Health Insurance Claims

Atlas Pre-Authorisation      Schedule of Benefits

How to Make a Claim

Once cover is confirmed, we will send you a claim form, or you may download one from our website. When planning the following types of treatment, you must telephone/contact our Health Claims Department on 23265641 or submit an online pre-authorisation form to check that you are covered for that particular treatment:

  • In-patient or daycare treatment (this is treatment for which you are admitted to a hospital or clinic even if only for a  few hours);

  • A bone density scan

  • A mammogram

  • Home nursing of any kind (except that provided by MMDNA);

  • Psychiatric treatment

We will confirm your level of cover and how it applies to the doctors and hospitals providing the treatment .

You do not need to contact us before receiving outpatient treatment unless as detailed above, however if in doubt, please do contact our Health Claims Department on 2326 5641.

You should mail claim forms together with receipts to AXA PPP healthcare, Abate Rigord Street, Ta' Xbiex XBX 1121, but please read the information below first.  

If you still have a query after reading this section, please mail us on health@atlas.com.mt or call on 21322600.

Pre-Authorising Your Treatment

Please do call us before having any treatment which involves a surgical procedure, whether walk-in walk-out, day case or in-patient (overnight stay) at a hospital.

You should telephone our Health Claims Team when planning any of the following:

  • In-patient or daycare treatment in Malta or abroad (This is treatment for which you are admitted to a hospital or clinic even if only for a few hours)
  • A bone density scan
  • A mammogram
  • Home nursing of any kind (except that provided by MMDNA)
  • Psychiatric treatment
  • CT & MRI scans

We will confirm your level of cover and how it applies to the hospital in which you are to receive treatment.

You do not need to telephone us before receiving out-patient treatment.

If the treatment is given as an emergency then you may not be able to telephone beforehand. Do, however, ask somebody to telephone us as soon as possible and make sure that, when you are admitted to hospital, the hospital is given your membership details and proof of identity so that they can contact us straight away.


Direct Settlement of Bills for In-Patient and Daycare Treatment

When you become a AXA PPP healthcare member we will provide you with a list of hospitals on request. These are hospitals with which, depending on the type of plan you have, we can arrange Direct Settlement.

This means that if you require in-patient or daycare treatment and it is received at one of these listed hospitals then AXA PPP healthcare will be able to make payment direct to the hospital on your behalf subject to the terms of your plan and providing that treatment has been pre-authorised by AXA PPP healthcare.

In case of out-patient bills hospitals will ask you to pay when you attend and give you a receipted bill to send to Atlas Healthcare Insurance Agency Limited for refund.


Claim forms & General Practitioner Referrals

When you want to make a claim lets us know and we will send you a claim form. You must make sure it is filled in, signed by yourself and the general practitioner or specialist treating you and sent back to us as quickly as possible, giving us all the information we request. This will ensure that your claim will be processed promptly. Remember that you must be referred for specialist consultation or other treatment by your general practitioner.

Please note that we will only consider claims made within two months of treatment being received.


Reasonable & Customary Charges

In your membership agreement we explain that we will not pay charges higher than those customarily made. This rarely happens but it is obviously important that we should only pay fees that are at the level normally charged. Through experience we have established what is generally charged for all the procedures that we cover and we query any charges which are above that normal range.