Best medical care
Whichever scheme customers choose, it will enable them to access the best medical care at times and locations that suit them most, whilst offering peace of mind for them and their loved ones.
Three levels of cover
These schemes provide THREE levels of cover, with the first two valid in Malta only, and the third scheme providing cover on a worldwide basis except USA and Canada. The schemes offering In-patient and Out-patient cover are:
- Basic Scheme
- Hospital Scheme
- International Scheme
In order to make its schemes more accessible to a wider section of the public, Mapfre Middlesea p.l.c. is also introducing a number of cost-reducing options whereby the applicable premium may be significantly improved when the following variations are selected:
- Basic Scheme (In-patient cover only)
- Hospital Scheme (In-patient cover only)
These two variations provide insurance protection for hospitalisation as an in-patient. By opting not to be covered for out-patient treatment and consultations, a person could still have the peace of mind that he/she is covered for expensive in-patient treatment costs.
Further flexibility is provided by allowing customers to introduce a voluntary excess of 10% or 20% and enjoy a further reduction in their premium.
We care for your health as if it were our own. Read how you can get a second opinion from an international panel of doctors.
Benefits & Advantages
Your MAPFRE Middlesea Health Insurance policy includes a wide range of interesting benefits for you and your family:
- We offer you different levels of cover to best suit your individual requirements and budget: Basic (1), Hospital (2), International (3), Family Health (4).
- We offer you cost-reducing options, such as Basic and Hospital in-patient cover only schemes, that pay for valuable in-patient treatment charges.
- We provide further flexibility by letting you introduce a voluntary excess of 10% or 20% and enjoy a further reduction in your premium.
- Our 24-hour telephone medical advice service, Mediphone, provides you the possibility to contact a doctor who can offer guidance in any health-related circumstance. This includes extensive services such as sending a doctor, nurse and medication to your home.
- Second Medical Opinion service program: If you are diagnosed with a severe illness and would like to get further information, this benefit gives you access to a network of recognised international medical experts.
- Both Mediphone and Second Medical Opinion service are provided at no charge on policyholders having a Mapfre Middlesea Hospital or Mapfre Middlesea International policy. Policyholders on a Schemes 1 and 2 may subscribe these additional benefits at a nominal premium.
- As a policyholder, you are entitled to a special discount on a number of services offered by We Care, a care agency which assists the elderly, disabled, and people with mobility problems to live an independent life. We care offers day and night care, help with house work such as laundry and ironing, nurse services, occupational therapy, psychologists assistance, physiotherapy, speech language pathologists service and social workers assistance.
- Parent accommodation (staying with a child under 14) is full refunded for Hospital and International Schemes.
- International Scheme offers in-patient and out-patient cover on a worldwide basis (except USA and Canada.).
- Consultant oncologist fees for all the active phase of the cancer treatment are full refunded for Hospital and International Schemes. Hospital charges for cancer tests and drugs, including chemotherapy and radiotherapy for each course of treatment are also included.
- The Family Health Scheme offers payment options to choose from: monthly, quarterly, half year, annually. New born children can be included in the Family scheme free of charge, until the next date of renewal.
With this insurance you can choose between 4 levels of coverage: (1) Basic Scheme, (2) Hospital Scheme, International Scheme (3) and Family Health Scheme (4).The first two schemes offer in-patient cover only, and in-patient and out-patient cover valid in Malta only. Basic and Hospital in-patient cover only schemes are cost-reducing options providing insurance protection for hospitalisation as an in-patient.
Basic Scheme covers essential health services, and refunds prearranged amounts for treatments. It includes in-patient services such as specialist consultations, pathology, radiology, diagnostic tests and physiotherapy; up to 250 euros per policy year.
Hospital Scheme covers full refund of hospital accommodation, including intensive care and nursing care. It also comprises operating theatre charges, surgeons’ and anaesthetists’ fees for surgical operations, Computerised Tomography Scan (CT Scan), Magnetic Resonance Imaging (MRI) and PET Scans.
If the insured or an insured member of his family requires emergency treatment whilst outside of Malta then the Mapfre Middlesea Health Insurance Basic and Hospital schemes will cover the cost for the treatment received up to the same level as what would have been paid for the same treatment having been received in Malta.
International Scheme provides in-patient and out-patient cover on a worldwide basis except USA and Canada. It offers full refund of osteopathy, homeopathy, acupuncture, and chiropractic treatments provided by qualified practitioners.
The Family Health Insurance Scheme covers all the health insurance needs of all family members, upon payment of a single premium only. This scheme protects family members in case of any injury or other medical contingencies such as hospitalisation, and medical and surgical expenses. This scheme offers out-patient benefits including refund for general practitioners’ fees, consultations with specialists, a dental benefit and a maternity cash benefit (€240 per pregnancy).
This fourth scheme offers you the Second Medical Opinion service: if any member of your family is diagnosed with a severe illness and would like to get further confirmation, this service gives you access to a network of recognised international medical experts at no extra cost.
If you become unemployed as a result of redundancy, and consequently not being able to pay for the Family Health insurance premium, MAPFRE Middlesea will cover the annual renewal premium for you.
Requirements & Restrictions
This policy has certain requirements that shall be evaluated by the customer. It is very important to consider them in order to decide which insurance policy satisfies better the policyholder needs.
- The aim of this policy is to provide cover for the reasonable fees of accredited treatments. This insurance is not planned to cover experimental or unproven treatments, but if such possibility occurs, we will discuss it with the policyholder specialist and decide if the cost of the suggested treatment will be covered.
The following restrictions apply to the policy:
- We will not pay for pre-existing medical conditions that, however, will be covered after five years of continuous insurance with us, provided that during that period policyholder has not consulted any doctor for treatment or advice, or taken any medication (including drugs, medicines, special diets and injections) for that condition.
- We will only cover pre-existing cardiac or cancer conditions provided at the time when the condition reappears the beneficiary has been free from treatment, advice or medication for that condition during the previous ten years.
- We will not pay for fees charged for providing medical reports and prescriptions.
- We will not cover pregnancy or childbirth, other than for related complications arising at least ten months after the expectant mother contracted the policy. In the case of a caesarean section we will only pay the difference between the reasonable fee for the intervention, and the fee which would have been charged for a normal delivery.
- We do not cover contraception, sterilisation, termination of pregnancy, infertility and/or any form of assisted reproduction, and treatment of sexual problems. Treatments arising from or related to a sex change are excluded.
- The cost of vaccinations, routine or preventive medical examinations, medical screening including health check-ups, sight and hearing tests are excluded.
- Treatments received in health hydros, spas, nature cure clinics or in any similar establishments, even if they are registered as a hospital, are not included.
- We do not cover regular or long-term kidney dialysis or end stage renal failure.
- We do not pay for treatments caused by a deliberate self-inflicted injury or attempted suicide.
- Treatments given to relieve any allergic condition or disorder are excluded.
- We do not pay for treatments arising in any way from alcohol, drug or substance abuse.
We recommend to the policyholder, in order to receive benefits of all the guarantees of the policy, to consider some relevant aspects before and after contracting the policy:
- Premiums are payable to us in euros and must be paid on the date when they become due. If they are not paid by such date, we will have the right to cancel the policy with effect from the day when the premium or any instalment became due.
- If we accept new members under your policy, you will pay an additional premium. This additional premium will be a pro-rata premium based on the number of days remaining between the date of the acceptance and the renewal date following the said date.
- In any member or his/her dependant wish to cancel the cover during the policy year, a pro-rata refund of premium will be made by us, provided that no claims, whether paid or not, shall have been made in connection with this policy during the period in which this cover is to be cancelled. The refund of the premium will be based on the number of days remaining between the cancellation date and the expiry date of the policy.
- The policyholder must give us notice of any planned In-patient treatment. This will give us the opportunity to confirm whether or not your proposed treatment is covered under your policy and the level of cover you have. An infringement of this condition will prejudice the payment of the claim.
- For a claim to be payable, all treatments must be initiated on the referral of a general practitioner (a registered medical practitioner in general practice or a registered medical specialist in family medicine licensed to practise medicine). Consultations or treatments given by gynaecologists, paediatricians or ophthalmologists are included. All treatments must be given by and under the control of a specialist.
- If you pay for appropriate overseas treatment in currency other than in euro, we will cover the equivalent in euro at the rate of exchange prevalent at the time of settlement of the claim.
- To qualify for the nursing at home benefit, all home nursing must immediately follow a period of in-patient or day-case hospital treatment covered by the policy, and be approved by a specialist.