. Arachas StudyandProtect Team
days after receiving confirmation that the
syndrome The Courtyard, Carmanhall Rd,
• driving under the influence of alcohol; Policy has been concluded, we will refund Sandyford Business Estate,
• disease or any physical defect, injury or the Premiums paid provided no claims have Sandyford, Dublin 18, D18 X377
illness which existed before the Journey; been reported or paid. After 14 days there is T 01 - 6395800
• any physical defect, infirmity or medical no refund provided. E studyandprotect@[Link]
condition for which medical advice or
treatment has been received within the Who are we 2. The Accident & Health Manager
24 months prior to an Insured Person’s Chubb
effective date of cover. This policy is arranged and administered 5 George’s Dock
by Arachas. Arachas Corporate Brokers International Financial Services
For further details please refer to the Limited t/a Arachas, Capital Insurance Centre
policy document Markets, Capital IM, Covercentre is regulated Dublin 1
Cover – Pages 16 - 20 by the Central Bank of Ireland. Company T 1800 707170
Exclusions – Pages 21 - 25 registration number: 379157 E irelandenquiries@[Link]
quoting policy details.
Section C. Personal Liability – up to This policy is underwritten by Chubb
€5,000,000 European Group SE. Chubb European If not satisfied with Chubb’s final response,
Group SE trading as Chubb, Chubb Bermuda an Insured Person can ask the Financial
Covers legal costs and damages which the International and Combined Insurance, Services and Pensions Ombudsman to
insured person becomes legally liable to pay is authorised by the Autorité de contrôle review their case.
as a result of having caused death or injury to prudentiel et de résolution (ACPR) in
a third party or damage to their property. France and is regulated by the Central Financial Services and Pensions
Bank of Ireland for conduct of business Ombudsman
Significant or Unusual Exclusions or rules. Registered in Ireland No. 904967 at 5 3rd Floor, Lincoln House
Limits applicable to Section C George’s Dock, Dublin 1. Chubb European Lincoln Place
Group SE is an undertaking governed by Dublin 2
This section does not cover liability for: the provisions of the French insurance code D02 VH29
• Bodily injury to any person in the course with registration number 450 327 374 RCS T (01) 567 7000
of being engaged in the activities of the Nanterre and the following registered office: E info@[Link]
insured persons’ employer La Tour Carpe Diem, 31 Place des Corolles, W [Link]
• Bodily injury to the insured persons’ Esplanade Nord, 92400 Courbevoie, France.
immediate family Chubb European Group SE has fully paid The existence of these complaint procedures
• Property belonging to or in the custody share capital of €896,176,662. does not reduce an Insured Person’s
of an insured person Statutory Rights relating to this Policy.
• Mechanically propelled vehicle, aircraft, Chubb European Group SE is a subsidiary For further information about Statutory
hovercraft, watercraft or firearms of a US parent and Chubb Limited (a NYSE Rights an Insured Person should contact
• The ownership, possession or listed company) and part of the Chubb the Competition and Consumer Protection
occupation of land or buildings, Group of companies. Consequently Chubb Commission.
immobile property or caravans European Group SE is subject to certain
• Any wilful or malicious act US laws and regulations in addition to EU,
• Punitive or exemplary damages UN and national sanctions restrictions
which may prohibit it from providing cover
No admission, offer, promise or indemnity to or paying claims to certain individuals or
be made without the consent of Chubb. entities, and from insuring certain types
of activities in or connected with certain
For further details please refer to the countries and territories such as, but not
policy document limited to, Iran, Syria, North Korea, North
Cover – Pages 16 - 20 Sudan, Cuba and Crimea.
Exclusions – Pages 21 - 25
How to claim
General Exclusions applicable to whole
policy 1) Should you need emergency medical
assistance contact Chubb Assistance on:
Coronavirus Disease 19 (COVID-19) (or any +353 (0)1 440 1762
mutation or variation thereof ) and / or its 2) Should you wish to make any other claim
outbreak; to the extent that any term or you should contact:
condition in the Policy may be inconsistent
with this exclusion, this exclusion shall Arachas Study & Protect Team,
prevail; any travel to areas where the The Courtyard,Carmanhall Rd,
Department of Foreign Affairs allocates a Sandyford Business Estate, Sandyford,
security status of ‘Avoid non-essential travel’ Dublin 18, D18 X377
or ‘Do not travel’; War; radioactivity; armed T 01 - 6395800
forces; scuba diving; mountaineering; E studyandprotect@[Link]
drink driving; motor bike or scooter riding To avoid delays in settling your Claim:
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Data Protection Declaration
We use personal information which you
supply to us or, where applicable, to your
insurance broker in order to write and
administer this Policy, including any claims
arising from it.
This information will include basic contact
details such as Your name, address, and
policy number, but may also include
more detailed information about You (for
example, Your age, health, details of assets,
claims history) where this is relevant to the
risk Chubb are insuring, services Chubb are
providing or to a claim You are reporting.
Chubb are part of a global group, and Your
personal information may be shared with
Chubb’s group companies in other countries
as required to provide coverage under
Your policy or to store Your information.
Chubb also use a number of trusted service
providers, who will also have access to Your
personal information subject to Chubb’s
instructions and control.
You have a number of rights in relation to
Your personal information, including rights
of access and, in certain circumstances,
erasure.
This section represents a condensed
explanation of how Chubb use Your personal
information. For more information, Chubb
strongly recommend You read Chubb’s
user-friendly Master Privacy Policy,
available here: [Link]
ie-en/footer/[Link]. You can
ask Chubb for a paper copy of the Privacy
Policy at any time, by contacting Chubb at
[Link]
com.
C1201/20 0123
Date: 30/11/2023
Certificate: IN-IE-30112023439510IAS84420
STATEMENT OF SUITABILITY ON BEHALF OF ARACHAS
Important Notice – Statement of Suitability.
This is an important document which sets out the reasons why the product(s) or service(s) offered or
recommended is/are considered suitable, or the most suitable, for your particular needs, objectives and
circumstances.
Class of Insurance: Private Medical Expenses Insurer: Chubb European Group SE
First Name(s): Rafi Family Name: Shaik
Policy No.: IAS84420
Arachas Corporate Brokers Limited is regulated by the Central Bank of Ireland. The quotation obtained for you
for the above noted class of insurance is based on the information you have provided to us.
This product is part of an exclusive facility ǁĞŽĨĨĞƌŝŶWĂƌƚŶĞƌƐŚŝƉǁŝƚŚŚƵďď ƵƌŽƉĞĂŶ'ƌŽƵƉ^ ;MedicoverͿ͘
We do not rebroke each policy on this facility individually but on a block basis, as we regularly check the rates
and cover levels provided by this facility to ensure that they remain market leading and with your best
interests in mind.
We believe the product recommended is competitively priced and meets your insurance demands and needs.
We would be happy to discuss with you the reasoning behind us taking this approach should you wish.
All information in relation to your policy can be found in your policy terms and conditions which will be issued
to you once cover has been put in place and is available from our offices at all times.
We assume that by transacting business with us in relation to this policy offering, you accept the detail
outlined in this suitability statement.
Conor Brennan
CEO, Arachas.
Date: 30/11/2023
