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PRIMARY HEALTH PLAN |
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The following is a summary of the Benefits payable under the Primary Health Plan. For a full description of the Benefits and Policy conditions, please refer to the Policy wording.
The Benefits must be reasonable and customary and are only payable for treatment received in Malta.
| Hosptalisation Costs for in - Patient Treatment |
| If the Beneficiary receives treatment in a hosptal for a medical condition as a private paying patient, the Company will pay the costs of: |
| Accomodation, nursing care, ward prescribed drugs and medication |
Full cover up to a maximum of Lm 75 per night up to a maximum of 5 nights
(Lm 50 per episode for day surgery) |
| Charges made to you as a parent staying overnight in hospital with a child of under 14 years of age |
Lm 10 per night up to a maximum of 5 nights |
Use of operating theatre, surgical drugs and dressings, intensive care, diagnostic proceedures including Pathology and Radiology |
For each major operation up to Lm 150,
For each intermediate operation up to
Lm 100,
For each minor operation up to Lm 50
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| Specialist Fees as an In-patient |
| If the Beneficiary receives treatment in a hospital for a medical condition as a private paying patient the Company will pay the costs of: |
Professional fees for Surgeons, Anaesthetists and Physicians and medical consultation |
For each major operation up to Lm 400,
For each intermediate operation up to Lm 300,
For each minor operation up to Lm 150 |
| Out Patient |
| If the Beneficiary receives treatment for a medical condition with an episode of hospitalisation, the Company will pay the costs of: |
| Professional fees specialist consultations, Diagnostic procedures including Pathology and Radiology, computerised Tomography, second surgical Opinion |
Full cover during period of 30 days prior to commencement of Hospital stay and 30 days after the end of the Hospital stay up to a maximum of Lm 100 per Beneficiary per policy period. |
| If the Beneficiary receives treatment for a medical condition without an episode of hospitalisation, the Company will pay the costs of: |
| Professional fees for Specialist Consultations, Physiotherapy, Pathology, Radiology, ECG |
Full cover up to a maximum of Lm 100 per Beneficiary per policy period. |
| Professional Fees for oncology, chemotherapy and radiotherapy |
Full cover up to Lm 150 for each complete course subject to a maximum of 2 courses per annum |
| Nursing |
| Home nursing by a professional nurse following a surgical intervention and if prescribed by the Specialist |
Lm 80 per week up to a maximum of 15 weeks per annum |
| MMDNA Nursing Services |
| 1. Nursing treatment by a qualified nurse by day or night as prescibed by the General Practitioner. The treatments include blanket baths, prevention and treatment for bed sores, toe-nail cutting, injections (other than intravenous), enemas and washouts, dressing of wounds catheterization as well as nursing care and treatment of diabetics. |
As Required |
2. Midwifery services by a state registered nurse for ante-natal and post-natal care |
As Required |
| Private Ambulance |
| If you require a Private Ambulance (provided a medical professional recommends it on medical grounds ) |
Full cover subject to a maximum of Lm250 per policy period |
| General Practitioner Charges |
| If you consult a General Practitioner the Company will pay the consultation charges |
Full cover subject to a maximum of Lm 25 per Beneficary per policy period. |
| In-Patient / Hospitalisation Cash Benefits |
| If you have treatment in a hospital for a medical condition as a non - paying patient, the Company will pay : |
| In-patient cash benefit |
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| For the first 30 nights |
Lm 15 per night |
| For the next 30 nights |
Lm 10 per night |
Day Care cash benefit ( payable only if surgery is undertaken ) |
Lm 10 per day / episode |
| Overall maximum payable per Beneficiary per policy period Lm 50,000 |
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ENHANCED HEALTH PLAN |
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The following is a summary of the Benefits payable under the Enhanced Health Plan. For a full description of the Benefits and Policy conditions, please refer to the Policy wording.
The benefits must be reasonable and customary and are only payable for treatment received in Malta.
| Hosptalisation Costs for In - patient Treatment |
| If the Beneficiary receives treatment in a hosptal for a medical condition as a private paying patient, the Company will pay the costs of: |
Accomodation nursing care ward prescribed drugs and medication |
Full Refund |
| Charges made to you as a parent staying overnight in hospital with a child of under 14 years of age |
Full Refund |
| Use of operating theatre, surgical drugs and dressings, intensive care diagnostic proceedures including Pathology and Radiology |
Full Refund |
| Specialist fees as an In-patient |
| If the Beneficiary receives treatment in a hospital for a medical condition as a private paying patient the Company will pay the costs of: |
Professional fees for Surgeons, Anaesthetists and Physicians and medically necessary consultation |
Full Refund |
| Psychiatric, nervous and mental conditions |
Full Refund |
| Out Patient |
| If the Beneficiary receives treatment for a medical condition with an episode of hospitalisation, the Company will pay the costs of: |
| Professional fees specialist consultations, Diagnostic procedures including Pathology and Radiology, computerised Tomography, second surgical opinion |
Full cover during period of 30 days prior to commencement of Hospital stay and 30 days after the end of the Hospital stay up to a maximum of Lm 200 per Beneficiary per policy period. |
| If the Beneficiary receives treatment for a medical condition without an episode of hospitalisation, the Company will pay the costs of: |
| Professional fees for Specialist Consultations, Physiotherapy, Pathology, Radiology, ECG |
Full cover up to a maximum of Lm 200 per Beneficiary per policy period. |
| Professional Fees for oncology, chemotherapy and radiotherapy |
Full cover up to Lm 150 for each complete course subject to a maximum of 2 courses per annum |
| Provided that the treatment is given under the direction of a specialist and the patient is referred by a General Practitioner we will pay for |
Osteopathy, Homeopathy, Acupuncture, Chiropractic treatment and the like |
Full cover up to a maximum of Lm 200 per Beneficiary per policy period
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| Emergency Dental Treatment necessary to restore or replace sound natural teeth lost or damaged following an accidental injury |
Full cover up to a maximum of Lm 200 per beneficiary per policy period |
| Nursing |
| Home nursing by a professional nurse following a surgical intervention and if prescribed by the Specialist |
Lm 80 per week up to a maximum of 15 weeks per annum |
| MMDNA Nursing Services |
1. Nursing treatment by a qualified nurse by day or night as prescribed by the General Practitioner. The treatments include blanket baths, prevention and treatment for bed sores, toe-nail cutting, injections (other than intravenous), enemas and washouts, dressing of wounds catheterization as well as nursing care and treatment of diabetics. |
As Required |
| 2. Midwifery services by a state registered nurse for ante-natal and post-natal care |
As Required |
| Private Ambulance |
| If you require a Private Ambulance (provided a medical professional recommends it on medical grounds ) |
Full cover up to a maximum of Lm250 per annum |
| General Practitioner Charges |
| If you consult a General Practitioner the Company will pay the consultation charges |
Full cover subject to a maximum of Lm 25 per Beneficiary per policy period |
| In-Patient / Hospitalisation Cash Benefits |
| If you have treatment in a hospital for a medical condition as a non - paying patient, the Company will pay : |
In-patient cash benefit
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| For the first 30 nights |
Lm 15 per night |
| For the next 30 nights |
Lm 10 per night |
| Day Care cash benefit ( payable only if surgery is undertaken ) |
Lm 10 per day / episode |
| Overall maximum payable per Beneficiary per policy period Lm 50,000 |
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ELITE HEALTH PLAN |
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The following is a summary of the Benefits payable under the Elite Health plan. For a full description of the Benefits and Policy conditions, please refer to the Policy wording
| Hosptalisation Costs for In - patient Treatment |
| If the Beneficiary receives treatment in a hospital for a medical condition as a private paying patient, the Company will pay the costs of: |
Accomodation nursing care ward prescribed drugs and medication |
Full Refund |
| Charges made to you as a parent staying overnight in hospital with a child of under 14 years of age |
Full Refund |
| Use of operating theatre, surgical drugs and dressings, intensive care diagnostic proceedures including Pathology and Radiology |
Full Refund |
| Specialist fees as an In-patient |
| If the Beneficiary receives treatment in a hospital for a medical condition as a private paying patient the Company will pay the costs of: |
Professional fees for Surgeons, Anaesthetists and Physicians and medically necessary consultation |
Full Refund |
| Psychiatric, nervous and mental conditions |
Full Refund |
| Out Patient |
| If the Beneficiary receives treatment for a medical condition with an episode of hospitalisation, the Company will pay the costs of: |
| Professional fees for specialist consultations, Diagnostic procedures including Pathology and Radiology, computerised Tomography, second surgical opinion |
Full refund |
| If the Beneficiary receives treatment for a medical condition without an episode of hospitalisation, the Company will pay the costs of: |
| Professional fees for Specialist Consultations, Physiotherapy, Pathology, Radiology, ECG,Professional Fees for oncology, chemotherapy and radiotherapy |
Full refund |
| Provided that the treatment is given under the direction of a specialist and the patient is referred by a General Practitioner we will pay for |
Osteopathy, Homeopathy, Acupuncture, Chiropractic treatment and the like |
Full refund
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| Emergency Dental Treatment necessary to restore or replace sound natural teeth lost or damaged following an accidental injury |
Full cover up to a maximum of Lm 300 per Beneficiary per policy period |
| Nursing |
| Home nursing by a professional nurse following a surgical intervention and if prescribed by the Specialist |
Lm 80 per week up to a maximum of 15 weeks per annum |
| MMDNA Nursing Services |
1. Nursing treatment by a qualified nurse by day or night as prescribed by the General Practitioner. The treatments include blanket baths, prevention and treatment for bed sores, toe-nail cutting, injections (other than intravenous), enemas and washouts, dressing of wounds catheterization as well as nursing care and treatment of diabetics. |
As Required |
| 2. Midwifery services by a state registered nurse for ante-natal and post-natal care |
As Required |
| Private Ambulance |
| If you require a Private Ambulance (provided a medical professional recommends it on medical grounds ) |
Full refund |
| General Practitioner Charges |
| If you consult a General Practitioner the Company will pay the consultation charges |
Full cover subject to a maximum of Lm 25 per Beneficiary per policy period |
| In-Patient / Hospitalisation Cash Benefits |
| If you have treatment in a hospital for a medical condition as a non - paying patient, the Company will pay : |
| In-patient cash benefit |
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For the first 30 nights |
Lm 20 per night |
For the next 30 nights |
Lm 10 per night |
| Day Care cash benefit ( payable only if surgery is undertaken ) |
Lm 10 per day / episode |
| Maternity Cash Benefit |
Payable upon the birth of the child (provided the pregnant mother has been insured with us continuously for a period of two years, under Health Plan 4) |
Lm 200 per child |
| Optional Benefits |
| (available at an Additional Premium) |
| Funeral Expenses |
| (applicable to all Middlesea Insurance schemes) |
The Company will pay the cost of the Funeral Expenses following the death of the Insured or Member, as the case may be, or their dependants uo to a maximum of Lm 1500 per policy and Lm 500 per event provided that death of the insured or Member, as the case may be, and their dependants occurs at least 90 days after the commencement date of the policy.
This benefit will not be payable should death be a result of suicide. |
| Additional Premium |
Lm 2.25 per person |
| Cover for Medicines |
| (applicable to Middlesea Insurance Enhanced and Elite Schemes only) |
| The Company will pay up to a maximum of Lm 45 per person per annum for the cost of drugs prescribed following a mojor operation. |
| Additional Premium |
Lm 2.00 per person |
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