Health Insurance FAQ

The policy covers the cost of treatment/investigations for acute medical conditions. An acute medical condition is a disease, illness or injury that is likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery.

• Convenience – Choose when you would like to be treated
• Choice – choose the hospital/clinic that suits your needs and your preferred doctor
• Quality – top healthcare services available to you on demand
• Comfort – private rooms with ensuite facilities
• Service – patient-focused individual attention
• Peace of mind – feeling safe in the knowledge that the financial side of things is being taken care of

We offer three levels of cover:

• Vital Plan – Limited Worldwide Cover excluding USA & Canada
• Key Plan – Comprehensive Local Cover with Limited cover outside of Malta, also excluding USA & Canada
• International Plan – Comprehensive Worldwide cover excluding USA & Canada

Our health insurance plans can cover you for in-patient, day-patient and out-patient treatment/investigations. For the vital plan and key plan, we can offer you the option to reduce the premium by removing the out-patient cover.

We offer two options that can be added to our standard plans:

• Repatriation – Covers for transport expenses from Malta to your home country if this is medically necessary and the repatriation of your mortal remains. This option can be purchased as an add on to all our plans.
• Preventive treatment package – The standard health insurance policy does not provide cover for routine and preventive treatment. This package can be purchased as an add on with our in and out-patient plans and it will pay for a number of examinations up to stipulated limits.

The policy covers for in-patient, day-patient and out-patient treatment/investigations such as:

• Hospital Accommodation
• Theatre Fees
• Surgeon & Anaesthetist Charges
• MRI, CT, PET Scans
• Oncology related charges
• State Hospital Cash Benefit
• General Practitioner & Specialist consultation charges
• Diagnostic tests such as ultrasounds, blood tests, x-rays etc.
• Treatment with a Psychiatrist
• Alternative Therapy
• Emergency Dental Care
• Home nursing
• Maternity Cash Benefit

Below please find some of the most common exclusions. For the full list of exclusions please refer to the policy wording.

• Pre-existing conditions – subject to the method of underwriting
• Monitoring of chronic medical conditions
• Treatment undertaken by a specialist without a General Practitioner referral
• Cosmetic treatment
• Drugs & dressings (unless specified in your health plan)
• Routine health check-ups and preventive treatment
• Routine pregnancy expenses
• Dental treatment unless specified in your plan
• Appliances and medical aids such as hearing aids or crutches
• Sports injuries as specified in the terms and conditions
• Experimental treatment
• Congenital conditions
• Routine eye check-ups
• Epidemics/Pandemics
• Any other specific exclusion or limitations shown in the policy wording

The policy is an annual contract and premiums are charged based on the person’s age which will increase every time one moves up an age band. In addition, there may be increases to health insurance premiums due to medical inflation from time to time.

You will be required to complete an application form which can be done online or directly with our offices. Full medical underwriting will apply as you will need to answer questions on your medical history which means that pre-existing conditions will not be covered. By pre-existing we mean any disease, illness, injury, signs, symptoms and results of investigations for which you have received medical advice or treatment or of which you have experienced symptoms prior to the inception date of your policy, whether medical attention has been sought or not. Based on the information provided we may ask for more details or medical reports to help us understand better your medical history. We will then review the application form together with your medical history and decide if we can accept cover and what terms to offer. You will be informed of any exclusions relating to your medical history prior to inception of the policy.

You may make changes to your level of cover, but these changes may only be done at renewal. If you want to increase your level of cover, cover, you will need to complete an application form giving details of your medical condition. The same process of underwriting as described in the question above will apply. However, since you would be already insured with us rather than exclusions, restrictions will apply. This means that for those conditions pre-existing to your upgrade, you will still be covered up to the limits of your previous policy. If you want to lower your level of cover, you may do so by sending written instructions to us. In this case, an application form is not required. You may also include or remove dependants at renewal.

We have specifically designed health plans for the Individual Investor Program (IIP), Malta Residency Visa Program (MRVP) and Global Residence Program (GRP). These health plans cover for treatment in the European Union or Worldwide including emergency treatment up to €50,000 in the USA and Canada. Please contact us for more information.

Companies, Associations, Cooperatives and Families can request a personalized group quotation by contacting our offices and one of our friendly customer agents will assist you. We can offer you tailor made health plans specifically designed to your needs at advantageous rates.

Yes, you can however, you will still be required to complete a simple application form and go through the underwriting procedure.

Yes, we do. When applying for a visa or work permit you will be asked to provide a health insurance. All our plans are available to non-Maltese citizens however, we also offer specifically designed products for these requirements at very competitive prices. You can also choose to purchase repatriation cover for a small additional charge.

Should you be interested in knowing more about our products, you may contact one of our representatives on 21 345 123, who will be happy to explain the different type of plans we have to offer, or you may email us on [email protected].

Please refer to our claims procedure for full claims information from here:

https://www.gasanmamo.com/support/make-a-claim/health-insurance-claims/

Always contact us before receiving any treatment as we would need to confirm your level of cover and whether direct settlement would apply. In such cases a detailed medical report is required from the specialist to confirm if direct settlement will apply. The insured can contact us on 21 345 123 or by sending an email to [email protected].

Should you need to be hospitalised urgently and have no time to contact us or the emergency happens outside of office hours please inform the hospital that you have an insurance policy with us so they will be able to contact us themselves. Please note that if the insured member is covered under the Vital Plan direct settlement does not apply and therefore, any expenses will need to be paid by them and all documentation is to be provided to us within 3 months from date of treatment.

Direct Settlement is when we settle your medical bills directly with participating hospitals and clinics in the case of in-patient or day-patient treatment for those insured under the Key Plan and International Plan. Failure to allow us to manage direct settlement may expose you to additional costs.

Below is a list of Hospitals and Clinics in Malta which we recognize as participating hospitals/clinics. Always confirm with us before receiving any treatment as this list may be updated from time to time at our discretion.

• St James Hospital in Sliema
• St James Hospital in Zejtun
• St Anne’s Clinic in Birkirkara
• Da Vinci Hospital in Birkirkara
• St Mark’s Clinic in Msida

 

The General Practitioner and/or Specialist must complete a claim form and you may claim the costs incurred by submitting the completed and signed claim form together with the original receipts, copy of the results in case of diagnostic tests and breakdown of charges incurred. A General Practitioner referral is required before consulting a specialist/therapist except in the case of a Gynaecologist, Ophthalmologist or Paediatrician. All diagnostic tests need to be referred by a General Practitioner or Specialist whilst MRI, CT or PET scans must be referred by a Specialist.

The International Plan provides comprehensive cover outside of Malta however, both the Vital plan and Key plan include limited cover for treatment received outside of Malta excluding USA & Canada. Direct Settlement may apply for in-patient treatment outside of Malta with prior authorisation from us if you are insured on the International Plan. If direct settlement is not possible the insured has to settle his/her medical bill with the hospital and claim within 3 months from the date of treatment by submitting a completed and signed claim form together with the original receipts, any medical reports, copy of the results in case of diagnostic tests and breakdown of charges incurred.

This will all depend on your level of cover. For treatment received for an acute medical condition for which you must be covered under your policy, we will cover out-patient treatment up to what we consider to be fair and reasonable taking into account the complexity of the treatment involved, the degree of professional skill and other relevant factors up to the limits of your chosen plan. The following Fair & Reasonable fees apply for out-patient treatment.

• General Practitioner Charges – €25 per consultation
• Specialist Consultations – €70 per consultation
• Chiropractor, osteopaths, acupuncturists, homeopaths, physiotherapists and podiatrists – €40 per session up to 10 sessions per medical condition

It is important that treatment for In patient or day patient treatment is received in a participating hospital. Fair & Reasonable fees apply for surgeon and anaesthetist charges in case of in-patient and day-patient treatment. These can be found on our website (GMI-Health-Fair-reasonable-fees-GMI.HLT_.-FAR.0523.pdf (gasanmamo.com) and the list may be updated from time to time at our discretion. Routine/preventive medical treatment or investigations are not covered unless these form part of your chosen plan.

Once we have all the information required to process your claim, payment can only be made directly into the patient’s bank account unless otherwise instructed. In the case the patient is under 18 years of age payment is made to the parent/legal guardian.