Health Insurance – FAQs
Manufacturer of the product is: MAPFRE Middlesea
MAPFRE Middlesea p.l.c. (C-5553) is authorised by the Malta Financial Services Authority (MFSA) to carry on both Long Term and General Business under the Insurance Business Act. MAPFRE Middlesea p.l.c. is regulated by the MFSA.
FAQs Health Insurance
What am I covered for?
The purpose of the policy is to provide cover for any medically necessary surgical or medical service (such as consultations, diagnostic tests or investigations) needed to diagnose, relieve or cure a disease, illness or injury.
Treatment can be received as an in-patient or day-patient; or as an out-patient (this depends on your choice of scheme).
Full terms and conditions are detailed on the Health Policy; and the Table of Benefits of your chosen scheme.
Where am I covered?
This depends on the scheme you choose, and is detailed on the Table of Benefits:
- Basic Scheme covers treatment worldwide
- Europa Scheme covers treatment in Malta on full refund of maximum payable fees; and in Europe if the same / similar treatment is not available in any hospital in Malta
- Hospital Scheme covers treatment in Malta on full refund of maximum payable fees; and limited cover worldwide
- International Scheme covers treatment worldwide on full refund of maximum payable fees. In the USA and Canada limited cover applies for emergency treatment only.
If you are insured on a group policy, the list of benefits and cover limits may be different from the ones available on this website. Please refer to the Table of Benefits available from your group administrator.
Can I include my dependants in my policy?
Yes, you may include your spouse / partner and children on your policy, by including their details on the application form. Premium is charged for each individual according to their age and chosen cover.
Parents or siblings are not considered as dependants, and will be quoted for separately.
As a policyholder you may include a new born child free of charge until the policy period expiry date. You will need to send a copy of the birth certificate within three months of the baby’s birth date.
If you are insured on a group policy that allows for inclusion of dependents, this must be arranged through your group administrator.
Can I pay my policy by instalments?
Your premium is due at the start of the policy period and must be paid for a full year, irrespective of your chosen frequency of payment.
We accept half yearly, quarterly or monthly instalment payments from the second year of cover. Instalment charges (calculated as a percentage of your annual premium) will apply.
Instalment payments must be arranged through direct debit.
Am I covered immediately?
You are covered from the policy start date detailed on your Schedule, subject to premium being paid.
Some conditions are subject to a waiting period (detailed on the Health Policy and the Table of Benefits) – this means that medical expenses related to these conditions or procedures are covered only after the completion of the defined waiting period.
Will I be able to change my plan after I purchase the policy?
Your policy contract is for one year. You can request changes to your plan, such as an upgrade or downgrade, or adding / removing optional extension at policy renewal by writing to us.
You will need to complete an application form for a plan upgrade, declaring any symptoms or medical conditions you have (whether you have been diagnosed or not, and irrespective whether you have made claimed for on your policy or not). These conditions may be restricted from your upgraded cover, however, will continue to be covered up the limits of your previous cover. Any cover limitations will be communicated to you in writing.
No application form will be needed in the case of inclusion of optional extensions or plan downgrades.
Can I have health insurance if I already suffer from an illness?
Our health insurance policies do not cover pre-existing medical conditions. These are conditions for which you had symptoms, consultations, medication, surgery or other treatment in the past.
You will be asked to disclose these in your application form. These conditions may be excluded from your cover, in which case we will advise you in writing.
Exclusions may be permanent or for a specified period of time.
How do I claim?
Out-patient treatment (such as consultations with doctors, therapists and specialists; and tests) are on a pay and claim basis.
Ask your doctor/medical professional to complete the relevant section of your claim form. A completed form, together with receipts and itemised invoices must be received by us within 3 months of the initial date of treatment.
Submit your claims for reimbursement here. When this is not possible, the original documentation can be sent to us by post.
You will need to contact us for pre-authorisation before receiving any of the following treatment:
Any type of surgery
- Hospitalisation
- MRI/CT/PET scans
- Home nursing
- Mental health treatment
When do I need GP or specialist referral?
You need referral from your family doctor or specialist for:
- Physiotherapy
- Diagnostic tests
A referral from a specialist is mandatory in case of:
- Admission to hospital
- Alternative treatment
- Consultations with psychologists or psychotherapists
- MRI / CT / PET scans
- Home nursing
How are claims paid?
Claims for out-patient expenses are paid by direct credit to your bank account or by cheque. Cheque payments below €20 cannot be issued.
Invoices for pre-approved in-patient treatment or MRI/CT scans are paid directly to the provider of your choice.
What is not covered?
The full list of exclusions is detailed on the Health Policy, available in the Downloads section.