HEALTH INSURANCE SCHEMES: In-Patient & Out-Patient Cover
Day-case & In-patient Treatment
| Basic Scheme In-Patient & Out-Patient cover | Hospital Scheme In-Patient & Out-Patient cover | International Scheme In-Patient & Out-Patient cover |
|
|---|---|---|---|
| Hospital accommodation, including Intensive care; nursing care and ward prescribed drugs | Up to €175 per night Maximum 5 nights per episode Up to €120 per episode for Day Surgery | Full Refund | Full Refund |
| Parent accommodation staying with a child under 14 | Up to €24 per night. Maximum 5 nights per episode | Full Refund | Full Refund |
| Operating theatre charges, drugs and surgical dressings; eligible prosthesis | Per Operation up to: Major: €350 Intermediate: €240 Minor: €120 Eligible prosthesis:€338 | Full Refund | Full Refund |
| Surgeons' and Anaesthetists' fees for surgical operations | Per Operation up to: Major: €940 Intermediate: €700 Minor: €350 | Full Refund | Full Refund |
| Consultant Physicians visits and medical consultations | Up to €60 per day. Maximum 6 days per episode | Full Refund | Full Refund |
| Pathology, radiology, diagnostic tests and physiotherapy | Up to €165 per policy year | Full Refund | Full Refund |
| Computerised Tomography Scan (C.T. Scan) and Magnetic Resonance Imaging (MRI) | Up to €165 per episode | Full Refund | Full Refund |
| Psychiatric, Nervous And Mental conditions | Up to €175 per night. Maximum 5 nights per episode | Full Refund | Full Refund |
Cancer Treatment
| Basic Scheme In-Patient & Out-Patient cover | Hospital Scheme In-Patient & Out-Patient cover | International Scheme In-Patient & Out-Patient cover |
|
|---|---|---|---|
| Oncologist fees for all the active phase of the cancer treatment and hospital charges for cancer tests and drugs, including chemotherapy and radiotherapy for each course of treatment | Up to €175 per night. Maximum 5 nights for each course of treatment | Full Refund | Full Refund |
Out-Patient Treatment
| Basic Scheme In-Patient & Out-Patient cover | Hospital Scheme In-Patient & Out-Patient cover | International Scheme In-Patient & Out-Patient cover |
|
|---|---|---|---|
| Professional fees for specialist consultations , diagnostic procedures including pathology, physiotherapy, radiology and ECG | Maximum of €240 per policy year | Up to €600 per policy year | Full Refund |
| CT Scans and MRI's referred by a Specialist | Up to €165 per policy year | Up to €600 per policy year | Full Refund |
| Oncology- related CT Scans and MRI | Up to €240 per policy year | Full Refund | Full Refund |
| Mini-minor procedures performed by a general practitioner under local anaesthetic | Up to €50 procedure fee per episode Up to €50 surgery fee per episode | Up to €50 procedure fee per episode Up to €50 surgery fee per episode | Up to €50 procedure fee per episode Up to €50 surgery fee per episode |
Emergency Road Ambulance
| Basic Scheme In-Patient & Out-Patient cover | Hospital Scheme In-Patient & Out-Patient cover | International Scheme In-Patient & Out-Patient cover |
|
|---|---|---|---|
| Emergency local road ambulance | Up to €600 per policy year | Up to €600 per policy year | Full Refund |
Nursing Care
| Basic Scheme In-Patient & Out-Patient cover | Hospital Scheme In-Patient & Out-Patient cover | International Scheme In-Patient & Out-Patient cover |
|
|---|---|---|---|
| Home nursing by a professional nurse following a surgical intervention and if prescribed by a specialist | Up to €190 per week Up to 15 weeks per policy yea | Up to €190 per week Up to 15 weeks per policy year | Up to €190 per week Up to 15 weeks per policy year |
| MMDNA Nursing Care | As required | As required | As required |
Alternative Therapy
| Basic Scheme In-Patient & Out-Patient cover | Hospital Scheme In-Patient & Out-Patient cover | International Scheme In-Patient & Out-Patient cover |
|
|---|---|---|---|
| Osteopathy, Homeopathy, Acupuncture, Chiropractic Treatment | Not covered | Up to €470 per policy year | Full Refund |
Emergency Dental Treatment
| Basic Scheme In-Patient & Out-Patient cover | Hospital Scheme In-Patient & Out-Patient cover | International Scheme In-Patient & Out-Patient cover |
|
|---|---|---|---|
| Eligible Dental Treatment | Not covered | Up to €470 per policy year | Up to €700 per policy year |
General Practitioner’s Charges
| Basic Scheme In-Patient & Out-Patient cover | Hospital Scheme In-Patient & Out-Patient cover | International Scheme In-Patient & Out-Patient cover |
|
|---|---|---|---|
| General Practitioners' Charges | Up to €60 per policy year | Up to €60 per policy year | Up to €60 per policy year |
Cash Benefits
| Basic Scheme In-Patient & Out-Patient cover | Hospital Scheme In-Patient & Out-Patient cover | International Scheme In-Patient & Out-Patient cover |
|
|---|---|---|---|
| Cash Benefit - for treatment received in a State or Private hospital for a medical condition as a non-paying patient | €24 per night for up to 40 nights each policy year | €35 per night for up to 40 nights each policy year | €50 per night for up to 40 nights each policy year |
| Day-case - following day surgery as a non-paying patient | €24 per episode | €24 per episode | €35 per episode |
| Maternity cash benefit | Not covered | €240 Per newborn child / episode | €470 Per newborn child / episode |
Other
| Basic Scheme In-Patient & Out-Patient cover | Hospital Scheme In-Patient & Out-Patient cover | International Scheme In-Patient & Out-Patient cover |
|
|---|---|---|---|
| Prescription Drugs following a surgical procedure | Not covered | Up to €105 each policy year | Up to €105 each policy year |
| Cover for funeral expenses | Up to €1,200 | Up to €1,200 | Up to €1,200 |
| Annual overall Maximum payable per person | €120,000 | €120,000 | €175,000 |
Purpose of policy
The purpose of the policy is to provide cover for the customary and reasonable fees of recognised Treatment, which is medically necessary for acute medical conditions and injuries.
This policy is not intended to cover experimental or unproven Treatment, but should such situations arise we will discuss these with the beneficiary’s specialist and decide whether the cost of the proposed Treatment is covered. Claims will be paid for those items specified in the policy benefits (up to the amounts stated, if applicable).
The Middlesea Health Insurance Basic and Hospital Schemes will provide cover for Treatment received in the Maltese Islands only, however, if the insured or a member of his family requires emergency Treatment whilst he / she are outside of the Maltese Islands, then the 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 had the same Treatment been received in Malta.
The Middlesea Health Insurance International Scheme will provide cover for Treatment received in Malta and Worldwide excluding USA and Canada.
