Health FAQs
The policy covers eligible private treatment of acute medical conditions. By acute conditions we mean, an unexpected disease, illness or injury that is likely to respond quickly to treatment.
- You will be eligible for cover in private hospitals and clinics.
- You may also choose the consultant and specialist of your choice.
- You will plan the date of your treatment and avoid waiting lists.
- Depending on your level of cover, we may arrange to pre-authorize your treatment and settle invoices directly with the hospital.
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
For full details of what is not covered you may refer to the list of 'General Exclusions' on your policy document. A few of these exclusions are:
- Chronic conditions or non-acute conditions
- Pre-existing conditions
- Pregnancy and child birth
- Preventive screening
- AIDS and HIV
- Hospital / clinic fees for out-patient services
- Sexually transmitted diseases
- Sleep disorders
An acute medical condition is an unexpected 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 accident or which leads to your full recovery and has a definite end point.
We reserve the right to determine which medical condition has become a chronic medical condition. We will not pay for more than 180 days of treatment for any medical condition in a policy year.
Preventive screening procedures, tests and vaccinations are not covered. These include but are not limited to, screening procedures including familial conditions, cervical smears, colonoscopy, mammograms, prostate tests, well person health checks, vaccinations, immunizations and osteoporosis screening (bone densitometry).
The policy excludes pre-existing conditions (conditions diagnosed before the start of the policy cover) and you are therefore specifically not covered for these conditions.
Premiums for medical insurance are reviewed because of medical inflation which reflects advances in medical technology, general increases in the costs of hospital/clinic and increases in the price of medicines. Premiums also increase in proportion to the different age band.
We will apply any eligible discounts to your premium, however they may be reviewed or removed upon renewal depending on circumstances.
Upon renewal you may change your plan or level of cover and increased benefits. You will then be entitled to these benefits for new medical conditions that arise after the effective renewal date. However, benefits for medical conditions that originated under your previous level of cover will continue to be limited to the previous level.
A Proposal Form would have to be completed including a medical history declaration and you may be asked to supply us with further information. It is important that you consider the questions carefully and that you answer them in full.
A Claim Form must always be fully completed by the policyholder and the treatment providers. We can send you claim forms or you may down load them from our website www.elmoinsurance.com. It is important that all necessary documents are attached and sent to us within three months of the date of treatment.
- Your attending Family Doctor (GP) or Specialist must state your medical condition, together with full details of the treatment on a Claim Form.
- Complete the remaining section of the Form, sign and date it accordingly.
- Attach original invoices and receipts to the Claim Form. Photocopies are not acceptable.
- Attach a copy of all results of any tests performed.
Post the Claim Form to: Elmo Insurance Ltd, Abate Rigord Street, Ta’ Xbiex XBX 1111
Please follow these guidelines to help us process your claim promptly and efficiently. If you have any queries you may contact our dedicated health claims department on 2343 0000 and we shall be able to advise you accordingly.
Once you know that you might need treatment, please contact us immediately on 2343 0000 or email us on health@elmoinsurance.com so that we pre-authorise your treatment, subject to the terms of your policy. We will then send you a treatment guarantee form confirming your cover.
The direct settlement facility is only available on our full refund plans for in-patient and day-patient treatments, MRI, CT or PET scan.
Once we confirm direct settlement for eligible and medically necessary treatment, the hospital will claim expenses directly from us and we will settle medical bills on your behalf. If requested additional information is not given to us, your consultant or the hospital, we will not be in a position to pre-authorise your treatment.
May we advise you to confirm with the hospital that they have received our written authorisation before undergoing treatment. If you are taken to hospital in an emergency, it is important that you or the hospital contacts us immediately.
We will pay for eligible customary and/ or reasonable fees. By this we mean the expected fees charged for treatment, facilities or equipment, based on the fees charged to the majority of our members for those services in that location.
We have plans which have been specifically designed to offer cover in the European Union or Worldwide excluding the USA and Canada up to a limit of €50,000.
We offer an affordable plan, specifically designed for non-Maltese residents. Repatriation cover is also included.