Claims

What should I do if I want to claim?

Please refer to the health claims procedure.

What should I do if I am not satisfied with the service I am given?

With the best will in the world, concerns about some aspects of our service can occasionally arise. In such circumstances our staff have wide authority to settle problems and will do everything they can to help. This should be your first point of contact. For further information please refer to our complaints procedure.

How often can I claim?

You can claim as many times in a year as you like, although benefit limits may apply.

How can I be sure that I am covered before I go ahead with treatment?

Just call our team of claims handlers and tell them about your proposed treatment. For more information see our claims section. We require you to contact our offices when planning the following types of treatment:

In-patient or daycare treatment (admittances to hospital even if only for a few hours)

Bone density scans or mammograms

Psychiatric treatment

Home nursing

PET, CT and MRI scans

Genetic testing

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

Insurance Cover

What is health insurance?

Many people confuse life and health insurance. Health insurance covers you for costs which you may incur which are related to medical expenses, from a simple visit to your family doctor for a cold, to specialist visits, diagnostic tests, hospital stays and complex operations.

On the other hand, life insurance is a benefit policy which would pay an amount to the heirs following death of the insured.

What is the difference between the health plans Atlas offers?

We offer three main plan groupings with the clinic plan offering limited cover in clinics and hospitals, the hospital plan offering full refund on most benefits in Malta and the international plan offering full refund on most benefits internationally with limited cover for non elective treatment in the USA. Our international plan uniquely covers treatment in Canada. Each of these plans can be bought with or without out-patient cover. The Private Hospital Value Plus benefits offer a cost effective private hospital plan with some outpatient benefits. Members also get access to Health at Hand and various 24/7 emergency services.

What are the benefits of taking out a private health insurance policy?

A private health policy will cover medical treatment which you pay for privately, rather than using state health facilities (such as polyclinics and hospitals). Private medical insurance covers the costs of private medical treatment for what is commonly known as an acute condition (a disease, illness or injury that is likely to respond quickly to treatment). In general, it will not cover the treatment of long-term and incurable illnesses. As a private patient you can:

avoid waiting lists, cutting down on the time it takes you to get better

choose where to receive treatment and who provides the treatment

benefit from being treated in private hospital facilities, with a private room

Get the best treatment you need, irrespective of whether it is provided in the public sector

Do you cover pre-existing conditions?

Health insurance is there for what is unexpected and unknown, therefore any existing health condition will usually be excluded. When you decide to take out a health policy, you'll be asked to fill in an application form which includes questions regarding your current and past health. If necessary, we may seek further medical information from hospitals or doctors who have treated you.

Any disease, illness or injury (whether or not diagnosed) for which you have received medication, advice or treatment, or for which you have experienced symptoms before taking out your policy will be excluded from your insurance cover along with any related conditions unless we agree to accept it. Some existing conditions may become insurable after a waiting period set by us, provided the condition does not reoccur during this period, and you must not receive treatment for this condition during this period.

What does being fully medically underwritten mean?

Your answers to the 'medical history declaration' section in the application form will help us to understand your medical history (and that of any family member you may wish to include in your policy).

It is important that you consider the questions carefully, (for each person to be covered), and answer them in full. We will review your details and decide the basis on which we can accept you for cover. If necessary, we will ask your medical practitioners or hospitals to help us compile the necessary information.

If you have a pre-existing condition that is likely to need treatment in the future, this is usually excluded from cover along with any conditions related to it. We will show any exclusions on the membership statement you receive from us when we have processed your application. (The same process will also apply for any members of your family included in your application.)

Of course, any unexpected acute medical conditions arising after the start of your policy will be covered immediately subject to the policy terms and conditions. It is your responsibility to ensure that you provide full and accurate information in answer to the medical history declaration. Failure to do so may mean that we cannot honour a claim or even that your policy is invalidated. If you are in any doubt whether we would want to know about a particular fact, please contact us for assistance.

What does moratorium policy or moratorium underwriting mean?

There is no need to disclose medical history on your application as is usually required on most insurance policies. Instead, we automatically exclude pre-existing medical conditions which you have:

received treatment or medication for (including diet) or

sought medical advice or

become aware of or might reasonably have become aware of any signs or symptoms during the five years immediately before the start of your cover. We may need to ask for additional medical information when you make a claim.

Once you have been a member for two consecutive years, you may be able to claim for treatment of pre-existing conditions as long as you have had a period of two consecutive years with no treatment or symptoms for that condition since you became a member. There are some medical conditions, called chronic conditions, that continue or keep recurring that you may never be able to claim for, since you will never have a two year symptom or treatment free period. There are some conditions, namely diabetes, raised blood pressure, prostrate troubles and bowel trouble where certain specified related conditions will be excluded. At the moment, health policies bought online through our website are all moratorium policies. All other policies are available to purchase through any offline traditional methods.

I had a knee operation last year, will I be covered for any further treatment to it after my policy starts?

In most cases, the application of any exclusion will make future claims for treatment to this particular knee ineligible for benefit. If further information is provided regarding the detail of the knee operation or a specific diagnosis is made, the exclusion may be made more specific. Sometimes the exclusion may also be reviewable after a period of time following the start of the policy.

What happens if I wish to reconsider my application?

You can do so within 15 days from the date of acceptance of cover and receipt of your policy documents. We will cancel your policy and any money paid will be refunded as long as you haven’t made a claim.

Will my premium keep increasing from year to year?

Premiums for health insurance may rise because of medical inflation and because as you get older, you are more likely to need and receive medical treatment. Premiums are charged according to the age band you fall into and will differ for each band.

Will I need to take a medical test before taking out a health insurance policy?

No, however you will be asked to complete a medical history declaration on the application form and if necessary, we may ask your doctor or hospitals to provide us with further information.

Are there any ways of reducing premiums?

Our range of plans are designed to suit your requirements. If your main concern is in-patient treatment, then you could opt for a Value Option which covers in-patient and daycare treatment but does not provide out-patient benefits. Choosing a different method of payment may also mean that you could benefit from a discount on your annual premium.

Am I covered immediately?

Once we have processed your application form and premium, we will send confirmation of cover together with your membership statement and a handbook giving full information in plain language on how to claim.

Am I covered abroad?

Atlas Healthcare represents AXA, a global insurance company with a wide network of hospitals worldwide. For a full list of hospitals please refer to the AXA website. If you have the international plan, we can arrange direct settlement with many of these and we even offer cover for non-elective treatment in the USA up to €75,000 per year. Our hospital plan, although designed to cover charges locally, does offer cover in hospitals not forming part of our local hospital network (supporting hospitals) but generally up to limits which we would expect to pay in local hospitals.

What is not covered by the policy?

These are the main exclusions in your policy. For a full list please refer to a membership handbook.

Routine medical examinations unless you purchase the Preventive Care or Preventive Care Plus extensions where a selection of these tests are available.

Treatment for the routine management of recurrent, continuing or long-term medical conditions. Unforeseen complications of these conditions would be covered.

Medical costs which are not reasonable or are higher than those usually charged.

Normal pregnancy and childbirth. Limited cover is available under the international and private hospital plans and a higher optional level of cover is available for groups. Complications of pregnancy or childbirth are covered. No claims are payable if the mother has been on the policy for less than 10 months prior to the expected delivery date of her baby.

Optical check-ups and dental treatment, except for specific oral surgical operations unless you buy the Preventive Care or Preventive Care Plus extensions where limited cover would apply, or if you have purchased a Dental corporate product from our unique dental range.

Treatment for alcohol and drug abuse

Treatment of sexually transmitted diseases

Cosmetic surgery (to solely enhance appearance)

How much will it cost?

Do call us on 21 322 600 for a tailor made quote or contact your intermediary or broker. A quote can also be obtained on our website and a unique Value Plus product or the clinic plans may be directly purchased online.

Are discounts available?

Yes, we offer discounts for annual payment by direct debit through a Malta bank. Kindly contact us for details.

What about easy payment options?

Yes, these are also available. Half yearly, quarterly or monthly instalment payment options are available when paying by direct debit.

What about groups?

Yes, we offer group discounts and many benefits for groups including tailor made plans for larger groups and a unique group secretary’s portal which makes administering group business so much easier.

Corporate Dental insurance

What are the main exclusions and limitations of the Dental Corporate plans?

Treatment prescribed, planned or advised or taking place on or before the start date of the policy

Restorative treatment which is diagnosed in your first examination after you take out the policy if you have not had an exam two years prior to taking the policy out.

Claims under the Injury or Emergency benefits for treatment required as a result of an incident which took place prior to the start date of the policy

Treatments in connection with Dental Injury which commenced more than 6 months from the date of the Injury or completed more than 18 months from the date of the original incident

Any treatment relating to damage or injury caused while participating in contact sports (including training).

Any treatment not deemed to be clinically necessary

Dental implants and all costs associated with the preparation and fitting of such a device

Treatment for mouth cancer diagnosed before or within 90 days after you joined or for which tests or consultations began within those 90 days even if the diagnosis is not made until later.

Orthodontics

Drugs and Dressings except for that provided under emergency dental treatment

Will I need a dental check-up to join a Dental Corporate plan?

No, in the case of Essential and Extensive cover we will however require details of your past dental history on the application form.

Dental insurance normally covers new dental conditions. Does this mean I won’t be covered for any dental conditions I have had in the past?

Any dental treatment which was prescribed, planned, diagnosed as necessary or is currently taking place at the start date of your policy will no t be reimbursed.